If you’re convinced that DM is right for your company, there are some important steps to take to ensure that your program benefits your employees and the company.

First you must determine which diseases you want a DM program to cover. Start by gathering data on the frequency, severity and consequences of diseases and illnesses among your workforce. You can glean this from claims data your health insurance plan and your prescription plan provide.

“Ask your health plan and pharmacy benefit manager to determine what percentage of costs are going to specific diseases,” suggests Larry Boress, vice president of the Midwest Business Group on Health, based in Chicago. “These include doctor visits, hospitalizations and prescription costs.” You also can supplement this information with health risk appraisals completed by your employees.

Next, decide which of these most common diseases you actually want to cover. The four most popular DM candidates are asthma, diabetes, heart disease and depression.

Comprehensive DM programs can be expensive, so you may not be able to cover all the diseases your employees have. Despite the costs, most employers find that DM programs yield a positive return on investment (ROI). Not only is there a reduction in direct costs associated with health care (such as insurance premiums and short-term disability payouts), but there are significant indirect savings as well. These include increased productivity and lower absenteeism. DM programs also can cut “presenteeism”—employees showing up to work but performing at a reduced capacity because they don’t feel well. Although indirect savings can be difficult to measure, they may offer the greatest ROI to employers.

When calculating ROI, Kuraitis says it’s important to take a long-term view. “The clinical value of controlling hypertension is not disputed. However, the payback could be 10 or 20 years, when your employees may not even be with you anymore.”

Once you identify your workforce’s disease profile, talk with your health plan representative and other potential DM providers about the impact these diseases could have on health care and presenteeism costs, how expensive the diseases are to manage and whether ROI is short-term or long-term.

One of the most important benefits of DM programs is that they can complement primary physician care. “When you visit your doctor and he tells you that you have diabetes, you might get five minutes with him,” notes Dandalides. The physician may say: “This is what diabetes is. Here is a pamphlet. Here is some medicine. I want you to exercise, follow a special diet, and I’ll see you again in three weeks.” But many patients need more support.

“Disease management helps people understand their diseases and treatments better,” Dandalides says. “It reinforces good health behaviors and works with patients between their doctor visits. As such, there is a much better chance of patients complying with instructions and being able to report success to their doctors when they return for visits.”

Disease management programs also can keep track of medication usage. “If we find that a prescription is being refilled every six or seven weeks instead of monthly, we can find out why or alert the patient’s doctor to this fact,” Dandalides adds.

Armed with information, the patient can make better health care decisions.

“We focus on disease self-management,” says Daniel Gold, director of research for StayWell Health Management Systems in St. Paul, Minn. The company has staff nurses, dietitians and health educators, who conduct mail- and telephone-based programs, as well as on-site classes. “We target compliance, knowledge, attitudes and beliefs in participants that they can control their conditions. We want participants to increase their knowledge and skills in order to be able to better manage their conditions, follow their health care provider recommendations and comply with medication and nutrition instructions.”

The best DM programs divide members into three categories. High-risk individuals should receive frequent telephone contact as well as occasional home visits and medical monitoring, such as blood pressure or glucose level checks. Medium-risk individuals often require just frequent phone contact. Low-risk individuals can get by with frequent mailings and occasional phone contact.

Encouraging Involvement

Once your company selects the diseases to manage and develops an in-house program (or chooses a third-party provider), the real challenge begins: getting your employees to sign up. Some people are just not that interested in their health; others may be reluctant to bring health concerns into the workplace. But encouraging eligible employees to participate is critical to obtaining maximum ROI. Here are some ways to help your workforce see the benefits of your DM program:

• Create a health promotion and health management culture in your organization. “Disease management is not just about going to a doctor and taking medications,” explains Sue Willette, senior consultant with William M. Mercer of Minneapolis. “It is about lifestyle. You have to create a culture showing employees that you value their health.” Obvious demonstrations of this commitment can include exercise facilities, wellness education programs, health fairs and healthy food in the cafeteria.

• Demonstrate how participation will benefit employees. “You want employees to view the program as a service or benefit to them, not only in the management of current, chronic medical conditions, but also in the quality of life,” says Joseph Marlowe, senior vice president of the health and welfare practice at Aon Consulting in Conshohocken, Pa.

• Make participation enjoyable. “Make the program fun and engaging so that people will want to participate,” suggests Riedel. “One example is providing engaging, interactive web-based information.” (For more information on using technology in DM programs, see the “HR Technology” article on page 69). Also consider offering incentives for participation, such as free diabetic supplies, free peak flow meters for asthmatics or prize drawings for all participants.

• Emphasize protection of privacy. “Employees need to know that employers will not have a role in identifying or tracking participation,” emphasizes Boress.

• Be sure communication is comprehensive and continuous. Options include payroll stuffers, mailings, posters, bulletin boards and intranets. Provide selective communication for specific diseases and audiences.

Once you’ve selected the diseases to cover and encouraged your employees to participate, you should monitor the program’s results. Ask your DM program provider for progress reports. “While health plans are not always good about management reporting in terms of telling each employer what is going on with its employees in specific, you can hold independent vendors much more accountable for delivering these reports,” suggests Willette. They should show the number of people participating and the level at which they initially were enrolled. Then, over time, you should be able to see the migration of people from high severity to moderate severity and from moderate severity to low severity, based on the effectiveness of your DM strategies.