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Melon Health Blog

How Health Plans Can Close Gaps In Care

Posted by Siobhan Bulfin on Dec 12, 2019 12:00:00 PM

Health disparities often prevent patients from getting the medical help they need, resulting in poor health outcomes and increased costs for health plans.If a minority population is more prone to heart disease, any disparities that act as obstacles to health care will likely result in complex chronic conditions that are preventable but end up costing payers more. 

Health plans can take proactive steps to close gaps in care and provide members with the care they need—all while improving their bottom line.

What Are Health Disparities?

Some key health disparities, also known as social determinants of health, are the following:

  • Socioeconomic factors
  • Race and ethnicity
  • Gender, sexual orientation, and identity
  • Disability status
  • Geographic location

Health disparities are also related to genetics. Many of these disparities are out of a member’s control. They are born into a specific set of circumstances and an environment that will affect their future behavior. In the world of medicine, people need to be given equal access to care regardless of their determinants of health.

Why Do Health Disparities Matter?

Access to quality education, nutritious food, safe housing, culturally sensitive health care professionals, decent health insurance, and even something as seemingly simple as clean water and air can have an influence on health. 

Not only do health disparities affect the people with barriers to care—they also limit wider gains in quality of care for the overall population. This leads to unnecessary costs as well. A recent analysis estimated that disparities amount to about $93 billion in excess health care costs and $42 billion in lost productivity each year (not to mention economic losses due to premature deaths). 

The U.S. health care system is serving increasingly diverse populations, making it crucial that these health disparities are addressed appropriately. 

Where Do Health Disparities Stand Today?

Communities and groups across the country are already working on this issue—but it can always be better. Significant progress has been made so far in shrinking the gap in health outcomes. However, countless findings have shown that various populations are still disproportionately impacted by inequity. 

Social determinants of health and health disparities are industry buzzwords, but the fact remains that certain groups are statistically more prone to specific diseases. This seems to be a major reason behind health disparities still. For example, the LGBTQ community is disproportionately affected by AIDS and the African American community is disproportionately affected by heart disease

However, compared to research being done for other segments in health care, health inequities need more research. Partnerships need to be developed as organizations work together to solve these segmented problems.

What Can Health Plans Do to Help Solve Health Disparities?

In this digital age, 96 percent of Americans own cell phones, regardless of ethnicity, age, location, or socioeconomic status. Many own mobile devices beyond that, such as tablets. These mobile tools should be used to provide better access to health care to individuals seeking better care.

Engagement apps developed with accessibility in mind can help activate members in their health by giving them control over their care. They can feel connected and empowered to keep track of the things that will impact their own daily lives regardless of their specific condition, background, or treatment strategies set up by doctors. 

Applications like these can lead to self-awareness and behavior changes because they offer peer support, health coaching, and health tracking. They also provide helpful resources, learning modules, and human connection and support to help people know they are not alone. This technology aims to keep members healthy by influencing them outside the clinical setting and enables them to self-manage. This is especially beneficial for members with chronic conditions.

Self-management is important in patient care, and now it’s made more practical by technology that enables quick, effortless, and accurate insights.

Effectively recruiting and keeping patients can also be done through the right tool. With Melon Health, for instance, health plans can build member loyalty and retention by providing better access to care.

What’s at Stake if We Don’t Work Together to Solve Health Disparities?

Health disparities lead to people falling through the cracks and in need of further costly medical interventions. This results in reduced ROI and a lower bottom line for health plans as they spend more money on more complex conditions. 

Ready to improve member engagement regardless of health disparities? Download our ebook on how to create the right member engagement mobile solution to improve member retention.

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Topics: healthcare,, whole person care, value based care

How Supported Self-Management Reduces The Cost Of Chronic Disease

Posted by Siobhan Bulfin on Dec 5, 2019 11:02:47 AM

According to the CDC

-  6-in-10 adults in the U.S. have a chronic disease. 

-  4-in-10 adults have two or more.

-  90% of the nation’s $3.3 trillion in annual health care expenditures are for people with chronic physical and mental health conditions. 

Annual spending on health care in the United States has crossed the $10,000 per person threshold, according to the CHCF Almanac. This is more than twice that of nearly every other developed country, including Canada and the United Kingdom.

A Closer Look at the Costs of Chronic Disease

Obesity: Affecting almost 1-in-5 children and 1-in-3 adults, obesity increases a person’s risk of developing chronic diseases including diabetes, heart disease, stroke and certain cancers. Obesity costs the U.S. health care system $147 billion a year.

