Chronic disease is a classic example of the proverbial 80-20 rule. Only in this case, people who have one or more chronic diseases actually drive 90 percent of the nation’s health care costs. That’s according to a widely cited RAND report, Multiple Chronic Diseases in the United States.
Among the study’s more startling revelations is the estimate that 12 percent of the American population suffers from five or more chronic diseases — and this cohort is responsible for a whopping 41 percent of all health care expenditures.
Put it another way: The average patient with five or more chronic conditions spends more than $18,000 on health care expenses each year, as opposed to less than $2,000 for someone with no chronic illness, according to the RAND report.
It’s not surprising that employers are starting to look for solutions. For years, companies have promoted well-being programs with the goal of keeping their populations healthy and productive. Employers have also touted their wellness perks in recruiting.
While the matter of ROI is hotly debated — a recent UnitedHealthcare survey did find improved productivity and fewer sick days among the majority of wellness participants — these programs have nonetheless become nearly universal within large companies.
But more employers are also realizing that promoting lifestyle changes is only one part of an integrated strategy to keep workers healthier and cut health care costs. Companies are making a shift from solely focusing on well-being to looking at disease management as a way to substantially control the expense of treating chronic illness in the workplace.
In fact, a corporate well-being strategy that doesn’t include disease management may soon be seen as lacking an essential component. The new thinking is to offer both wellness and disease management.
“Since chronic disease management yields the greatest long-term reduction in employer health costs (as much as 86% in hard health care cost savings), it has to be incorporated into any effective workplace wellness program,” according to a new report by Transamerica examining how employee health affects business success.
Where employers should focus
According to the Centers for Disease Control and Prevention, one out of every two adults in America reported having at least one of six chronic illnesses — cardiovascular disease, cancer, chronic obstructive pulmonary disease (COPD), asthma, diabetes, or arthritis.
The CDC also reports that heart disease, cancer, and stroke together account for more than half of all annual deaths in the US.
Programs that are specifically tailored to attract and engage employees who are dealing with these diseases, and help them control the progression of their illnesses, would help employers realize cost savings.
It’s important to note, however, that helping employees manage chronic illnesses and their well-being shouldn’t be considered mutually exclusive goals. In fact, lifestyle changes can mitigate the risk factors for a host of chronic diseases.
According to the Transamerica study, four factors are principally responsible for the prevalence of the most common “big ticket” chronic health conditions:
- Lack of physical exercise and poor fitness
- Obesity and poor nutrition
- Drinking alcohol
- Smoking
As the report bluntly states: “Too many members of the U.S. workforce engage in too-little physical activity, consume a diet loaded with too many energy-rich (calorie-rich) foods, (are) too frequently dependent on nicotine from tobacco, endures excessive workplace stress and long hours, then too often opts for alcohol before receiving inadequate restorative sleep.”
For millions of employees, that picture of poor health sounds all too familiar. So, a combination of chronic disease management and lifestyle programs looks more and more like the winning combination to employers.
It starts with an integrated approach
At Rally, we’ve built a platform to make it easier for employees and employers to engage around lifestyle programs. Earlier this year, we also added 18 clinical Missions to our wellness product, and 14 more are on the way early next year.
These clinical missions cover asthma, high blood pressure, high cholesterol, coronary heart disease, and diabetes, among others — all conditions that are prevalent in employee populations. Missions like Avoid Asthma Triggers, Check Your Blood Sugar, or Check Your Blood Pressure reward people for taking small but important steps in learning to better manage a chronic disease.
These missions are a low-cost approach to disease management and education for members who don’t have access to lifestyle coaching programs. They can also help move members through the first steps of learning how to manage a disease before they start working with a live coach.
"There's no question that lifestyle change is the key to both preventing many chronic health conditions as well as managing them once they occur,” says Rally chief medical officer Adam Bernstein, MD. “And often it’s the same exact actions that prevent and treat diseases — diet, exercise, stress management, sleep, weight control, alcohol moderation, and tobacco cessation.”
It’s also important to note that certain behaviors can prevent or treat multiple health conditions at once.
“Not too many drugs can do that,” Bernstein says. “Our hope now is that by better tailoring Rally experiences to where our users are — and by offering Missions that may help prevent or manage certain diseases — we can not only help our users improve their health, but also gain the skills, confidence, and motivation to maintain healthy lifestyle habits."
Since we launched our Clinical Missions in July, more than 200,000 Rally members have joined. Even better, the majority of participants (73 percent) have a 98 percent completion rate in the first week.
For employers, that kind of engagement is a hopeful sign. Clearly, employees are looking for tools to help them manage their conditions. For employers, the challenge is creating a wellbeing program that integrates both lifestyle and disease management.
“Employer workplace wellness programs are just one component to enhancing employee health, and not the sole solution to this complex problem,” said Bill Lloyd, MD, the clinician and medical educator who prepared the Transamerica white paper. “We've reviewed research that has shown that chronic disease management generates faster and larger cost savings… Reducing chronic illness results in a healthier workforce and lower health care costs for employers.”
Increasingly, companies are coming to the same conclusion: The most effective approach seems to be a combination of disease management in sync with well-being programs that address the precursors of chronic illness.
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