Chronic diseases and conditions like a heart condition, stroke, cancer, type 2 diabetes, obesity, and arthritis are among the foremost common, costly, and preventable of all health problems, consistent with the CDC. In fact, about half all adults within the US—117 million people—had one or more chronic health conditions, while one in four adults had two or more such conditions. Further, the CDC notes, seven of the highest 10 causes of death in 2014 were associated with chronic disease. Two of these—heart disease and cancer—together assumed for nearly 46 percent of all US deaths that year.
Health plans, perhaps quite the other stakeholders within the US healthcare system, are acutely conscious of the financial burden of chronic disease. The CDC reports that 86 percent of the nation’s $2.7 trillion annual healthcare expenditures are attributed to people with chronic and psychological state conditions. Consistent with a report from the Partnership for Solutions, a national program whose goal is to enhance care and quality of life for Americans with chronic health conditions, “People with chronic conditions, particularly those with multiple chronic conditions, are the heaviest users of healthcare services.
In addition to the rising incidence of chronic disease, the amount of health plan members over the age of 65 is growing, statistically placing them at a better risk for chronic illness. because it is usually these aging communities who develop chronic diseases only adds to the financial concern that health plans are shouldering. It is, therefore, more important than ever for health plans to develop a technique for maintaining the health of their members, improving patient outcomes while reducing costs.
Managing Member Health
Traditionally, payers have focused on a couple of key efforts to take care of member health including Utilization Management, Wellness, and care management, and sophisticated case management.
The challenge inherent in these approaches of care management isn't that they're feeble, but that they're not optimized to deal with the complicated clinical needs unique to the individual patient. On one end of the thread, such care management actions specialize in population health, accentuating efforts that are good for a whole population generally, like the previously mentioned annual eye exams for members with diabetes. These population health efforts are in fact necessary and prudent, but they’re not personal.