If an employee is diagnosed with a chronic condition, it can create anxiety for an employer. Often, a number of issues arise concerning the health, well-being and productivity of the employee. For employers, this may mean the possibility of a complex, long-running illness that could result in higher premium costs for the company.
In a delicate situation such as this, an employer must look at the needs of the employee and demonstrate patience and understanding. With chronic care management, available through the employer group’s health plan, the illness can be managed so the employee can lead the healthiest, most productive life possible. Chronic care management can benefit both the employee and employer.
“An employer needs to understand the chronicity of the disease,” says S. Ramalingam, M.D., MBA, the senior medical director for UPMC Health Plan. “You won’t see results right away from an effective chronic care management plan. First, one must invest in the plan; the payoff sometimes comes years later in terms of improved health and productivity from an employee who has learned how to live with a chronic illness.”
Smart Business spoke with Ramalingam about chronic care management and what employers should know about it.
What is chronic care management, and how does it differ from other care?
Unlike care for acute illnesses, chronic care requires planned, regular visits with caregivers and special emphasis on preventive measures. Care should be clinically grounded and tailored to an individual’s needs. Treating chronic illness effectively usually means the use of personal care managers. These managers (trained nurses employed by a patient’s health plan) can identify problems and work with the patient’s physician to develop treatment plans based on specific medical needs. The care manager can also provide educational materials through periodic mailings, online resources and regular follow-up phone calls. One of the most important things that care managers do is what a physician often cannot do, which is to identify and remove any barriers to care.
With the personal attention, the care manager may be able to answer important questions such as: Why isn’t a patient taking his or her medicine? Why isn’t a patient going to see the doctor as scheduled? A care manager may find that medication is too expensive and may be able to recommend a more affordable generic alternative. Maybe the patient can’t get to a doctor’s office because of transportation issues or conflicts at work. The care manager can help the employee find another doctor who is more accessible. Care managers help patients receive the best treatment possible.
Why is it necessary to invest in the help of a care manager when dealing with a chronic illness?
Chronic disease is not only the major cause of disability, it is the main reason people seek health care, and it accounts for more than 70 percent of all health care spending. Employers need to invest in the proper treatment. One area that is overlooked is the behavioral health element.
In recovering from a chronic disease, the mindset of the individual plays an important role. The biggest danger with many patients who have a chronic disease is depression. A care manager can see to it that the employee receives the behavioral health care that might be needed.
What role should an employer play when dealing with an employee who has a chronic illness?
If an employer has employees with chronic conditions, it must understand how important it is to make time available for the patients to do the things needed to manage their condition. An employee needs to feel comfortable and not ashamed for having a chronic condition. It is a fine balance because it is important not to foster a sense of unfairness among employees who see one of their colleagues missing work to treat their condition. Employers should work with their health plan provider to learn methods to keep things positive for everyone. Flexibility is most important for an employer.
What should an employer understand about treating a chronic condition?
One of the biggest things for an employer to understand is, with chronic care, you do not see the results instantaneously. Both the person with the condition and the employer should understand the chronicity of the disease. Chronic care management is an investment for an employer. If a chronic condition is treated aggressively through a disease management program, an employer gains an employee who will be more productive through the years and who is more likely to avoid more costly procedures in the future. The employer should also understand that caring for a chronic condition does not mean finding a cure for that condition but rather improvement in the person’s quality of life.
S. RAMALINGAM, M.D., MBA, is the senior medical director for UPMC Health Plan. Reach him at firstname.lastname@example.org or (412) 454-5702.