Improving Life With Ongoing Conditions Through Consumer-Centered Care

According to the Centers for Disease Control and Prevention (CDC), 6 out of 10 adults are living with a chronic disease. In addition to being the nation's leading causes of death and disability, the same source found that ongoing conditions are the driving force behind $4.1 trillion in annual healthcare costs.

Traditional Models Can Be Costly

People living with certain ongoing conditions often require complex and expensive tests, medications, medical devices, and surgical procedures. Using the traditional healthcare “fee-for-service” model, costs can add up quickly. Today’s healthcare delivery model is increasingly shifting to proactively center around the consumer. Better known as value-based care, this change rewards doctors and other care providers for collaborative, personalized care that drives better outcomes and higher value.

Shifting From Volume- To Value-Based Chronic Condition Care

Value-based programs are rapidly being considered by employers for their employee benefits mix. Putting your employee at the center of a doctor’s focus means improved doctor-patient collaboration and more appropriate tests, medications, and medical procedures. Employees with chronic conditions will likely pay lower care costs, experience better health outcomes, and have a simpler, more effective care experience. 

Let’s look at how this value-based model could work with two common chronic conditions:

Diabetes: A study concluded that the average annual healthcare costs for a person living with diabetes in the U.S. is around $19,736, with about $12,022 going directly to diabetic-related costs. Results from the same study showed people living with diabetes have 2.6 times higher medical expenses than those without diabetes.

Value-based care incentivizes doctors to take a comprehensive look at an employee’s overall diabetes management, preventing costly complications and simplifying the care experience. Through this holistic lens, care providers may see the need to:

• Refer the employee to a dietitian.
• Suggest sessions with a fitness professional.
• Ensure the employee is up-to-date on eye exams.
• Connect an employee to a diabetes educator.

Heart disease:  Heart disease has a national economic toll amounting to $239.9 billion each year. A value-based care approach seeks to improve outcomes and reduce these costs. Consumer-centered care doctors want to prevent health problems before they occur, so they may prioritize heart health for high-risk patients or those with a family history of heart disease.

This could include conversations about dietary and lifestyle modifications or how to recognize warning signs and symptoms. They may recommend using a wearable device to track heart rate irregularities, suggest one-on-one coaching from a health professional, or help patients make better-informed decisions with cost transparency about where to receive high-quality cardiac procedures.

Advancing Consumer-Centered Care While Lowering Costs

Trusted partners like Anthem are at the forefront of value-based care delivery, developing comprehensive offerings that deliver enhanced consumer-centered care for employees. Some examples include: 

• Anthem’s Well-being Coach program engages your employees with the right resources at the right time to make a healthy difference in their lives, add value, and help improve costs. 

 

• Oncology solutions offer enhanced care support through cancer care navigators. These are specially-trained health educators who help ensure employees’ care teams are in lockstep, minimizing risks and lowering costs of care.

 

• ConditionCare is designed to create healthier habits, improve nutrition and self-management, and support customized care plans for ongoing conditions like asthma, diabetes, heart disease or failure, and lung disease.

When employers, care providers, and insurers partner together to take a value-based care approach, employees living with ongoing conditions can expect more comprehensive condition management and a better care experience. Focusing on whole-person health not only supports employee’s specific health needs, but also provides improved outcomes and lowers costs for all.