Diabetes: More than 30 million Americans have diabetes but 1-in-4 don’t know they have it. Diabetes can cause heart disease, stroke, kidney failure and blindness. Diabetes costs the U.S. health care system $237 billion a year.  

Cardiovascular Disease: Heart disease, stroke and other cardiovascular diseases kill more than 859,000 Americans each year. That’s 1-in-3 deaths. Cardiovascular disease costs the U.S. health care system $213.8 billion a year. 

Chronic Pain Management: In 2016, an estimated 20.4% of U.S. adults had chronic pain. Health economists estimate the cost of chronic pain in the U.S. is as high as $635 billion a year. This is more than the combined yearly costs of cancer, heart disease and diabetes.

Osteoarthritis (OA): OA, the most common type of arthritis, affects more than 30 million adults in the U.S. It is one of the most expensive conditions when joint replacement surgery is required. In 2013, OA cost the U.S. health care system $140 billion.

Congestive Heart Failure (CHF): About 5.7 million adults in the U.S. have heart failure and approximately half of people who develop heart failure die within 5 years of diagnosis. Heart failure costs the U.S health care system an estimated $30.7 billion each year.

COPD: Almost 15.7 million Americans (6.4%) have been diagnosed with COPD. In 2014, COPD was the third leading cause of death in the U.S. In 2010, health care costs were $32.1 billion and are projected increase to $49.0 billion by 2020.

Mental Health Disorders:19.1% of U.S. adults (47.6 million) experienced mental illness in 2018. This represents 1-in-5 adults.People with depression have a 40% higher risk of developing cardiovascular and metabolic diseases. In 2013, health care for anxiety and depression cost the U.S. $201 billion.

Schizophrenia: 1.1% of U.S. adults were diagnosed with schizophrenia (3.5 million) in the U.S. in 2013. This cost the U.S. health care system $155.7 billion with an average of $44,773 per person.

 Cancer Survivorship:

According to the CDC, the number of people with a history of cancer in the U.S. increased from 3 million in 1971 to approximately 13.4 million in 2012, representing 4.6% of the population. Given the advances in early detection and treatment, the number of cancer survivors is projected to increase by 30% during the next decade, to approximately 18 million. 

Cancer survivors face many challenges including medical care follow-up, managing the long-term and late effects of treatments, monitoring for recurrence, and an increased risk for additional cancers.

From 2008 to 2010, the additional cost of a recently diagnosed cancer survivor was $16,213 (age 18 to 64 years) and $16,441 (age 65 years and older). 

Among previously diagnosed cancer survivors, the additional cost was $4,427 per survivor (age 18 to 64 years) and $4,519 (age 65 years and older).

Managing these conditions, through patient self engagement, can reduce the cost of health care.  

Let’s Take Prediabetes as an Example 

 Prediabetes is a risk factor for type 2 diabetes. 

-  More than 84 million adults in the U.S. (that’s 1-in-3) have prediabetes

-  90% don’t know they are prediabetic

Costs:

Diagnosed diabetes (all ages), undiagnosed diabetes, gestational diabetes, and pre-diabetes (adults) exceeded $322 billion in 2012 with $244 billion in medical costs and $78 billion in reduced productivity. 

Combined, this amounted to an economic burden exceeding $1,000 for each American in 2012. This national estimate is 48% higher than the $218 billion estimate for 2007. The burden per case averaged $10,970 for diagnosed diabetes, $5,800 for gestational diabetes, $4,030 for undiagnosed diabetes, and $510 for pre-diabetes.

More than 84 million adults in the U.S. (that’s 1 in 3) have pre-diabetes. 90% don’t know they are prediabetic.

Out of those 84 million patients with prediabetes, a self-management platform can help the majority of them take an active role in their own health, lowering the cost of their chronic condition.

Here’s the Story of One Person with Prediabetes

 Brian checked all the at-risk boxes. He was overweight, had just turned 52-years-old and despite being a runner for most of his life, his work and family obligations filled his days and nights. He hadn’t gone for a run in years. 

When Brian was told he was prediabetic, he knew he needed to change his lifestyle—fast. 

His doctor, in addition to talking with Brian about his diagnosis, asked him if he’d like to work with one of the practice’s health coaches. Because the program was online, Brian would be able to login and reach out for support when he needed it, and when it was convenient for him.

Brian immediately engaged with his online community. He chatted with people who, like him, were working to get their conditions under control. He turned to his online community when he needed answers and when he felt defeated. He even became a source of support for the new members who joined the group.

