Case management for seniors (More on Health Management, March 2007)

Disease management programs aimed at enhancing quality of life for older adults with multiple chronic illnesses are blossoming and are expected to experience future growth.

Health Dialog Services Corp., a Boston-based disease management company, provides health education, information and support across a broad spectrum of healthcare needs, including opportunities and challenges for the fast growing senior population. "We offer whole person, whole family support for the broad range of conditions facing an individual, from healthy living behaviors to complex condition management," says Mary Jane Favazza, senior vice president, business development and client services.

"We see more and more seniors and their healthcare support teams–spouses, adults children, friends and neighbors-seeking guidance in navigating a complex care system. They want to find up-to-date, evidence-based information on conditions, treatment option choices and self-management strategies for improving quality of life and healthcare outcomes," she continues.

She sees the benefits of services like those provided by Health Dialog as improved quality of life, more appropriate healthcare consumption, improved outcomes and the intangible but real results of people actively and successfully participating in the management of their own healthcare. "There are opportunities to reduce cost while improving quality and that is a win-win for everyone involved," Favazza says.

Independence Blue Cross (IBC) headquartered in Philadelphia relies on Health Dialog's shared decision-making philosophy and health coaches for five primary chronic disease states–COPD, CHF, asthma, coronary artery disease and diabetes-in its Connections Health Management Program. Personalized health coaches provide objective, evidence-based information to help patients understand their diagnoses, available treatment options and benefits and risks of each option. Connections programs serve approximately two million health plan members, including more than 235,000 members with at least one of the five most common chronic diseases.

IBC also works in conjunction with Accordant Health Services, a disease management company and part of Caremark, to target physicians and their patients with Parkinson's disease, multiple sclerosis, rheumatoid arthritis, hemophilia and 12 other rare diseases. The programs provide easy-to-read health information, improve compliance by communicating with physicians and patients, assess patient's conditions and coordinate care among members of a patient's healthcare team.

Finally, IBC contracts with RMS Disease Management Services to deliver a disease management program for end-state renal disease (ESRD), which provides an individualized care plan developed in conjunction with key treating physicians; 24/7 availability of a personal, dedicated renal professional; educational materials; coordination of care services; and one-on-one coaching to ensure treatment and care plan compliance.

Esther Nash, MD, medical director of population health and wellness for IBC, has found that Medicare members engage more fully in disease management programs than younger members. Research indicates that more than twice the number of IBC Medicare beneficiaries than its commercial members responded to a targeted mailing about health coaches. Nurse coaches reached as many as 90% of the high-risk Medicare population, while they reached 75% of commercial members.

In addition, Dr. Nash points out that all of IBC's disease management programs-mostly attributable to the five primary chronic conditions-have resulted in 1.5% to 2% reductions in medical cost trends for the first year and 3% to 5% during the second year.