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By Monica E. Oss

For all the discussion about the cost of chronic diseases—and their increasing prevalence—not much is happening. Or so it would seem. We recently reported on chronic disease management in the Medicare Advantage market, where 44% of consumers with a chronic disease reported that they have not heard from their health plan about the condition, and only 10% report that their health plan offers reminders about chronic conditions. Additionally, the recently released HealthMine Medicare survey reports that about 53% said they do not receive any follow up from their health plan after a health care provider visit (see 70% Of Medicare Advantage Members Have A Chronic Disease; 44% Report No Health Plan Communication About Disease Management).

The statistics clearly show the situation when it comes to consumers with chronic conditions. The National Center for Chronic Disease Prevention and Health Promotion reported that chronic diseases affect approximately 133 million Americans, representing more than 40% of the total population. And three in four Americans aged 65 and older have multiple chronic conditions like heart disease, cancer, stroke, or diabetes (see Chronic Diseases In America). This is corroborated by statistics from the National Council of Aging, which reports that 77% of older adults have at least two chronic diseases (see Healthy Aging Facts). And, the costs couldn’t be clearer—this is the population that frequent falls in the “superutilizer” category (see Looking Beyond The Superutilizer Umbrella and How To Define A Superutilizer Population).

So what are health plans doing to address the needs of these consumers and to improve health and decrease costs? From virtual health solutions, to addressing social determinants of health, to enhanced consumer engagement strategies, health plans are looking for solutions that focus on whole person care models and allow for better care management (see Value = ‘Whole Person’ Approach). Here are a few examples:

  1. Cigna Expands Its Diabetes Prevention Program In Coordination With Omada Health
  2. CVS Health Invests $100 Million Over 5 Years In Community Health Initiatives
  3. Anthem & Propeller Health Launch Ohio Medicare Advantage Digital Medicine Program For COPD
  4. Geisinger & Merck Unveil EHR-Embedded Apps For Medication Management & Care Coordination
  5. Capital BlueCross Launches New Virtual Care App & Expands Telehealth Access For Behavioral Health Services
  6. Walgreens, Humana Partner To Open Senior-Focused Health Center In Raytown, Missouri
  7. Kaiser Permanente Invests In Affordable Housing Complex In Oakland, California For $5.2 Million As Part Of Initiative To Improve Community Health By Addressing Housing Insecurity
  8. Aetna Medicaid Launches New Service Coordination Model
  9. Cigna Acquires Technology Company Focused On Consumer Engagement
  10. Humana Expands Availability Of Fitbit Platform

But while health plans are gearing up to address the needs of consumers with more complex needs, there are great opportunities for the entrepreneurial provider organization. A few statistics provide an idea of the openings for new solutions. According to the HealthMine survey, 47% of all respondents prefer digital communication from their health plan and 43% prefer telehealth—including those 71 to 75 years old (just in case you think it’s only millennials who prefer virtual health). And, when asked about their most desired covered services, more than half of Medicare Advantage respondents chose services that enabled them to remain at home, including home modification for medical needs; assistance at the home; transportation reimbursement; food deliveries (see As CMS Promotes Telehealth, Survey Reveals Medicare Beneficiaries May Need Better Understanding/Awareness of Telehealth: HealthMine Survey).

Understanding the “pain points” of health plan managers has been a continual refrain at our summits and institute sessions focused on breaking through the health plan contracting competition—see Pain Points Matter, Watch Out For Elephants, and Health Plan Relationship Building Skills Key To VBR Success. These survey results and a review of the recent programs being launched by health plans shows that virtual health, consumer engagement, and home-based services are top of mind for health plans. This information is “food for thought” for your next conversation.

For more, check out these resources in the OPEN MINDS Industry Library:

  1. Making Consumer Engagement A Reality
  2. The Formula For Success In Long-Term Services & Supports
  3. Consumer Engagement = Performance
  4. Successful Self-Direction Is Successful Consumer Engagement
  5. Less Consumer Education Demands More Consumer Engagement
  6. Making Consumer Engagement A Reality
  7. From Consumer Engagement To Consumer Activation
  8. Social Media Listening As Consumer Engagement Strategy
  9. Consumer Satisfaction, Consumer Engagement & Shared Decisionmaking
  10. Consumer Engagement Is The Missing Piece In Population Health

For even more, join me on June 4 at The 2019 OPEN MINDS Strategy & Innovation Institute for the session “Self-Determination In The I/DD Market: Keys To Incorporating Consumer-Directed Care Into Your Services,” featuring Ray Wolfe, J.D., Senior Associate, OPEN MINDS; Dan Ohler, Vice President, State Government Programs, Optum Behavioral Health; and Mollie Murphy, President, Applied Self-Direction.

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