How to use a disease management program to reduce health care costs and create a healthier work force Featured

8:00pm EDT July 26, 2010

Many employers who are watching their group health insurance premiums increase are asking obvious “what if” questions: What if my healthy employees could stay healthy? What if my unhealthy employees didn’t get sicker?

And health care professionals are asking, “Why not?” says Dr. John Wallendjack, vice president of Medical Affairs for HealthAmerica. “Why not change the focus of health care from illness to wellness, from high-cost treatment to low- or no-cost prevention, from passive patient to self-care participant? The health care approach that resulted from this questioning is called disease management.”

Smart Business spoke with Wallendjack about how employers can use disease management to address cost and quality concerns.

What is disease management, and how does it affect the cost of health care?

Disease management is the process of reducing health care costs and improving quality of life for individuals by preventing or minimizing the effects of a disease, usually a chronic condition, through integrative care.

What has driven the increasing interest in disease management?

Two developments have served as catalysts for the increased interest: the unsustainable rise in health care spending and advances in information technology.

The numbers help explain why early prevention and disease management are necessary. Health care costs have been rising for years and will continue to do so. The Office of the Actuary in the Centers for Medicare & Medicaid Services projects that from 2009 to 2019, average annual health spending growth, at 6.1 percent, is anticipated to outpace average annual growth in the overall economy, at 4.4 percent. By 2019, national health spending is expected to reach $4.5 trillion and comprise 19.3 percent of the nation’s Gross Domestic Product.

The nature of health care in the U.S. has changed dramatically over the past century, with longer life spans and greater prevalence of chronic illnesses. The Centers for Disease Control and Prevention estimates that health care costs for chronic disease treatment account for more than 75 percent of national health expenditures. As the baby-boom generation ages and develops chronic illnesses, boomers will use more health care services.

Second, technological advances are making the disease management concept more achievable. The ability to collect and analyze patient data using information technology has resulted in major improvements to the health care delivery system. This has allowed for significant strides in the creation of effective disease-management programs. IT makes it possible to determine the health risks of individuals, as well as of entire populations, and track treatment, outcomes and costs.

Once a patient’s information is in the system, it can be accessed by health care providers to coordinate care and avoid medical errors. IT helps identify health care best practices and monitor their use, and it’s behind many of the quality comparisons consumers can access to evaluate health care providers and hospitals.

How does a successful disease management program work?

Research-based guidelines are at the core of successful disease management. Simply put, they are recommended standards of treatment based on scientific evidence. The Federal Agency for Healthcare Research and Quality works with many groups that collect existing research on treatments for medical conditions, rate the quality of the research and report the accumulated scientific findings. That information is used by other professionals to develop guidelines.

Health care providers improve quality not only by practicing evidence-based medicine but also by reporting their results with patients and contributing to research. In that way, quality begets more quality.

What role do employers and health insurers play in disease management programs?

Health insurers must continue their leadership role in driving quality up and costs down. Employers who partner with health plans that have disease-management expertise make an investment in the health of their employees.

To determine how strong a partner your health insurer is, look for features such as:

  • Intervention: This ranges from reminders about required care for high-risk patients to enrolling patients with chronic diseases into disease-management programs.
  • Coverage of health screenings: These can detect disease early and include colonoscopies, Pap tests, mammograms, and cholesterol screenings. The tests must be affordable.
  • Patient education: Such efforts teach high-risk patients how to minimize their risk of disease by changing risky health behaviors. The plan should provide tools for change, such as interactive Web sites and low-cost or no-cost health education opportunities.
  • Workplace education: The plan should provide onsite health education targeted to the health needs of employees, include a health-risk assessment tool for employees to learn about their risk factors and conduct health screenings at the worksite.
  • Research-based guidelines: The plan should work to discover the most effective preventive measures and treatments, and these should be communicated to and followed by all plan providers.
  • Quality measurement: The health plan’s clinical guidelines should translate into better health for plan members.

What can employers do to determine if disease management is right for them?

Employers should ask themselves, ‘Am I concerned with health care value, not just costs? Am I attentive to how I can improve my employees’ health while they’re on the job? What about during their off-hours? Am I willing to invest in long-term benefits?’

If you answer yes, you are joining the list of employers seeking to lower insurance costs and produce a more productive work force through disease management.

Dr. John Wallendjack is vice president of Medical Affairs for HealthAmerica. Reach him at