Disease Management is an enormous task for payers and providers. To defeat the challenges faced by society in managing patient illness, many different types of technology and personnel are needed to make a measurable difference. Healthcare thought leaders have defined a term that helps break down a strategy to conquer these challenges. This term is often referred to as “Triple Aim”. According to the Institute for Healthcare Improvement (IHI), the Triple Aim is comprised of three specific goals meant to enhance care at every level. The IHI states that those three goals are:
- Improving the patient experience of care
- Improving the health of populations
- Reducing the per capita cost of healthcare
With an aggressive disease management strategy, each one is attainable. The CDC states that chronic diseases account for 7 out of 10 deaths every year. Treatment of patients with chronic diseases account for about 86% of America’s healthcare costs. Due to the consistent rise of healthcare costs, patient count, and chronic disease diagnoses, we must face these issues head on with all three goals in mind. From provider to insurer, disease management technique matters.
Thanks to the Healthcare Readmissions Reduction Program (HRRP), hospitals are now seeing reduced payments for an excessive rate of readmissions. This puts more pressure on providers to manage illnesses and chronic diseases more effectively. Effective and measurable disease management is an integral component of the care coordination toolbox and has quickly gained merit for its capabilities.
Let’s discuss a specific patient named Sally. She is a smoker who was diagnosed with diabetes a few years ago. Her smoking habit and poor diet causes her blood sugar to skyrocket. Her medical chart suggests she has been admitted to the hospital multiple times over the span of a few years due to diabetic complications. With a disease management program powered by an actionable care management software solution, she is flagged as someone who can benefit from some additional care management. Sally is then assigned to a case manager who contacts Sally to learn more about her lifestyle habits.
A personalized care plan is then developed based upon what the case manager uncovers during her interaction with Sally, enabling the case manager to create a custom treatment plan based on Sally’s history, assessments and medications. Alerts are then tailored to Sally, with real-time notifications of changes to her critical values.
Sally is given nutrition plans that she incorporates into her daily life and attends smoking cessation classes. Her risk factors for diabetes complications decrease significantly, as do her chances of readmissions, continued unplanned testing, and increased trips to the doctor. Now, not only is Sally healthier, but she has received higher quality, more comprehensive care, while her healthcare costs have decreased.
Similar issues are faced by insurers, with slightly different goals in mind. When a patient continues to be readmitted for the same issues, especially when those issues stem from a manageable illness or disease, insurers look for new and innovative ways to lower patient costs and improve health. By utilizing enhanced care team models within the payer environment, and coupling these models with care management software, patient lives improve and costs are reduced. Healthcare costs can be used towards Sally in the event of an emergency, necessary testing and regular provider appointments instead of Sally’s frequent readmissions.
The CDC released how much chronic diseases cost and the numbers are astonishing. Healthcare costs that could be linked to obesity reached $147 billion in 2008. In 2012, diabetes diagnoses costs reached $245 billion. Because healthcare costs are always on the rise, these numbers are much higher today in 2017.
Because the cost of healthcare is skyrocketing, disease management is more important than ever. In addition, healthcare technology is the bridge to lower cost, better care, and enhanced patient satisfaction. As healthcare costs continue to rise, it is vital to discuss cost reducing mechanisms that also increase patient satisfaction and overall population health. The Triple Aim was born out of necessity, but now all parties involved see that it not only consists of attainable goals, but that is it highly effective and offers many benefits. Providers and insurers alike strive to meet the ultimate goals of the Triple Aim, not only because they feel it fiscally necessary, but also because they have seen that it truly works.