ith wide acceptance of a link between lifestyle and the onset of chronic illness,
disease management firms are incorporating wellness and health promotion into their
traditional service model.
Unlike a more fragmented approach in which wellness and disease
management services are provided by separate companies, usually to different groups
of plan members, an integrated approach puts all plan members together so they can
access both services regardless of health status.
The objective is to keep healthy people healthy, reduce the
risk factors among at-risk members and improve the health of those who already have
chronic conditions by encouraging them to make lifestyle changes that wellness programs
promote.
Some experts also say bundling wellness and disease management
programs will save employers money, both through lower administrative costs and
lower health care costs made possible by improvements in employee health status.
"I think that wellness is being focused almost exclusively
on the well. People are missing the fact that for somebody who’s already manifestly
ill with a chronic disease, there’s insufficient emphasis" on wellness, says Dr.
Lonny Reisman, CEO of New York-based ActiveHealth Management Inc. "For example,
a diabetic may not be learning about diet and exercise" in a traditional disease
management program.
By managing patients holistically, rather than treating each
disease separately, it may be possible to improve their health, he says.
"The wellness notion needs to extend from cradle to grave,
helping you to get as well as you can possibly be given your underlying physiology
and pathology," Reisman says. "You may not be able to cure your diabetes, but how
can you become as well as you can, given your limitations?"
This evolution toward an integrated approach is blurring the
lines that once separated wellness from disease management providers. The Disease
Management Association of America, saying it was reflecting that market direction,
changed its name last fall to DMAA: The Care Continuum Alliance.
"We’ve gone from the siloed approach to the multi-disease
approach to expansion into the wellness area with the recognition that people don’t
just suddenly one day get diagnosed with diabetes," says Tracey Moorhead, president
and CEO of the Washington-based DMAA. "There are a lot of things that happen in
their lives that lead up to a diagnosis of diabetes or another chronic condition."
"We changed the name of the organization to better represent
this full set of services ranging from wellness and prevention all the way through
to chronic disease management to palliative end-of-life care and complex case management,
which is at the other end of the spectrum," Moorhead says.
To provide integrated wellness and disease management services,
disease management providers have either built their own integrated platforms, acquired
them or partnered with wellness providers, says Patricia Curran, director of national
health management at Buck Consultants in Washington.
Major insurers, such as Aetna, have been working internally
on integration.
"When we developed the disease management program, it was
developed so that it could be integrated," says Sherry Brodeur, who is the McLean,
Virginia-based head of program design and sales support for medical operations for
Aetna. "We also launched a new wellness program on April 1 that is also focused
on integration."
Disease management provider SHPS recently unveiled a "person-centric"
delivery model dubbed Carewise that assesses the health status of an entire employee
population through health risk assessments and biometric screenings and then works
to mitigate the risk factors that it identifies in each individual on a one-on-one
basis.
"If you are trying to engage a member who has a clinical condition,
smokes and is overweight, you can’t be asking the person to participate in three
separate programs. You’re going to overwhelm the member," says Krishnan Sastry,
executive vice president of strategic product development at SHPS, which is based
in Louisville, Kentucky.
"SHPS starts with the member and looks at the risk holistically.
We have an ability in our platform and processes to adjust how we reach out to the
member to yield the best possible outcome," he says. This is done by "prioritizing
the risks, using a consistent method of communicating with the member and by being
able to address both clinical and lifestyle risks in a tightly co-managed process."
Bob Queyrouze, internal consultant-compensation/benefits/health
and productivity management at the Federal Reserve Bank of Dallas, likened the merging
of disease management and wellness to the evolution that has occurred in employee
assistance programs.
"They historically addressed psychological problems. But today,
EAPs have branched out into work/life," Queyrouze says. "In fact, the most used
part [of EAP services] is work/life benefits, not psych, such as elder care, day
care, tuition assistance."
"There’s a very similar evolution occurring in wellness and
disease management. They’ve combined to become a holistic program," Queyrouze says.
In fact, "our EAP is also combined with our wellness and disease management programs."
Combining disease management with wellness has a twofold benefit
for employers, says Bill Reed, president and CEO of AllOne Health Group Inc., a
disease management provider formed in 2002 to provide integrated health and information
services. The company is based in Wilkes-Barre, Pennsylvania.
Because combining the programs generally lowers administrative
fees, "the cost is more economical than the individual siloed approach," Reed says.
"But the bigger issue is the outcome impact. The integrated approach produces better
outcomes."
"One of the mistakes that have been made heretofore is focusing
on the high-cost population, ignoring the majority of the population who are either
healthy or at-risk and who will become high-cost claimants in the future," says
Dr. Robert Jacqmin, a senior clinical consultant at Hewitt Associates Inc. Jacqmin
is based in Eagle, Colorado.
However, "it’s five times more cost-effective to keep the
healthy people healthy than to just focus on managing the diseases of those who
are already sick," Jacqmin says, citing research by Dr. Dee Eddington, director
of the Health Management Research Center at the University of Michigan.
Therefore, combining wellness with disease management should
reap even greater savings for employers, Jacqmin says.
Workforce Management Online, May 2008
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