HealthScreen Disease Management. LLC
HealthScreen Disease Management seeks to provide health plan sponsors with a proven method of identifying and managing healthcare costs and to provide plan enrollees with proven disease management protocols to manage their disease states.
Situation
Health plans are traditionally reactive in nature. No one disputes the existence of the chronically ill populations, but health plans have historically ignored these individuals until an event occurs such as a heart attack, emergency room visit, etc. At that point, the components of the health plan “scrambles” to try and contain the cost. This is a significant contributing factor in the escalation of health care costs.
Solution
The focus of this example is to demonstrate the impact an employer can have by proactively identifying the population at risk with a chronic disease such as diabetes, hypertension, hyperlipidemia, asthma, digestive (GERD), or co-morbidity and, through financial incentives, successfully manage this population. The end result is that financial incentives increase participation, can be used to enforce compliance to protocols, and result in a reduction of claims trends as well the development of a positive return on investment for the employer.
Most disease management programs do not provide incentives for enrollment and fewer utilize incentives to enforce compliance to protocols. In order for a disease management program to be successful, there must be a formal enrollment process and there must be a behavioral change. At HealthScreen, we have found that by waiving the co-pay by therapeutic class for medications encourages enrollment and allows for the enforcement of compliance.
The involvement of case management nurses is also critical. A disadvantage with the utilization of call centers is that the patient rarely ever speaks to the same case manager and the case manager may be from a completely different part of the country. HealthScreen’s case managers are individually assigned to each patient and are local or regional. This allows for the development of relationships between the case manager and the patient as well as an understanding of local customs, foods, etc.
Better Health & Lower Costs
The impact of this program has been real and justified with clinical and financial results. In the initial 25 months of the combined programs, there were1,525 eligible individuals of which 476 (31.2%) were enrolled for diabetes, hypertension, high cholesterol, asthma, digestive (GERD), and co-morbidity. Four years into the program, there are 959 individuals eligible with the current enrolled population at 438 (45.7%).
The aggregate return on investment for the programs in the first 25 months was 222 percent. The aggregate return on investment for the programs at the end of 48 months was 227 percent with documented net savings over the time period of $1,140,954.
