Chronic Care Management: Getting People The Care They Need

posted by AHIP

on August 15, 2018

Roughly four in five Americans will suffer from a chronic disease by 2030. And with each additional chronic condition, people face higher costs and greater difficulty in managing their health.

That’s why all health insurance providers offer disease management services for members with chronic conditions like diabetes and asthma. These programs provide patients with online resources, treatment and medication reminders, and access to 24-hour nurse hotlines. Prior research shows patients avoid unnecessary, costly hospital readmissions and have better health outcomes as a result of these health insurance provider-led initiatives.

Health insurance providers are tailoring their chronic care outreach and resources to better suit patient needs. A key element of these initiatives is embedded clinical care coordinators who help patients with chronic conditions navigate the health care system and provide counseling with behavior and lifestyle changes. Health insurance providers are in ongoing communication with patients through a wide range of channels, including mailings, phone calls, text messages, and online chat rooms, to empower and provide them with the support they need to effectively manage their chronic conditions.

Making sure doctors and nurses have the tools they need to deliver better care for patients is also critical, and health insurance providers work hand-in-hand with clinicians to improve care coordination and target at-risk patients. For example, health insurance providers regularly send providers reports identifying gaps in care, such as failure to refill prescriptions or missed appointments. Many health insurance staff members are also integrated into provider practices to provide additional support so these chronic care management programs work.

All of these efforts complement redesigned payment and delivery models that ensure patients with chronic illness get the right care and have the coverage that supports their health needs.