Disease management programs

Health insurance premiums are driven largely by the cost of claims, and the 80/20 rule prevails — 20 percent of your employees account for about 80 percent of your claims expense.

How can this be? The 20 percent of your employees with chronic illnesses may not be following doctor’s orders. They can end up in the emergency room for costly visits that could have been avoided if a health professional had educated them on how to stay well.

Most health insurance companies offer a disease management program to help keep your costs down. But there are wide variations among carriers on how extensive their disease management efforts are and who pays for them.

Here are some questions to consider.

  • What disease management programs does the insurer offer? It should, at minimum, have programs in place for employees who suffer from chronic heart disease, diabetes and asthma.
  • Are the insurer’s disease management programs certified by the independent, not-for-profit National Committee for Quality Assurance? There can be wide variation in the effectiveness of these programs.
  • Does the insurer provide these programs as part of your regular premium, or does it charge a separate fee? Some insurance plans consider disease management a critical component to their operations. Others may contract with third-party disease management vendors and are likely to pass that expense along as a fee in addition to your premium.

Source: Kaiser Permanente of Ohio