Webinar Recap: What is a Chronic Condition Management Program?

By Todd Peterson - AVP, Health & Wellness Services September 06th, 2023

Did you know that 90% of total healthcare spend in the United States is driven by people with one or more of five chronic and mental health conditions? With that in mind, we invited Gabe Castaneda from Omada Health, a virtual-first chronic care provider, to join our monthly Health Risk Webinar Series to discuss how employers can implement programs to control the cost of chronic conditions over time while bettering the lives of their employees.

Continue reading for a recap of Castaneda’s presentation.

Consider the Statistics

According to Castaneda, the top five most expensive chronic conditions are:

  • Musculoskeletal (MSK)
  • Diabetes
  • Behavioral Health
  • Pre-diabetes
  • Hypertension

It’s important to note that one-third of Americans have three or more of the chronic conditions listed above. According to Castaneda, these individuals make up a disproportionate share of healthcare costs.

Consider these additional statistics from Omada:

  • 68% of adults with diabetes also have hypertension.
  • 58% of people with diabetes also suffer from an MSK condition.
  • 47% of Omada members with chronic conditions also have behavioral health concerns.

With the percentage of chronic condition cases continuing to rise, it’s important for employers to understand why costs are rising and how to control them through modern solutions.  

Why are Chronic Condition Costs Continuing to Rise?

According to Castenada, individuals with chronic conditions often receive unnecessary or ineffective treatment, driving up the overall cost of care.  

During his presentation, Castenada gives specific examples of unneeded treatment using the MSK care path. For instance, Omada’s data shows that 29% of MRIs related to lumbar spine injuries are unneeded, as clinical guidelines suggest acute back pain should be treated with conservative care, such as physical therapy, instead of an MRI within the first six weeks. Another example included MSK patients being sent to costly specialty physicians who end up recommending ineffective and expensive surgery.

Data from Omada Health shows that unnecessary care, such as the examples cited above, can increase healthcare costs by over $2,000 per patient.

Another reason for rising costs lies in the virtual care value gap. Many employers who partner with chronic condition management companies are led to believe they will be met with best-in-class, streamlined solutions. Instead, they often receive disjointed member experiences, missed or ignored comorbidities, impersonal AI coaching, unsustained health improvements, and lack of PCP alignment.

Potential Solutions

Curbing the cost of chronic conditions comes down to aligning care providers with treatment best practices while providing employees with tools to prevent, control, or better their conditions. To do this, many companies turn to a chronic condition management partner.

According to Castenada, there are several traits employers should look for when searching for an effective chronic condition management partner.

  • Streamlined management: It’s important to find a vendor that streamlines the entire experience for employees. Some chronic condition management companies use several different platforms and providers for each condition, making the management process overwhelming and time-consuming. When researching vendors, look for partners that allow your employees to manage their condition(s) in one place while also integrating with your company’s other healthcare cost containment vendors, such as your PBM partner.
  • Dedicated, human-led, tech-enabled care teams: Programs that rely heavily on artificial intelligence do not deliver the same results as programs that offer care from live experts. Find a program that provides your employees with a care team comprised of real people who can offer personalized plans and suggestions.
  • Best-in-class tools. What benefits does your chronic condition management partner provide your employees? It’s important to find a vendor that helps align your employees’ treatment plan(s). For example, some chronic condition management platforms allow employees to print off their recommended treatment plan and bring it to their primary care physician. This helps the employee avoid unnecessary and expensive treatment while aligning the primary care physician with the expert recommendations of the company’s chronic condition management partner.

In conclusion, Castenada asserted that the right chronic condition management partner has the potential to save employers thousands of dollars per year. If you have additional questions about chronic condition management or want to learn more about joining a Medical Stop Loss group captive, please get in touch with our team.

About the Webinar

This presentation was part of Captive Resources’ Medical Stop Loss Webinar Series — regular installments of webinars to educate medical stop loss group captive members. The thoughts and opinions expressed in these webinars are those of the presenters and do not necessarily reflect Captive Resources’ positions on any of the above topics.

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