Managing Chronic Conditions

What percentage of medical costs is associated with chronic disease? 

In the last 20 years, the prevalence of chronic disease in the United States has grown by a steady 7 to 8 million people every 5 years. Today, chronic disease affects 50% of the population, and its care consumes more than 85% of health care costs.

Most Plan sponsors are concentrating on the most common available "Tools" to get their health plan claims cost down i.e.: Network discounts, Reference Based pricing, Prescription plan formularies, case management, Low engagement wellness programs etc. These are only "QUICK FIXES" the problem still remains "Unhealthy Employees".

More Emphasis should be put on driving employee engagement to Healthy lifestyle Behavior and the most efficient Providers.

Driving employee engagement with "Effective" Wellness strategies/Plans will reduce chronic conditions

https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm

THE PROBLEM

• Employees are less engaged, less motivated and less informed about their health then ever before
• Employees-73.6% Percent of adults aged 20 and over are overweight and obese
• Employers-Chronic Conditions and related lifestyle risks are the leading drivers of health care spend for employers
• The high costs of unhealthy behavior…
• 2/3 OF AMERICANS ARE SEDENTARY, OVERWEIGHT OR OBESE.
• $160B IS THE ESTIMATED AMOUNT EMPLOYERS SPEND ANNUALLY ON MODIFIABLE HEALTH RISKS.
• 7/10 EMPLOYERS SAY POOR HEALTH HABITS ARE ONE OF THEIR TOP CHALLENGES IN CONTROLLING HEALTH COVERAGE COSTS.

OUR SOLUTION AND WHY IT WORKS

How Employee's Benefit 

• MOTIVATES employees to live a healthier lifestyle
• EASY to understand and use
• BUILDS better health through positive behaviors and activities
• DRAWS awareness towards healthy lifestyles and habits
• INCENTS positive actions through financial rewards 

How Employer's Benefits

• MOTIVATES consistent activity
• SUPPORTS high deductible plans
• REDUCES chronic conditions/medical claims
• PROVIDES reporting that helps influence usage
• SIMPLE to explain to employees and to administer
• IMPROVES employee productivity
• REDUCES absenteeism

Our Program leverages cash incentives, smart Technology and wellness data to engage, inform ,encourage and drive healthy behaviors that are outcomes based reducing chronic conditions.

• Driving employee engagement with Wellness strategies/Plans That actually show real ROI in outcomes 

• Strategies that Aggressively engage and reward employees, Outcomes focused in Reducing chronic conditions.

Along with a meaningful "Effective" wellness plan/strategy,

Remote patient monitoring is a method of managing acute or chronic conditions via RPM technology while securely collecting and exchanging patient data.

RPM enables the monitoring of patients in their own homes, at work, in transit, or even on vacation, using monitoring devices like:

• Glucose meters for diabetes management
• Heart rate monitors to manage congestive heart failure
• Blood pressure cuffs to measure blood pressure
• Oximeters to measure blood oxygen levels

These easy-to-use affordable RPM Vendors/programs enable virtual care management by gathering and analyzing health data to streamline high-risk patient care and quickly determine whether their condition is stabilized, deteriorating, or improving.

Years of studies have demonstrated that remote patient monitoring is one of the most effective ways to manage chronic diseases like diabetes, heart failure, and chronic obstructive pulmonary disease (COPD) while increasing patient engagement and reducing Emergency Department readmissions.

Americans across all age groups—including seniors—are already using smartphones and tablets, which often resemble RPM devices. A quality platform makes leveraging RPM technology easy, comfortable, and empowering—it bridges the space between healthcare settings and patients’ living environments so they can partake in their own healthcare delivery. The better they understand their care, the less confused they’ll be when interacting with their payers.

Patient engagement

RPM can’t succeed if patients don’t use it. To develop self-monitoring habits, patients need to perceive them as useful. Witnessing the improvement of other patients with similar conditions will often help engage your patient as much as any formal instructions can.

Another way to get chronic care patients excited about monitoring is to be proactive. RPM COMPANIES Check in often and point out even slight improvements while offering constant encouragement and positive feedback, COUPLED WITH A REAL WELLNESS INCENTIVE. How frequently do they interact? That depends on the patient—observing each personality and each condition’s severity  guide's them to a custom protocol for your specific population.

