Disease management may lower insurance expenses

Andrea Croley, a registered health underwriter, is co-owner of Croley Insurance and Financial Inc.

As an employer evaluating your health program, insurance company and broker, don't overlook the significance of disease-management programs. Disease management is defined as a prospective, disease-specific approach to delivering health care for chronic illnesses managed medically.

Most health care costs are generated by the 3 percent to 5 percent of patients that are at high risk, have a critical injury or suffer from a chronic disease, according to David Plocher in "The Managed Health Care Handbook."

Commonly targeted ailments include depression, hypertension, cancer, diabetes, cardiovascular disease, asthma and obesity, according to the October 2002 edition of Employee Benefit News.

The benefits of implementing disease management programs are that they will lower costs, enhance patient care and improve overall health for individuals.

When rate increases are received, benefit adjustments are a common solution. Cost shifting and cost shaving in copayments, physician office visits and drug benefits are frequent in these situations, but they only serve as a short-term solution.

In the graphics, you will notice the large percentage of employers that have made such adjustments in their health care benefits. However, more questions should be asked about ways in which to solve the long-term issue of rising costs.

To begin with, employers should discuss with their broker or insurance company what measures to take to control these costs.

An Ernst and Young benchmark study indicates that plans offering disease-management programs had lower commercial medical loss ratios and use rates than plans that did not include disease-management programs.

The disease-management program presents an opportunity to assess patient care and disease benefit costs by maintaining its three separate but integrative components: identification, intervention, and monitoring and evaluation.

The first portion of this program begins with identifying and selecting chronically ill individuals who represent the high-cost users of medical care. Then, the program will link these individuals with appropriate providers and outpatient interventions. This targets groups of individuals with the identified high-risk disease in an effort to prevent acute episodes. Lastly, the plan utilizes these health-care resources to periodically monitor and evaluate these patients.

The purpose of disease management is to produce positive changes in an individual's health status with a focus on education. Disease management emphasizes the education of group members through self-care and of physicians through guidelines.

Ultimately, the goal of disease management is to reduce the frequency and the severity of the worsening of a chronic illness so that hospital re-admission costs are reduced.

Eventually, each individual is responsible for his or her own health care Empowering men and women to manage their illnesses and to follow the guidelines presented by their physicians can improve outcomes and lower costs for health care.

Although employers are typically held responsible for increased costs, education through wellness and disease-management programs should be accepted as the responsibility of the individual in order to improve quality of life and to help manage costs.