Case Study: Disease Management is Outsourced from the Medical Carrier
A healthcare community provider wished to improve employees' management of asthma, chronic obstructive pulmonary disease (COPD) and depression. The organization also hoped to increase utilization of its facilities and encourage higher generic drug utilization.
Starting last summer, Cammack LaRhette Consulting loaded the client's historical employee medical data into a data warehouse. Through the data warehouse employees were identified:
- Who had one or more chronic diseases or conditions known to have a potentially debilitating impact
- Who had been newly diagnosed with one or more diseases or conditions that would likely have a debilitating impact
- Who demonstrated a capacity to self-manage their condition with the identified co-morbidities
Our proprietary risk stratification tool analyzed the client's data elements to define and measure health risks among individuals and populations. The tool applies logic to identify high risk members who would benefit from the disease management (DM) program, and is able to measure the changes in participant and population risk over time.
Once high risk members were identified, Cammack LaRhette implemented an integrated communication program to target three specific populations.
1. High risk members - this population was encouraged to participate in the client's disease management (DM) program. Communications channels included companywide communications, such as onsite/hospital newsletters, email blasts and open enrollment material.
2. DM nurses - this population was connected to coordinators of the programs/services offered by the hospital (i.e., social work, occupational health, fitness center, bariatric and diabetic programs). The nurses familiarized themselves with the services offered. At the same time, having been introduced to the program, the coordinators started referring members, which, in turn, increased domestic utilization. DM nurses also attended office manager meetings at the hospital in order to raise visibility and increase use of the DM program.
3. Client’s physicians - this population became aware of the available resources through the program communications.
The DM and communications program that we implemented for the client has generated an ROI of 1.6 over the past year.
The program has also helped us to identify other potential opportunities to improve members' health and decrease medical expenses. These areas include outpatient care in lieu of inpatient care; self care in lieu of the previous utilization pattern; alternative funding for pharmaceuticals; reduced levels of service; and improved health behaviors. We continue to partner with our client to implement programs to achieve these goals.
