Alice Albu

Monday, 29 August 2005 11:18

Disease management programs

Finding affordable health care coverage is becoming increasingly difficult for both employers and consumers. Purchasers are facing the fourth-straight year of double-digit increases, with the average annual family premium approaching $10,000. The reasons for rising costs are complex and varied, ranging from increased pricing and rapid development of new medical technologies to consumer demand for more health care services as the population ages. While spending on health care is at an all-time high, in many cases, the quality of care delivered is suboptimal and actually contributes to excess medical costs.

According to a 2004 study by the National Committee for Quality Assurance, nearly 66.5 million avoidable sick days — at a cost to employers of more than $9.6 billion — can be traced to the health care system’s routine failure to provide needed care for just five health care conditions: asthma, depression, diabetes, heart disease and hypertension.

There are specific ways managed-care plans are helping to reverse this trend, especially as it relates to these conditions.

The costs of chronic conditions
Although employees with chronic conditions like those mentioned above constitute less than 10 percent of the work force, this same group accounts for 80 percent of all health care expenditures. That translates into 80 percent of inpatient treatments, 83 percent of prescription drug use and a whopping 50 percent of emergency room visits. It should come as no surprise to employers that providing patients with better care for chronic medical conditions can substantially lower health care costs and improve care.

Disease-management programs reduce the frequency of expensive hospitalization and disease complications by identifying groups of members who fall into defined disease categories and educating these members on how to manage their diseases. These management techniques are based on clinical evidence and play a significant role in improving outcomes. In fact, Michigan’s health plans have some of the best outcomes in the nation for managing chronic illness.

Wellness and health promotion programs help keep employees healthy and on the job. They work by helping members understand their disease, subsequently teaching them practical ways to prevent or control symptoms. Interventions include tactics such as postcards sent to members reminding them to get a check-up, or announcing free education programs.

For example, diabetes patients may receive pamphlets covering the importance of foot care. Asthma patients might receive information on keeping allergens out of the home and how to avoid conditions most likely to trigger an attack. There are also screening tools to help people determine whether they or additional family members are at risk for various diseases and information on minimizing risk.

The importance of patience with patients
Return-on-investment for disease management programs requires a long-term strategy, due to the fact that it takes years to track patient progress in quantitative terms. In well-managed programs, however, financial returns on investments have been reported, especially in the area of congestive heart failure.

The Disease Management Association of America (DMAA) recently released the results of a Thomson Medstat survey of 26 health plans across the country, “showing 71 percent of respondents were satisfied or highly satisfied with the clinical and financial results of their disease management programs. Nearly half reported improved financial outcomes, including returns on investment ranging from 2.5:1 to 4:1.”

Although waiting out the numbers requires patience, the short-term, qualitative impact on employees is evident in their quality of life. Once a chronic disease is under control, patients begin quickly to feel better. This will most likely result in less absenteeism and more importantly, less presenteeism, thereby boosting real productivity.

According to the DMAA, “... we have an industry that’s gone from zero to millions of lives being impacted in less than a decade. This is truly transformational. We have every major health plan in the country either building their own disease management programs, partnering with disease management providers, or planning to in the next year. We have nearly every major employer doing the same.”

News like that should leave employers feeling a little better.

Alice Albu, RN, MSN, director, quality management of Care Choices HMO, a nonprofit health care organization and a subsidiary of Trinity Health. Care Choices HMO is ranked first in Michigan in clinical excellence in health plans, according to the National Committee for Quality Assurance. Reach Care Choices at www.carechoices.com.