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Managing the High Costs of Chronic Disease

People with chronic diseases are the most frequent users of health care in the U.S. They account for 81% of hospital admissions, 91% of all prescriptions filled, and 76% of all doctor visits.

75% of all health care expenses are linked to chronic conditions. And it is estimated that employees with chronic diseases cost employers $153 billion in lost productivity.

The costs of chronic conditions are high. But your health insurer may offer strategies to help reduce these costs for you and your employees.

The strategies usually fall under three categories: plan design, condition support, and prevention. Find out if you’re taking full advantage of them.

Consider your plan design

Many insurers offer enhanced benefits for chronic conditions featuring lower out-of-pocket costs for the routine treatment of diseases like diabetes or heart disease.

These plan designs use financial incentives, such as reduced cost sharing (discounts that lower the amount your employees have to pay for copays, deductibles, or coinsurance), to encourage your employees to seek the medical care they need.

In many cases, these benefit plans cover preventive care, wellness visits, and treatments or medications to control blood pressure or diabetes at low to no out-of-pocket cost for members. And this can help avoid future expenses such as ER visits and hospital admissions that are the results of not managing these conditions.

These avoided costs can be significant—the average ER visit costs more than $2,000 and the average hospital stay is about $10,000.

When considering whether these enhanced benefits might be right for your business, determine:

  • Which chronic conditions are prevalent among your workers
  • Which services and incentives would help your employees most
  • How you’ll evaluate the plan’s effectiveness


Provide Support

Your employees will need information and support to improve their health awareness, adopt healthier lifestyles, and make better care decisions.

For example, your health plan may offer care management programs. These programs are designed to improve chronic and complex condition management and control medical costs. Thus, you may want to consider incentivizing participation in care management programs in your plan design. Benefits often feature:

  • 24/7 access to nurses and other clinical care resources
  • Dedicated, multi-disciplinary care teams
  • Comprehensive treatment planning
  • Home- and community-based care coordination
  • Systematic follow-up to ensure patients achieve established health and wellness goals
  • Telephone support

Other services from your insurer may include health awareness materials. These materials can go directly to your employees or be distributed by you. Many insurers provide:

  • Fact sheets about common chronic conditions
  • Health and wellness articles
  • Tips on how to most effectively use benefits

The more you can connect your insurance provider with your employees, the better they can work to coordinate your employees’ health care needs.


Focus on Prevention

Preventing disease is critical to managing health care costs. Many chronic diseases are linked to lifestyle choices, making them preventable.

Eating nutritious foods, becoming more physically active, and avoiding tobacco can help ward off many chronic diseases. If a person already has a chronic disease, these same preventive measures can help better manage the condition and keep it from getting worse.

Ask your insurer about its preventive care services. Your insurer may also offer onsite health screenings, wellness rewards programs, lifestyle challenges/campaigns, and wellness coaching.


What is a chronic disease?

While criteria vary among professionals, if a disease lasts 3 months or longer, it’s considered chronic. Chronic diseases generally cannot be prevented by vaccines or cured by medication. Nor do they just disappear.

Some common examples include arthritis, certain cancers, chronic obstructive pulmonary disease (COPD), depression, diabetes, epilepsy and seizures, heart disease, high cholesterol, mental illness, and hypertension.
Partner with your health plan and take advantage of the strategies to manage chronic conditions that work best for your business. It may take time to see measurable results. But you’ll be well on your way to healthier employees. And a healthier bottom line.