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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)


While health professionals encourage behavior changes, many medical systems still focus on disease management rather than on prevention. With aging populations and rising chronic illnesses, providers will be unable to keep up with mounting health demands and treatments.

Why disease management has taken center stage

When looking at patient outcomes, it initially seems like the strongest ROI is gained through disease management programs. However, this is only part of the picture. 

Disease management doesn’t actually help people address the many lifestyle factors that often contribute to chronic illness. As a result, patients need more interventions, ED admissions, treatments and prescriptions.

Upfront cost savings from disease management are only a short-term fix. As Baby Boomers pass retirement age and Americans continue to make unhealthy choices, disease management will no longer be cost-effective. 

Health care systems need to widen their ROI horizon and look beyond the short term metrics.

Disease management programs and rising expenses

The root problem of chronic disease is often tied to unhealthy lifestyles. Treatment of ongoing illnesses, without prioritizing self-management and lifestyle changes, will not fix the underlying issue. Instead, patients with non-complex chronic diseases will need more costly medical interventions and treatments to help manage their illness. 

For instance, patients with poor diets who are overweight may need prescriptions to regulate blood pressure and other heart related diseases. These medicines will moderate existing problems. However, if patients don’t make lifestyle changes, their symptoms may progress and their conditions worsen.

As conditions progress from non-complex to high-risk, patients will need more specialized interventions. These can include the management of infections or dialysis to regulate waste build up. And while disease management will initially lower these patients’ costs to providers, in the end medical organizations’ expenses will increase exorbitantly. 

Improving quality of life while reducing long term expenses

No one in health care recommends avoiding lifestyle changes. The reality is that many clinicians don’t have a scalable way to support patients as they self-manage chronic illnesses.

Nearly 70 percent of chronic illnesses in the United States are non-complex. This means the majority of patients can treat and prevent worsening symptoms with self-management, and it also means that hospitals and IDNs can proactively address the chronic disease crisis—before patient populations exceed what providers can handle and afford.

Needless to say, now is the time to make the switch from disease-specific management to whole-person care.

Steps to move from disease management to whole-person care

Making this paradigm shift won’t happen overnight. But here are the most important aspects to emphasize as health organizations move from disease management to self-managed prevention:

1. Self-management and activation

For starters, clinicians need a way to engage patients in self-management. 

With digital health platforms like Melon, providers can ‘prescribe’ a digital health program specific to the patient’s needs and extending support beyond the clinic.

2. Coordination with primary care

This points back to patients’ connection with primary care physicians. When clinicians connect wellness goals with digital tools, patients have the support and information they need to make behavior changes. In addition, by tying patients more closely to primary care providers, IDNs can preserve their referral streams and boost patient retention.

3. Empowered patients

There are two important facets when it comes to empowering patients—connection and education. A platform like Melon augments in-person programs so patients can stay connected to their peers. Patients can submit progress reports via this platform. They can also receive useful advice and ongoing motivation from both peers and health coaches.

Melon also acts as a stand-alone tool for providers who need a way to engage patients and monitor their conditions. By partnering with online health coaches, providers can give patients access to self-management programs without having to create one themselves.

These points of connection end up fuelling patient education as well. Oftentimes, peers have gained a wealth of experience by managing similar conditions. Because of this, online communities act as a volunteer workforce that offers other patients useful advice based on personal growth. 

Health coaches also provide education by monitoring patients’ progress and symptoms. For instance, when patients hit a wall with weight loss goals, health coaches can help patients problem-solve. As a result, patients learn more about long-term lifestyle changes and self-management.

4. Address the elements that contribute to comorbidities

Chronic illnesses often give rise to other ongoing conditions. Clinicians need a way to simultaneously treat all aspects of a person’s wellness. 

From depression and anxiety to heart disease and diabetes, these difficulties affect long-term outcomes for patients with chronic illness. If depression, for instance, isn’t treated alongside diabetes, patients may find it difficult to eat better or exercise. 

Melon’s digital health tools emphasize whole-person care so that clinicians can treat multiple conditions at one time. When health coaches conduct motivational interviewing, patients can address mental and emotional barriers that prevent them from self-managing their illness. 

As a result, these patients are prepared to make changes that last for the foreseeable future. This allows primary care practices, hospitals and IDNs to conserve revenue and improve patient outcomes at the same time.

What are some other ways providers can help reduce costs associated with chronic disease? 

Topics: healthcare,, digital health, value based care

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