The Case for Flexible Chronic Care Management

Despite efforts to reduce their impact, chronic diseases continue to impose an immense financial burden on the U.S. health system.

According to the CDC, 86 percent of all healthcare spending in 2010 was for people with one or more chronic medical conditions, with diabetes alone generating $176 billion in direct medical costs and $69 billion in decreased productivity.

For more than 15 years, healthcare stakeholders have responded by creating programs designed to cut these costs.

These have included 10,000-foot-level population health management efforts driven by providers, employer wellness programs emphasizing behavior change and disease-specific outreach efforts sponsored by health plans. Unfortunately, many such programs have not been particularly successful at reducing healthcare costs or improving outcomes, leading payers, providers and employers to question whether their investments were wasted.

However, I would argue that the fault is in how chronic care management programs are structured and how they work with patients, not in the concept itself. Historically, chronic care programs have taken a “one size fits all” approach to patient management, relying on older, more-expensive technologies and outdated models which don’t scale. But there’s no reason to cling to the past.

With access to communications technologies getting cheaper by the day, it’s now possible to personalize chronic care management programs effectively, and it’s high time we do so. By rolling out a more flexible approach to managing chronic illnesses, we can improve care, cut down on excess hospitalizations and save money without over-investing.

Patient management options growing

Over the past decade, a wide range of technologies have emerged which can help providers manage chronically ill patients, including smart phones and tablets, telemedicine and interactive voice response. By adding these newer, more cost-effective solutions into the mix, patient management costs may drop from $500/month to $30/month, without lowering the impact on patient health or program adherence.

There’s a huge range of tools now available to leverage for chronic care management programs, including the following:

  1. Bring Your Own Device technologies allowing patients to use their own platform, saving on hardware and connectivity costs.

  2. Low-cost connected hubs that seamlessly collect data and route it through the cloud and to the provider’s backend system.

  3. Analytics which not only find problems in a population, but also develop strategies for specific groups of patients and identify low-cost solutions.

  4. Use of Personal Emergency Response Systems not only as a concierge gateway, but also as a means of transitioning the cost of care to the patient (or their family caregiver).

  5. Lite medication adherence solutions such as smartphone apps.

  6. Integrated behavioral health applications and monitoring.

  7. Use of gamification and integration of chronic care management into consumer home entertainment products.

  8. Integrated 2-way video and voice on BYOD devices.

  9. Alignment with mHealth/telehealth vendors to provide add-on solutions like ECG patches, fetal monitors and dialysis integration, allowing customer to pick and choose solutions “cafeteria style.”

By targeting patients with the type of intervention that works best for their illness, age, gender and culture, providers can create significant results without breaking their budgets.

More cost-cutting options

While flexible technology deployment can cut the cost of chronic care management, it works best when combined with creative use of other cost-reduction strategies, particularly efforts to target patients with the most-affordable options that serve the purpose.

For example, whenever possible, such programs can leverage an affordable care coordinator rather than an expensive skilled nurse. After all, if patients are just out of diabetic test strips, need technology troubleshooting or are looking for a ride to the doctor, the coordinator can probably do the job.

Also, it’s important to consider the cost of the technologies you use. For example, it probably doesn’t make sense to roll out a high-cost hardware solution for patient monitoring if a patient responds well to an IVR call. And even an IVR system may be more costly than communicating via text reminders to nudge patients into program adherence.

The key here is to tailor the chronic care management intervention to the patient, using the right technology at the right time. Like every other care delivery effort, delivering just the right level of attention can accomplish more than throwing everything you’ve got at the patient. If we deploy flexible, cost-effective chronic care management, we will finally be in a position to reduce the human and financial costs of chronic disease.

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