November 7

Chronic Conditions Driving Health Care Costs

A new report has found that the top driver of health care costs in the U.S. is chronic conditions, emphasizing the role that employers can assume in helping their employees better maintain these ailments.

Chronic diseases are a major strain on the health care system, and they are costly to treat. Worse, many people with these ailments do not manage them well and do not change their lifestyles to improve them.

According to the Centers for Disease Control, six out of every 10 American adults have at least one chronic condition, with 40% having two or more.

As a result, chronic conditions play an outsized role in the cost of group health insurance. In order to contain costs and improve outcomes for their workers, employers can employ a number of different strategies, according to the report by the International Foundation of Employee Benefit Plans.

The CDC defines chronic disease as a condition that lasts at least a year and affects or limits daily activities or requires regular medical attention. The seven most common conditions are:

  • Heart disease
  • Cancer
  • Chronic lung disease
  • Stroke
  • Alzheimer’s
  • Diabetes
  • Chronic kidney disease.

While there is no one-size-fits-all solution, employers can try to contain costs, and hopefully their insurance premiums, by implementing a few strategies.

Disease management

Depending on the condition, chronic disease management programs will vary and it is usually a multi-pronged approach involving the plan enrollee’s health care provider and employer programs. Disease management should include:

  • Regular screenings and checkups.
  • Structured treatment plans.
  • Education on how to manage their disease and self-care strategies. Some programs help enrollees to set goals for their health.
  • Promoting the benefits of regular exercise and a nutritious diet, and empowering enrollees to take control of their health.
  • Integrating wellness programs focused on chronic disease management and that promote a healthy lifestyle.
  • Empowering enrollees to take control of their health.

Coordinated care

It’s important for people with chronic conditions to receive care that’s coordinated among different providers. This is crucial as these diseases can have multiple effects, requiring the involvement of more than one physician with different specialties.

The key is that providers have in place systems and procedures that ensure that the patient’s various physicians are sharing information with one another, and that the patient is kept in the loop. This care requires:

  • Access to care from different health care providers,
  • Coordination between primary care, acute care and long-term care,
  • Strong communications among providers, and
  • Easily understandable patient communications.

Employee engagement and education

You as an employer can also do your part by making sure employees with chronic diseases make choices that ensure access to providers that focus on coordinated care.

You can also offer wellness programs that give employees with chronic diseases access to care coordination, medication management, disease-specific education, self-monitoring tools and peer support. For example, an employee wellness program may provide employees with diabetes with glucose meters, insulin pumps, diabetes educators and online support groups.

Employee wellness programs can help employees adopt healthier behaviors and lifestyles by providing them with information, motivation, support and resources. For example, an employee wellness program may offer free or discounted gym memberships, healthy food options, wellness challenges and rewards for reaching health goals.

Take advantage of essential services

To keep their disease from worsening or to identify possible health issues that may be developing, it’s vital that plan enrollees take advantage of preventive services that the Affordable Care Act requires be offered with no out-of-pocket costs:

  • Screenings and counseling.
  • Routine immunizations.
  • Preventive services for men and women.

Even when a member does not receive preventive care and develops a chronic disease, preventive measures can ensure that the disease remains in a low-severity stage.

The takeaway

The key for employers is outreach, particularly in the run-up to and during open enrollment. You can take additional steps to ensure workers with chronic disease are engaged and that they are educated in choosing plans that may offer them the best care for their condition.

Furthermore, you can offer wellness plans that reward healthy behavior, and you can educate your workers about their health coverage and the importance of getting regular screenings and inoculations.


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