4 Essential Components of Chronic Disease Management Strategies

Disease management programs

Chronic disease management programs can take many forms. When the CMS Innovation Center decided to permit next-generation accountable care organizations (ACOs) to reward disease management program participation, it defined chronic disease management programs as initiatives that

• Involve structured treatment plans
• Help members manage their conditions
• Sustain an improved quality of life

To achieve these aims, payers’ initiatives might implement certain services or preventive care benefits, promote treatment adherence, offer opportunities for member education on a disease state or self-care strategies, and advocate for nutritional goals.

Payers like Blue Shield of California have incorporated three main components into their disease management programs to improve outcomes.

First, programs that focus on a specific condition should account for comorbidities. Over a quarter of US adults experience more than one chronic condition (27.2 percent). These additional mental, behavioral, and physical conditions can influence a member’s treatment adherence and patient experience, so addressing them in the program materials is essential.

Second, integrating wellness programming can promote a healthy lifestyle overall. Regular exercise and a nutritious diet reinforce the efficacy of self-management efforts.

Third, incorporating tools to support treatment and medication adherence distinguishes strong disease management programs. This involves refining communication strategies based on members’ preferences, partnering with other stakeholders that can encourage program participants, and sharing decision-making responsibility with members.

Payer support in chronic disease management is critical, but the ultimate goal is empowering members to take control of their health. To that end, CDC promotes self-management education programs. The centers provide a list of self-management programs based on conditions—such as arthritis, chronic pain, or lupus—and programs that address any long-term disease.

CDC self-management education programs help patients monitor their conditions and set goals for their health. They might address specific disease symptoms, but they also empower patients to manage stress, fatigue, depression, medications, and other relevant needs.

Care coordination

There are four components of coordinated care, according to an article from the New England Journal of Medicine. The four care coordination elements that are essential for strong collaboration between providers of multiple specialties include:

• Accessible care from a range of healthcare providers
• Strong communication and transitions between providers
• Emphasis on whole person health
• Simple communication with patients

Care coordination breaks down into three categories: primary care coordination, acute care coordination, and long-term care coordination. Chronic disease management requires excellent performance in each area.

Enabling better communication and access to care counteracts the disjointed nature of the healthcare system, bridging primary care and specialty care. It eases the referral experience by making specialists aware of why they received the patient and giving primary care providers insight into what occurred during a specialist appointment.

At Aetna, strong care coordination demands personalization and passing on resources to providers, Aetna executives shared on Healthcare Strategies.

Payers should share data quickly, feeding actionable information to providers at the point of care. They also can invest in bidirectional data analytics strategies that empower provider partners to coordinate care efficiently.

Lastly, payers can share their tools. This could come in the form of sharing technologies. For example, Aetna offers members a digital tool called Next Best Action that sends personalized messages to members. The app can connect members to their care manager for follow-up on certain services.

Similarly, Humana leverages its Humana Care Support program to help seniors manage their long-term conditions. The pilot targets seniors with diabetes and complex congestive heart failure and connects them to a multidisciplinary care team through cloud technology, data integration, and visualization. Providers can use Humana’s data analytics capabilities to monitor patients at home.

Member engagement and education

Payers should already have strong member engagement and patient education as key priorities. Successful member engagement is fundamental to member satisfaction, as the JD Power member survey highlights year after year.

The health insurance industry needs to overall its member engagement strategies overall, starting with its onboarding experience. However, the particularly high need for robust engagement with chronic disease patients cannot be understated and deserves payers’ attention as they hone their chronic disease programs.

Many payers use technologies to increase the frequency and improve the quality of engagement in chronic disease management.

Taking an omnichannel approach to member engagement can be crucial for effective communication. Omnichannel engagement involves connecting with members through multiple mediums—such as text, email, apps, and paper mail—and doing so seamlessly between the platforms.

However, these tools are most effective when combined with effective member education techniques. Elevance Health combined member engagement and education strategies by pairing educational curriculums for specific chronic diseases with concierge care.

As a member engagement strategy, Elevance Health’s app and concierge care took a personalized approach.

Members downloaded an app that guided them through a 12- to 16-week course on their disease states. The health insurer leveraged the app’s data to push relevant content to members, personalizing their experiences. Additionally, the payer paired each member with a nurse based on shared personality types and backgrounds.

The program’s educational content took a “less is more” approach, offering members enough information about their conditions to help them formulate care plans but not enough to overwhelm them. The program’s brevity and concise content prevented members from burning out on the tool.

As a result, Elevance Health retained six out of ten members more than a week after downloading the app, an unusually high retention rate for an app-based intervention. Many participants continued engaging with their nurses and the app after the course’s completion.

Disease prevention and screenings

The best way to reduce chronic disease spending is to stop diseases before they happen or before they progress to severe stages.

Depending on their markets, payers may be required to offer certain preventive care services. Plans that comply with the Affordable Care Act must cover four types of preventive care:

• Screenings and counseling
• Routine immunizations
• Preventive services for women
• Preventive services for children and youth

Payers rely on the US Preventive Services Task Force (USPSTF) to inform their preventive care benefits. The task force has issued recommendations on a broad scope of preventive care services for chronic diseases, such as using aspirin to prevent cardiovascular health events in middle-aged and older adults and affirming the benefits of colorectal cancer and hypertension screenings for certain age groups.

Additionally, CDC has identified four domains of chronic disease prevention that fall under the centers’ purview: pursuing epidemiology and surveillance, promoting health environments, implementing health system interventions, and connecting community and clinical programs. Payers can also tackle these areas to support individual and community health.

Health system interventions might be the most obvious domain for payers to address. They do so by enabling easier access to care, covering the four areas of preventive care, measuring progress, and more.

While payers are not obliged to publish research on chronic diseases, some companies have taken this approach to support preventive care efforts. Blue Cross Blue Shield Association (BCBSA) has published research on the prevalence of Alzheimer’s Disease and colorectal cancer. Some reports are specifically designed to inform preventive care efforts.

Payers’ social determinants of health initiatives can also reduce environmental factors that might increase chronic disease prevalence. For example, Blue Cross and Blue Shield of Texas (BCBSTX) awarded grants to community-based organizations that aimed to improve access to safe environments and opportunities for physical activity.

Many payers embrace the CDC’s community-based approach to prevention. For example, CVS Health’s initiative, “Project Health,” allows anyone to receive screenings at certain CVS Health locations, regardless of whether they are Aetna members.

In 2022, the healthcare company planned to host over 1,600 screening opportunities across the nation. Through CVS Health screenings, 25 percent of Project Health participants have discovered that they have or are at risk for a condition. The initiative aims to improve health equity and community health.

Even when a member does not receive preventive care and develops a chronic disease, preventative measures can ensure that the disease remains in a low-severity stage. Some chronic disease treatment plans are less expensive, depending on the disease stage.

For example, aggressive, late-stage cancer cases require higher-cost interventions than slow or early-stage cancer cases demanding less invasive procedures. End-of-life phase treatment for breast cancer costs, on average, $76,100 per patient, whereas the average initial phase treatment costs less than half that amount ($35,000), according to CDC.

In the face of staggering chronic disease spending, improving management strategies can lead to lower costs, better patient outcomes, and a more efficient healthcare system.