Wellness is NOT Disease Management …

Many employers have been disappointed at the results achieved through implementing wellness program with their employee population.  Typically these programs begin with much vigor and excitement, only to fade out rather quickly after the first 6 months to 1 year of the program.

Why do wellness programs fail to sustain themselves?  The reason is that wellness programs are focused on behavior change.  Behavior change is extremely hard to achieve!  Normally when we discuss behavior change it is in regard to weight loss and smoking cessation.  Unfortunately there is no magic bullet pill that plan members can take to solve behavior challenges.

Disease management however is educational.  For example, let’s consider a health plan member that has a diagnosis of atrial fibrillation.  For these members, we begin by educating them that they have a 8.4% chance of stroke over the next 12 months based upon this diagnosis.  However, if they were to take an ace inhibitor or beta blocker, their chance of stroke will reduce to less than 2%.

In the normal population, atrial fibrillation patients see that only 52% of patients will actually take an ace inhibitor or beta blocker.  In contrast, our Sky compliance on average ranges at 97%+ across all employer populations.  There is a simple pill to help in this scenario, and thus outcomes are fantastic.

Sky disease management does focus on behavioral change as well with our clients, however it is still much harder.  Our compliance rates regarding behavioral issues are some of the best in the industry, however the compliance rates never reach close to the results capable on conditions that allow for an educational answer to the problem.

More importantly, behavior change is not where the claims savings come from.  Rather, documented research shows over and over again that medical claims savings come from properly treating conditions based upon medical norms.

Leave a Reply

Your email address will not be published. Required fields are marked *