Managing chronic conditions reduces health plan costs.

Author:Coffman, Elaine
Position:Health Care CENTRAL - Medical case management

Beginning in the late '90s, many large organizations and health plans began engaging employees with chronic illnesses to help them manage their conditions more effectively. These programs are now commonly referred to as disease management programs and have the win-win goal of offering patients support for a better quality of life and employers lower health-care and absenteeism/disability costs.

Targeted conditions and their treatment are often not thoroughly communicated by physicians during a 20-minute office visit. In many cases, several physicians might treat patients without adequate coordination. A disease management program addresses these inadequacies of the health-care system.

What is the impact of chronic conditions on health-care costs? Chronic disease is the leading cause of illness, disability, and death in the United States, driving a significant portion of health-care costs for organizations. In 2000, approximately 125 million or 45 percent of Americans had one or more chronic diseases accounting for $510 billion in medical costs (see chart).

How do disease management programs work? Ongoing medical and pharmacy claim data, along with other tools such as health risk appraisals, are used to identify members with chronic conditions. Members are typically stratified and engaged by the severity of the condition and their ability to manage their illness:

* High-risk members receive frequent phone contact, home visits and medical monitoring.

* Medium-risk members receive frequent phone contact.

* Low-risk members receive frequent mailings and occasional phone...

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