Corporate Disease Management Programs Can Impact Claim Costs

A well managed Disease Management Program helps to reduce costs for the employer, because they eliminate unnecessary emergency room visits and reduce hospital admissions for these patients. Large claims are potentially avoided through proactive interventions. Some of the most common conditions that are managed within a Disease Management Program are: diabetes, high cholesterol, congestive heart failure, hypertension, asthma, depression and maternity.

Disease Management Programs are programs implemented by employers to improve the quality of health of their employees. Components of the program include: identification of employees with chronic diseases, direction to appropriate medical resources, maintenance of scheduled treatment, education with respect to the disease process and coordination with the patient’s physician.
Registered Nurse Disease Management Specialists are the individuals that interact with the patients. They do an initial motivational interview and attempt to gain the trust and establish a relationship with the patient. Then, together, they set realistic behavior changing goals. Patient education is the key component of the program. The ultimate goal is to empower patients to appropriately self manage their disease and comply with their treatment plan.
 

Disease Management Impact Story:
A 23 year old male asthmatic factory worker consulted with his Registered Nurse Disease Management Specialist. The young man works making concrete forms for bridges and overpasses in an environment where he is constantly exposed to particles of concrete dust. In conversation with the Registered Nurse, it was discovered that he wasn’t taking any medication nor carrying an inhaler, due to the fact that he had no health insurance with his previous employer.
Through proactive intervention by the Registered Nurse, the man was instructed to always wear a mask on the job (which is provided at no charge by the employer). He was also instructed to immediately make an appointment with a physician to get a prescription for the necessary asthma medications and inhaler-which should be mandatory for him to carry in his pocket in case of an asthma attack.
In this case, the intervention has prevented a minimum of an emergency room visit for exacerbation of asthma and a possible inpatient admission due to concrete particles in the lungs, which could lead to pneumonia or severe bronchitis.
Employers owe it to themselves to implement a well managed disease management program as an initiative to further reduce claim costs and possibly prevent high dollar claims.