Health and disease management

The value of better coordination and customized support

Insurers and plan sponsors have traditionally relied on wellness strategies and disease prevention, along with absence and disability management to help maintain the sustainability of their benefits plans in the long term.

However, with more working age people developing chronic diseases, the rising cost of medicine and a public healthcare system struggling to meet the needs of patients, sponsors are looking for a new kind of assistance.

What are chronic diseases?

Chronic diseases are defined as long-term diseases that develop slowly over time, often progressing in severity. They can usually be controlled, but rarely cured. We regularly hear of someone suffering from one or more of these conditions: cardiovascular disease (heart disease and stroke), cancer, diabetes, arthritis, back problems, asthma, and chronic depression. But what many don’t know is that these conditions often significantly impair everyday physical and mental functions and reduce one’s ability to perform daily activities1

Forty-five per cent of plan members report having one or more chronic diseases such as diabetes, arthritis or depression. And when high blood pressure and high cholesterol are considered, the number of employees living with chronic health conditions climbs to 56 per cent2.

Treatment of chronic illness consumes 67 per cent of all direct health care costs, and costs the Canadian economy $190 billion annually – $68 billion is attributed to treatment and the remainder to lost productivity3.

Typically, individuals suffering from chronic diseases have been treated through a family physician and drug therapy. However, considering the cost and impact on the Canadian economy and employers, we’re starting to question if more could be done.

When we look at health more broadly, there is a large gap in services offered from the early onset of a chronic condition, to the absenteeism that results from the development of multiple chronic health conditions. Health and disease management looks to bridge that gap.

What is health and disease management?

People with chronic conditions tend to use more health care services, which often are not coordinated among providers, creating potential misuse of medical care4.

Health and disease management is meant to provide the level of assistance people with chronic illnesses need. Offering customized support and timely assistance comes in handy to minimize or delay the impact of the illness on people’s daily lives, which can significantly reduce the associated costs.

What are the benefits of a health and disease management program?

For employees

  • Access to a multi-disciplinary team of professionals (physicians, pharmacists, nurses, dietitians and psychologists)
  • Interventions and services adapted to specific diseases
  • Tips and education on certain chronic diseases and how to best manage them
  • Reminders when needed of the importance of following prescribed treatment
  • Continuous evaluation and monitoring of health status
  • Overall health and quality of life improvement 
  • Encouragement to adopt healthy lifestyle habits
  • Access to support groups

For employers

  • Early intervention and support to help and guide
  • Well-informed individuals seek and receive better care
  • Reduction of unnecessary health and disability claims requests
  • Better quality of life for individuals with chronic conditions
  • Prevention and reduction of the effects of disease through integrated care
  • Treat chronic conditions more quickly and more effectively
  • Improvement of plan member health
  • Improvement of health outcomes
  • Reduction of long-term cost management (drug spend, productivity, absenteeism)
  • Increased employee engagement

Controlling costs through disease management

Considering the increasing rate of chronic diseases in the workforce today, employers are facing a higher risk of financial burden. In 2014, 21.4 per cent of Canadians aged 20+ years had at least one major chronic disease (cancer, diabetes, cardiovascular disease, chronic respiratory diseases)5 . Chronic disease rates are increasing faster among Canadians aged 35-64 than seniors (65+)6.

By offering adequate support to individuals suffering from chronic diseases through integrated care, the disease and health management approach can help improve quality of life and reduce overall health care costs.

Long-term value of disease management

Although we have no long-term studies in the Canadian insurance world to demonstrate the benefit of this approach on cost containment, clinical research and disease management programs in other jurisdictions have shown a significant reduction in health care costs.

According to the American Heart Association’s Expert Panel on Disease Management, “Private and public policymakers and health insurance plans increasingly are examining and introducing disease management programs to help treat chronic illnesses such as cardiovascular disease and stroke7.”

Investing today for tomorrow is the long-term vision and value of health and disease management.

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