Becker’s Article https://archive.is/GgVHS 

Remote Patient Monitoring is how you measure how well chronic illness is controlled. 

Telehealth is how you improve the control of chronic illness and prevent future complications. 

There are several ways RPM helps reduce medical costs: 

· As an example, high blood pressure is seldom a reason for a potentially preventable ER visit or hospitalization. However, uncontrolled blood pressure over a long period of time increases costs by being a factor in the development of strokes, heart attacks, peripheral vascular disease, and kidney failure. Controlling blood pressure should be a goal for all patients. Doing so will have long-term benefits but it will not reduce medical costs in the short term. Achieving blood pressure control requires regular follow-up that can be delivered via in-person or telehealth visits. Telehealth is more convenient for many patients resulting in better compliance. 

· RPM enables early detection of worsening of chronic illness and provides telehealth to help avoid ER visits and hospital stays. Essentially the trade-off is a $90 telehealth visit versus a $14,000 hospital stay. Congestive heart failure (CHF) is a chronic illness that is responsible for potentially avoidable hospitalizations. RPM for CHF should include daily measures of pulse, weight, oxygen, EKG, and respiratory rate. Any of these measures could identify CHF that is worsening and might lead to hospitalization. Telehealth then allows you to intervene and make adjustments thus avoiding an ER visit or hospital stay.

· RPM allows physicians to safely care for acute conditions at home by using remote monitoring and telehealth. Many patients are hospitalized due to the anxiety physicians feel about caring for them at home. A patient with community-acquired pneumonia may be safely cared for at home by monitoring their oxygen level, pulse, respiratory rate, and temperature. Knowing these are heading in the right direction is reassuring to physicians and makes them more comfortable sending these patients home. For every patient you care for at home the savings will typically be $10,000 or more.

· RPM supports documentation of illness burden which leads to higher monthly payments from Medicare in the Medicare Advantage program. The way this works is you start with the location and demographic factors which you add to the illness factors and then multiply that times the base rate. So say a patient who has no documented chronic illnesses has a demographic adjustment of 1.0 and the insurance company monthly payment from Medicare is $1,000. The physician does a telehealth visit and notes that the patient has stable angina (RAF 0.14), an amputated toe (RAF 0.55), and a gangrenous ulcer (RAF 1.4). The total RAF is 2.09. The monthly payment is a base rate of $1,000 times the demographic adjustment + the RAF or 3.09 times $1,000 or $3,090. The annual increase in revenue from Medicare for this one patient is $25,080. Illness burden documentation is the single largest contributor to being successful in Medicare risk and it can occur via telehealth with two-way video.

Telemedicine is Shaping the Future of Healthcare

Telemedicine is rapidly becoming an incredibly viable option for care. It offers convenience and efficiency – empowering plan members by giving them greater control over their healthcare choices, in addition to saving the plan's claims dollars.

Telemedicine services are changing the way members can be treated – enabling them to connect with a Doctor or Dentist by smartphone or tablet to obtain a diagnosis, determine a treatment plan or get a prescription without having to leave their home or workplace. And, they get the same high-quality healthcare at a reduced cost, when they need it.

Self-funded plans also benefit because telemedicine tools allow plan members to stay out of primary care facilities, Dental and Doctor’s offices and the ER – helping to avoid costly health claims.

 All factors that are sure to improve the productivity and satisfaction of plan members.

We provide solutions that benefit self-funded health plans. That’s why we offer several telemedicine solutions.

More info:

https://www.managedhealthcareconnect.com/articles/2019-telehealth-becomes-standard-care

https://www.dropbox.com/s/5ghm99x5d90pewd/Tele.pdf?dl=0

https://www.dropbox.com/s/xvkcpo50tszofja/value-proposition-teledentistry.pdf?dl=0

World Health Organization, Fact Sheet: Obesity and Overweight; updated June 2016. ’Donnell, M. P., Schultz, A. B., and Yen, L. (2015). The UM-HMRC Study. Journal of Occupational and Environmental Medicine, 57(12), 1284-1290,. Soeren, M., Lui, H., et. al. (2013). Workplace Wellness Programs Study: Final Report (Rep.). Santa Monica, CA: Rand Corporation.