America is a wealthy country, but
its citizens are often cited as
being among the least healthy in the industrialized world. A number of
chronic conditions — often springing
from poor diet, weight gain and a lack
of exercise — contribute to the
moniker. The nation’s employers, realizing the long-term impact of these
lifestyle risks, are looking to their
health plans for help.
Holistic and integrated clinical programs that address not only chronic diseases but lifestyle risk are a solution
now offered by a number of health
plans, such as Pittsburgh-based UPMC
Health Plan. Vice president of medical
affairs Dr. Michael Culyba notes that disease management is an evolving subset
of clinical interventions that emphasizes
the management of chronic conditions
and the lifestyle risks that lead to these
conditions.
Smart Business spoke with Culyba
about how health plans implement disease management programs for
employers.
Why are disease management programs
worthwhile?
The most common and costly medical
conditions, such as diabetes and cardiovascular disease, are often modifiable.
Well-designed programs that focus on
health education, care coordination —
as well as addressing the psycho-social
and environmental needs of the member
— can improve health outcomes, reduce
lifestyle risk and efficiently manage
health care resource utilization. These
programs are particularly successful
when performed in collaboration with
the member’s caring physician.
The pay-offs for the employer are controlled medical costs and a healthier,
more productive work force.
Why is there a movement away from historic disease management methods?
The prevalence of chronic diseases
continues to increase, in part because of
an aging population but more importantly because our society continues to
engage in unhealthy lifestyle behaviors.
Disease management programs that
focus only on chronic conditions do not
address the root causes of chronic diseases. Creating programs to encourage
people to quit smoking, maintain a
healthy weight, and learn to exercise
regularly is critical to the prevention and
management of chronic diseases.
What kinds of skilled services make such a
program?
Most people with a chronic condition
have more than one disease. We therefore use a holistic integrated approach, with care teams that consist of nurses,
social workers, health coaches, behavioral health specialists and pharmacists.
All are trained to provide telephonic and
occasional in-person consultation.
Programs for smoking cessation and
weight and stress management assist in
mitigating lifestyle risks. Many health
plans help interested employers provide
these programs at the work site. These
programs support the physician-patient
relationship by collaborating with the
caring physician to facilitate and coordinate care.
What employer benefits do these programs
produce?
These programs benefit the employer
in several ways.
First, they help control medical costs.
They also improve productivity by
reducing absenteeism and workplace
injuries. In addition, these programs provide an opportunity for the employer to
maintain a skilled and healthy work
force.
This approach is a win-win for all
involved — healthier and more active
members, employers with managed
medical costs and a more productive
work force, and assistance for physicians to care for an increasing medically
complex patient population.
DR. MICHAEL CULYBA is vice president of medical affairs at
UPMC Health Plan. Reach him at [email protected] or (412)
454-5532.
