Health care treatment methods Featured

7:00pm EDT February 28, 2007

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 culybamj@upmc.edu or (412) 454-5532.