Insurers and Employers: Beware of Disease-Management Programs!
Controllable chronic diseases are rapidly increasing and so are your costs. But that’s okay because “disease-management” programs are here to the rescue!
Hmm, what are these programs really about? Per AMCP.org, “Disease management empowers individuals, working with other health care providers to manage their disease and prevent complications.” This is a wonderful explanation as to what these programs aim to do. But, do such efforts actually yield a cost-savings? The key words: empowerment, self-care, and prevention are fabulous! But, the phrase “managing to avoid complications?” just rubs me the wrong way. How about you? Is that what you really intended to pay for? Wouldn’t you rather prevent disease than manage it?
While it sounds a little cynical, remember, it’s your company, your employees, your money. So it’s important for you to understand that “management”, in this case, often involves increased doctor’s visits which is wonderful if the doctor is up-to-date with root cause medicine and lifestyle modifications and has time to assist with healthy behavior change. In reality, here’s more cynicism, I’m not against doctors nor offices as I see them myself, but it’s no secret that office visits often spawn prescriptions (long-term costs), needed follow-up visits, then possibly more prescriptions, labs and office visits with little to no lifestyle investigation what so ever. It’s simply how it works. Our norm IS medicine. See, it’s in the name… “medicine”. No, I’m not against it, it’s a necessity in many situations but we need to be real. It’s a life or a costly slow death situation here.
It's rare for any actual nutrition and lifestyle information to be shared at these visits. But that’s okay because these programs often provide health coaches or nurses for a handful of phone sessions to assist your employees with this. However, they often aren’t thoroughly or properly trained in the material they provide. Well, that’s not necessarily a problem as the nutrition and lifestyle information provided is usually outdated and does not address the root cause of most conditions in the first place. Yes, more cynicism.
For instance, “management” of a type 2 diabetic often includes the recommendation of 6+ carbohydrates a day, sprinkled into small and frequent low-fat meals with an oral agent (prescription with no end in sight) and sometimes a few more. Starting a patient on a prescription for a lifestyle condition without an exit plan full disclosure of potential lifestyle issues that caused the condition in the first place, without the proper behaviors that can resolve the issue and without information regarding possible drug side-effects provided to “manage” the issue is a recipe for management (disaster), not resolution. And, some of these long-term prescriptions can make the condition much worse, IE long term insulin (IE type II diabetic).
When you’ve been in this field for as long as I have and have seen potentially healthy people degrade for no reason other than poor management, you may feel the same way. This is why I’m writing this article. It pains me to see patients provided management information for things that can be resolved. Can you imagine going to a debt consolidator to “manage” your debt. “Let’s not resolve your debt. Let’s stay in debt but reduce it just enough to keep you from going to jail (hospital) for now.”
People with controllable conditions (majority) are rarely, if ever, informed that they may be able to actually resolve or even improve their condition. And, you as an employer, or even an insurance admin, may not even realize it. You deserve programs that work.
So, let’s assess this situation. Is what you invested in yielding the savings or improved the wellness of your employees as you intended? So, is it “management” that you really want? Let’s change the management program to a resolution program.
That’s what we do. Let us help you. The mother of invention is necessity … and boy, do we NEED IT.
