Employers turning to disease management

Chronic illnesses affect more than 100 million Americans and account for 75 percent of the nation's annual health care costs.

This figure can only go higher as Baby Boomers reach maturity.

Historically, the problem of decreasing the onset and severity of chronic diseases such as diabetes, congestive heart failure, HIV/AIDS, respiratory compromise (COPD), stroke (CVA), hypertension, and others, has been placed on the back burner in favor of more immediate and acute health care conditions.

In the early 1990s, faced with the ever-increased aging of the population, a new concept of health care management emerged in this country aimed at reducing the onset of chronic disease and its severity, known as Chronic Disease Management (CDM).

The goal of this program is to address chronic illness with maximum effectiveness and efficiency through the application of clinical protocols for selected conditions.

The program is designed to actively engage patients in their own care and treatment by means of patient education and follow-up.

CDM management is accomplished by medical professionals, usually a licensed nurse with training and experience in chronic disease management.

In addition to medical protocols and education, the trained professional can assist patients in non-clinical aspects of their care, such as negotiating the best possible rates for medication, supplies, and medical services.

We know that once an employee or family member acquires a chronic disease it is usually for life, unless a medical breakthrough can establish a cure for the specific disease.

Given this fact, every effort must be taken to keep the patient from reaching an acute level of care, requiring expensive treatments and hospitalizations.

If patients have a clear understanding of their disease process and undertake a cooperative effort to manage their disease through a program such as CDM they are less likely to require an acute level of care.

Clearly, employers make a considerable investment in employees, usually within the first few months of employment.

Much time and expense takes place in initial training and the cost of medical benefits.

If such an investment in an employee takes place, it is important to keep that employee healthy and reduce the need for expensive acute care costs.

The cost of a CDM program is nominal to protect the investment made in an employee and to potentially avoid the costs of acute care.

Even within a healthy employee population the costs of health care benefits dramatically escalate each year.

It is to the employer's benefit to minimize the use of acute care services to help keep premiums as low as possible.

In some surveys of national employers it has been found that health care premiums increased some 14 percent or more last year, making employers rethink their financial ability to continue to pay for employee and family health care premiums.

Some employers have handled this problem by changing health plan benefits, increasing deductibles and co-pays.

Some employers have asked employees to pay their own premiums.

In some cases employers have dropped coverage altogether or given employees a fixed amount of money to spend on health care as they see fit.

The latter poses an additional risk that the employee given this fixed amount will not use it for healthcare, but rather some other personal benefit.

The results of this cost shifting usually results in unhappy employees and the risk of losing experienced workers who seek other employers with more attractive benefits.

Because of this situation, employers are now beginning to see the merits of investing in programs like Chronic Disease Management and involving the employee in the management of their own health care needs.

Previous thinking by some employers has been to consider programs such as Chronic Disease Management as a longterm investment in the individual employee or covered family member, but without an immediate return-on-investment it was thought to be a waste of money.

Few statistics have been available to demonstrate the usefulness of CDM, however, in the May issue of "Benefits Selling," a monthly periodical for the health-care brokerage community, such information has recently been established to show the value of such an investment.

The article states that, "Chronic medical conditions impact 5 percent of the health plan population and 30 percent of plan costs in any given year." In addition, the article goes on to say, "Some insurers have measured an average return-oninvestment ratio as high as 2.5:1 for early adopters of DZM (Disease Management) programs." Clearly, an employer cannot discount such results, especially when every ability available to an employer in maintaining the initial investment in an employee, and their long term health and happiness in their work cannot be overlooked.

"Benefits Selling," shows additional information as to the merits of Chronic Disease Management.

The effectiveness of CDM can be seen in the chart that accompanies this article.

As can be seen from the chart, Chronic Disease Management can pay off! Employers who agree to protect their initial investment for training an employee and maintaining an experienced one can save money be investing in a CDM program.

Although the CDM program may not realize an initial return-oninvestment, over the long haul using the program can result in a dramatic difference in outcome, both medically and financially.

Such a program used for employees and their covered family members who have chronic disease conditions can also make for a more satisfied employee and one in whom has been empowered to help manage their one condition.

If you, as an employer, do not currently have a Chronic Diseases Management program in place for your employees and covered family members, now is the time to investigate this opportunity.

If you are a self-funded employer group, contact your third-party administrator or health care broker and ask them to find such a program on your behalf.

If your health care benefits are fully insured through an insurance company, contact your insurance agent or the insurance company to ascertain the availability of a program for your organization.

A good program should have qualified health care professionals, usually registered nurses, who have at least two years experience in working with a Chronic Disease Management program.

The program should be able to demonstrate its impact by producing reports to the use of the program by employees, without identifying them, and show some correlation between the use of the program and improvement similar to the above chart.

Such programs must be in a position to provide educational services for employees in the program and have the ability to negotiate rates for health care services, pharmaceutical and supplies.

Below is a summary of the key clinical outcomes of managed conditions for Wausau Benefits' DZM program members.

Progress was measured by comparing the baseline results to the managed results.

To qualify as a managed result, there must have been at least two contacts between a member and a RN, and a minimum of one follow up.

Baseline Managed result result Asthma: Feel their asthma was controlled 69% 87% Used a peak-flow meter 45% 63% Congestive heart failure: Complied with low-salt diet 92% 98% Weighed self daily 62% 73% Coronary artery disease (CAD): LDL below 100 53% 67% Satisfied with ability to manage CAD 83% 97% Chronic obstructive pulmonary disease: Walked one block without shortness of breath 55% 89% Woke in night with shortness of breath 16% 8% Depression: Satisfied with ability to manage depression 30% 77% Received professional help 71% 100% Hypertension: Blood pressure less than 149/90 64% 81% Exercised three times a week for 20 minutes 63% 77%

Frank J.

Berrier, Jr.

is president and chief executive officer of Dynamic Resource Group, an employee assistance program and private mental health counseling center in Reno.He also is president and chief executive officer of Spectrum Review Services, a health care management company in Houston,Texas.

Portions of this article have been reprinted with permission from the editors of "Benefits Selling."