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Difficulties in engaging plan members cause programs to be underused
Programs to help employees (along with their covered spouses and dependents) manage chronic diseases such as diabetes and asthma have become a standard component of employer health plans, according to a recent
study by the Rand Corp., a nonprofit research organization. But while internal evaluations suggest that these programs improve care and reduce costs, plans report difficulties in engaging members and providers, leading to the programs being underused.
Researchers collected and analyzed information from a nationally representative sample of U.S. health plans for the study, published in the May 2015
American Journal of Managed Care. The results showed that health plans overwhelmingly—regardless of size, location and ownership—offer programs to support members with chronic conditions. Plans typically identify those members based on claims and laboratory data, and then match them to appropriate interventions and resources based on need and risk.
“The number of people in the United States with one or more chronic condition is expected to grow to 171 million by 2030, which means almost one in two Americans will suffer from a chronic disease in the not-too-distant future,” wrote Soeren Mattke, the study’s lead author and managing director of Rand Health Advisory Services. “There is an urgent need to improve management of chronic conditions.”
To overcome obstacles to effective chronic care, plans are changing their approach to chronic care management. These steps include:
Increased collaboration with providers Four-fifths of the studied plans attempt to integrate their chronic care management programs into provider workflow with two approaches. The first (taken by 24 percent of plans) is virtual integration, which happens either telephonically or by using information technology such as electronic medical records.
The second (implemented by one-third of plans) is to embed health plan staff into care settings. For example, some plans place behavioral health specialists in hospitals to assist members with discharge planning, while others place care management staff in practices with a high volume of plan members. Staff members then educate patients with complex chronic conditions on program offerings and other support resources.
Practice redesignHealth plans are making substantial efforts to redesign current payment and delivery systems to align them more closely with the needs of chronically ill patients. Three-fourths of all plans are working on reforming the current fee-for-service approach. Most plans also encourage practices to adopt patient-centered medical home models that offer continuous management of patient needs, team-based care and expanded access, including same-day appointments, after-hours care and electronic visits.
Use of patient-support technologyNumerous technologies to support chronic care and to motivate patients to adopt healthy behaviors are being offered or developed. These include telemedicine solutions that allow remote interaction with providers as well as remote monitoring products that transmit vital signs and other biometric data to providers from devices like scales, glucose meters and heart-rate monitors.
More recent developments include social media applications that allow patients to communicate with peer groups and other online communities.
About half of the plans said they use remote monitoring technology (56 percent) and online self-administered behavior change applications (48 percent), while 16 percent of plans reported using mobile health technology such as smartphone applications. Plans regard remote monitoring as a promising option, especially after hospital admission, if the patient has a provider who is able to respond to the data feeds.
Some plans have also started offering secure video chats for higher-risk members.
Many plans expect to expand the use of patient care technologies within their chronic care management programs, particularly with regard to the use of smartphone and social network applications.
Focused interventionsHealth plans are increasing their efforts to tailor interventions to members’ needs. Approximately four-fifths of plans use predictive modeling to identify patients for disease management (84 percent) and case management (76 percent). Plans are also working on differentiated algorithms to predict high-cost events like hospital admissions and to identify specific gaps in care, such as lack of follow-up after hospital discharge.
Identification algorithms are becoming more complex. Whereas claims data historically were the main source of information, plans are now experimenting with adding other data sources, such as health risk assessments, electronic lab data and member self-reported information, which the industry sometimes refers to collectively as “big data.”
Stephen Miller, CEBS, is an online editor/manager for SHRM. Follow him on Twitter
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