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How Condition Management Programs Save You Money

Written by Jennifer Koenig

Did you know that condition management, or chronic care management programs go beyond keeping patients compliant with care? Condition Management helps close the knowledge gap for members. From helping patients understand their condition, what it means to their long-term health, helping them understand their medical bills, to learning about what each prescription does, condition management goes way beyond checking the boxes. 

Studies show that between 33% and 50% of employees don't understand their benefits. This leads to poor utilization and unfortunately, the COVID-19 pandemic only widened the knowledge gap among American health plan members. Over 40% of US adults have a chronic health condition and those people are employees at your company. Without a condition management program, these employees are left to navigate the healthcare industry and their condition alone.


HealthCheck360 data shows that 59% of adult members who incur medical claims had at least
one chronic condition like diabetes or hypertension. Condition Management programs are one way to help close the knowledge gap among your members and control health care costs for your plan. 


Here are just a few of the ways chronic care management programs educate your members and save your plan money: 

  • Understanding Medical Conditions. This one might surprise you, but it's not uncommon for participants in a chronic care management program to have no idea how serious their medical condition is, let alone how to manage it. Guiding members through what the condition is, how it affects their body, what questions to ask their doctor, and lifestyle changes that are needed all contribute to managing and maintaining compliance with their condition.  
  • Managing Medical Conditions. Members with chronic health conditions get much less costly when they're managing their condition. It's simple. When their condition is managed, they're less likely to have complications, visit the ER, or have a catastrophic health event. In addition, HealthCheck360's clients on average save $2,500 per member, per year when they incentivize condition management. 
  • Learning about Prescriptions. Many times patients don't know why they take the medications they do, how to take them correctly, or that there are cheaper alternatives available. Helping members optimize their prescriptions leads to a better quality of life and lower costs.   
  • Reading Medical Bills. Reading medical bills is something a lot of people struggle with. Condition management nurses arm members with the skills they need to be more health literate. This helps members be better healthcare consumers and proactively catch when there is a billing error or they're being charged incorrectly. 
  • Seeing the Right Providers and Doctors. Like the confusion around their prescriptions, members don't always know what's covered under your plan, who is in-network, or what alternative treatment options might be. 

Is your condition management program working for you? Learn everything you need to know about condition management and chronic care management programs here.


You can also contact us for more information or check out the webinar recording below for ways to keep your highest-cost employees getting the right care. 

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Topics: Diabetes, Corporate Well-being, COVID-19



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