After a few short months, Brian’s motivation to self manage his prediabetes was yielding results. He was more mindful of his diet, started walking and felt better—and in more control of his health—than he had in years.


And even though it’s expected that Brian will reverse his diagnosis, he has made changes that will last a lifetime.


This will help him prevent the onset of a more serious chronic condition.

It will also prevent him from adding to the cost of the U.S. health care system.

Brian’s story is not unique. A self-management platform like Melon can work for your patients,

too. When we work with a health system’s patients or health plan’s members we drive better patient outcomes. For instance, in our work with patients with prediabetes, 78% are no longer pre-diabetic.

Ready to incorporate self-management into your health care organization? Talk with an expert today.

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Topics: healthcare,, whole person care, value based care

Why Disease-Specific Management Programs Are Costly

Posted by Siobhan Bulfin on Oct 30, 2019 3:39:11 PM

Healthy lifestyles among Americans are the exception, not the norm. 

According to a recent Mayo Clinic study, less than 3 percent of Americans adhere to the four criteria for healthy living:

  1. Avoiding smoking 
  2. Eating a healthy, nutritional diet 
  3. Exercising regularly on a weekly basis
  4. Managing Body Mass Index (BMI)
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Topics: healthcare,, digital health, value based care

Why Health Plans Wear The Cost of Chronic Disease (And How to Fix It)

Posted by Siobhan Bulfin on Oct 23, 2019 4:21:19 PM

Chronic diseases place a financial strain on patients and health systems. When combined with emotional and physical difficulties, high costs can make it even more difficult to manage these conditions.

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Topics: healthcare,, scaleable healthcare, digital health, value based care

Digital Health Is Consolidating. What Does That mean?

Posted by Siobhan Bulfin on Oct 17, 2019 6:49:14 PM

In the wake of ACA reforms and HITECH incentives, digital health innovations have rapidly expanded. These innovations are much-needed in order for health systems to keep pace with value-based measurements and EHR requirements. 

However, many healthcare organizations have implemented disparate IT solutions, leading to unintended fragmentation and frustration for clinicians. This often results in providers spending more time ironing out details with vendors and less time with actual patients.

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Topics: healthcare,, scaleable healthcare, digital health, value based care

This Is A Busy Digital Health M&A Market. Why?

Posted by Siobhan Bulfin on Oct 9, 2019 4:22:16 PM

The enactment of the Affordable Care Act in 2010 has turned health care on its head. Even though the ACA didn’t cause immediate consolidation of hospital systems, over the last five years the legislation has expedited integration within health care. 

In fact, around 71 percent of health care leaders indicate that in the next three years they expect to experience some form of M&A in their organization. And while much debate circulates around the cost benefit of consolidation for patients, in most cases these health care mergers lower expenses within both of the organizations involved.

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Topics: healthcare,, scaleable healthcare, digital health, value based care

How to Recruit and Retain Patients

Posted by Siobhan Bulfin on Oct 3, 2019 4:17:31 PM

Never before in the history of U.S. health care has there been so much competition for market share. In the past, traditional delivery was widely focused on particular geographic areas. This limited patient’s options to the providers nearest to them.

Now, however, patients have access to online telehealth and other wellness resources. Online retailers, who are new to the health care industry, are capitalizing on this consumer trend. We’re all aware that disruption and innovation has the potential to improve service delivery and patient care. However, the reality is that these new kids on the block are threatening the market share of established health systems.

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Topics: healthcare,, scaleable healthcare, patient community, digital health, value based care

4 Steps To Discover Hidden Health Solutions

Posted by Sam Rodney-Hudson on Sep 11, 2019 3:14:19 PM

How many times have you wondered what else might be affecting a person’s health? They seem to be doing all the right things but they don’t improve.

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Topics: wellness, patient engagement, healthcare,, digital health

How To Optimize Health Plans To Increase Revenue

Posted by Siobhan Bulfin on Sep 4, 2019 4:00:48 PM

It’s been nine years since the Affordable Care Act was enacted. 

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Topics: wellness, patient engagement, healthcare,, whole person care

What Holds Healthcare Back From Offering Patient Communities

Posted by Siobhan Bulfin on Mar 26, 2019 1:25:26 PM

Studies show that people living with chronic conditions benefit from human support in the form of online communities, where they can interact with peers and help each other achieve lasting change. 

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Topics: wellness, patient engagement, healthcare,, scaleable healthcare, peer support, patient community

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  • Uncover the secret to real patient engagement
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  • Enable behavior change
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