Adam Kaufman, PhD, president and CEO, Canary Health
For many years, healthcare organizations have invested in two approaches to population health management: First, wellness management for healthy populations who want to prevent illness, and second, disease/case management for the very sick who must adhere to physicians’ prescribed medical care.
Now, organizations are filling the gap between the healthy and very sick by investing in the 'emergent-risk' populationadults with one or more pre-chronic or early-stage chronic conditions. Population goal: arrest the trajectory of compounding chronic conditions that compound declines in quality of life and compound increases in cost of care.
Consumer Engagement with Digital Health Self-Management
For many years, the natural worsening of chronic illness has been the focus of academic institutions, a few digital health innovators, and pioneering health plans. As a result of these efforts, a new class of digital health programs is now proven to arrest the trajectory of chronic illness. It started when Stanford’s Patient Education Research Center discovered that self-efficacy (a person’s belief in his or her own ability to achieve goals) had the strongest correlation to improved health outcomes. With this discovery, the concept of health self-management was born. Thus began the drive to engage and impact consumers.
Over the years, healthcare organizations across the United States began offering Stanford’s in-person workshops with notable improvements in health and with measurable reductions in cost of care. According to Stanford research, participants reduced pain, fatigue, depression, and A1Cand reduced ER visits and days in the hospital for up to one year.1 While results were impressive, the programs had one drawback for managers of population health: due to the cost and complexity of in-person delivery, the programs were hard to scale.
As web-based technologies advanced, the research community began to search for ways to harness digital innovation to scale evidence-based programs. In 2006, researchers at the University of Pittsburgh tested the first digital self-management program aimed at diabetes prevention. This digital translation2 of the NIH’s Diabetes Prevention Program3 (DPP) delivered outcomes that mirrored those achieved with the DPP’s in-person, self-management interventionbut at a fraction of the cost.
Data-Driven Insight: The Compounding Effect
As health plans began to adopt digital health self-management, data revealed deeper insights into individuals with prechronic and early-stage chronic conditions. Data from years of Canary Health research with a pioneering health plan shows that chronically ill patients add, on average, a new chronic condition every two to three years. These compounding conditions drive compounding increases in the cost of carespecifically in the areas of pharmacy, medical equipment, and outpatient care.
And without intervention, according to Advisory Board, each year 15 to 20 percent transition to the high-risk population of very sick individuals who require high-cost medical care. This trajectory of chronic illness translates into an additional $1,000-$3,500 in expenses per person, per year. With 80 million adults in this population, that’s an additional $80-$280 billion in costs each year to the U.S. healthcare system. If healthcare leaders don’t prevent this compounding effect, both health plans and providers will hit a financial tipping point where the cost of care puts both margins and mission at risk.
Proven Outcomes: Arresting the Trajectory of Chronic Illness
As health plans began to measure the ROI of digital interventions, a deeper look at results revealed the broader and longer-term impact4 of digital health self-management programs. For emergent-risk populations, the interventions accomplished the following:
- Halted the progression of individuals’ preconditions to diabetes, heart disease and other conditions;
- Slowed the progression of existing conditions, and;
- Prevented compounding conditions and compounding costs of care.
On the heels of this research, the goal became “trajectory impact” at a population level: programs for the emergent-risk population are now designed to arrest the trajectory of compounding conditions and compounding costs of care. With digital technology’s ability to scale, entire emergent-risk populations can be targeted immediately for outreach and intervention.
And with the lower cost structure of digital technology, health self-management interventions can generate a return beginning one year after the intervention and continuing over the lifetime of each individual.
1 Lorig K, Sobel DS, Stewart AL, Brown BW, Bandura A, Ritter P, González VM, Laurent DD, Holman HR. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care 1999; 37(1):5-14. View the abstract at http://www.ncbi.nlm.nih.gov/pubmed/10413387.
2 The digital translation of the DPP was described in the journal article from McTigue, et al. Using the Internet to Translate and Evidenced Based Lifestyle Intervention into Practice Telemedicine and e-Health Vol 15#9 November 2009. Read more at http://www.ncbi.nlm.nih.gov/pubmed/19919191.
3 The Diabetes Prevention Program (DPP), a major, multicenter clinical research study, discovered that modest weight loss through dietary changes and increased physical activity sharply delayed the onset of type 2 diabetes among pre-diabetic patients. The study showed that taking metformin also reduced risk, although less dramatically. Read more at http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram.
4 A two-year, controlled matched study by Canary Health for GEHA, a self-insured, not-for-profit association providing health and dental plans to federal employees and retirees and their families through the Federal Employees Health Benefits Plan. For a briefing on case study results, contact akaufman.canaryhealth.com
About the Author: Adam Kaufman is a health economist and the president and CEO of Canary Health. He speaks to audiences nationwide on the accelerating trend of chronic illness and the financial tipping point that threatens the margins and mission of American healthcare organizations and advises healthcare senior management teams on making strategic investments in their emergent-risk populations. Prior to serving Canary Health as President and CEO, Adam served as general manager of dLife’s Healthcare Solutions division. Kaufman has served as adjunct assistant professor in the economics department at the University of Southern California, and he is the author of a data analytics patent that predicts consumer engagement.
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