Getting a Handle on Chronic Disease
Implementation of Health Management Services in the GCC region will help limit the far-reaching socioeconomic impacts that chronic diseases create, and help decrease the average 74% of public spending required for healthcare.
The growing prevalence of chronic diseases in Gulf Cooperation Council (GCC) countries is having far-reaching socioeconomic implications, including higher healthcare costs, lower worker productivity, clogged healthcare systems and declines in population health status. Well-crafted health management services (HMS) programs can help GCC nations stem the rising tide of chronic disease, but governments must start to lay a strong foundation for future health management services, today, according to a new report by Booz & Company.
The Runaway Costs of Chronic Disease
Unhealthy lifestyles and aging populations increase the prevalence of chronic disease, which drive up healthcare costs and restrict economies. Chronic diseases strain healthcare providers and the overall healthcare system by leading to frequent and costly trips to the emergency room and longer average stays: Patients with such diseases are heavy users of healthcare services, and take up a disproportionate amount of available services.
In addition, recent research shows that on-the-job productivity losses account for up to 60 percent of the total healthcare costs associated with chronic diseases. “To counter these trends, GCC governments, healthcare organizations, and private insurers can deploy health management services in their overall healthcare strategies,” said Ramez Shehadi, a partner at Booz & Company. These services mitigate the spread of chronic diseases by establishing wellness programs and other preventive strategies, and once a chronic disease has been diagnosed, they reduce the costs of treatment through ongoing monitoring and frequent interaction with the patient.
A Pressing Problem for GCC Nations
Rapid economic expansion in the GCC region has brought its citizens higher living standards, lower unemployment, and increased purchasing power. But with these advantages come new and pressing challenges. Lifestyle changes in the once highly active GCC population are triggering heightened obesity rates and incidences of hypertension, key factors that contribute to chronic disease.
Today, in the typical GCC country, chronic diseases are a leading cause of mortality; in 2007, the region was home to four of the top five nations in the world for diabetes among adults. Based on data available from several GCC geographies, chronic diseases currently account for approximately 35 percent or more of the deaths in those regions. “Because changing lifestyle factors are not addressed before they mature into chronic diseases, GCC governments are being forced to dedicate more money to treat a growing wave of patients,” stated Ali Hashemi, a principal at Booz & Company. Public spending on healthcare averaged 74 percent in GCC countries in 2004, nearly 20 percentage points higher than the global average of 57 percent.
Addressing Gaps in Patient Care
The rising socioeconomic costs of chronic diseases have caught the attention of GCC governments. Some have set up government bodies and programs to develop preventative healthcare strategies and address the low level of health awareness in the region. As yet, these have not been able to fully address the escalating needs of the GCC region’s growing population of chronic disease sufferers.
Typically, chronically ill patients need assistance in four major elements of their disease management: understanding the implications of their disease; navigating the healthcare system and communicating with the various care providers; gathering information about the various actions they need to undertake; and complying with their care regimen. “Currently, such needs are filled only during formal physician visits or informally by other sources such as family and friends. Critical gaps in care provision therefore exist before, between, and after provider visits,” commented Walid Tohme, a principal at Booz & Company.
The Case for HMS
To close these gaps and improve the overall care of chronically ill patients, healthcare leaders are employing HMS programs which bundle a prescribed set of healthcare services into condition-specific programs. The services address patients’ needs in terms of risk identification, awareness and education, adherence to treatment regimen, monitoring of health indicators, and care coordination. It assists individual patients by creating a support system that helps them manage their condition, providing critical guidance and employing incentives to encourage healthy behavior. “It also strengthens relationships between hospitals, physicians, and patients by creating a care continuum care that competitors without such programs cannot match,” stated Shehadi.
By supporting individuals in maintaining and managing their health, HMS programs have a direct impact on healthcare costs. Numerous studies have demonstrated this: A study published in Health Affairs in 2004 showed an 8.1 percent drop in the hospitalization costs of diabetes patients after enrolment in an HMS program to manage their illness.
Key Components of HMS Programs
HMS programs are broadly classified as either wellness programs or disease management programs. “Typical wellness programs provide healthy individuals with information, support, guidance, and encouragement to better manage their lifestyle-related health risks,” Hashemi said. Disease-management programs offer a prospective, disease-specific approach to coordinating the care of high-cost and high-risk populations with chronic conditions. Both types of HMS program are typically designed around four major components:
Adoption focuses on understanding risk profiles through health-risk appraisals, selecting the appropriate program and pricing strategy, and encouraging adoption through marketing efforts and enrollment incentives.
Program delivery centers on core intervention elements that are designed to help the consumer manage his or her condition and reduce risk factors through a personalized delivery strategy.
Monitoring sets clear performance metrics, measures against them, and verifies desired outcomes.
Improvement involves modifying the program elements to enhance the effectiveness of the program.
Putting HMS into Practice
The success of these programs depends on their ability to change behavior. The HMS industry is constantly innovating to develop new techniques to improve programs’ ability to ensure compliance, reduce risk factors, and carry out preventive screenings and thus deliver on their promised benefits. There are three key factors in successfully deployed HMS programs:
Incentives: “Well-designed HMS programs provide consumers with a variety of incentives to ensure participation. They are also using negative incentives such as increased premiums or co-pays for patients who don’t enroll,” commented Tohme.
Physician Involvement: Coordinating program interventions and other elements with the patient’s physician is another critical facilitator of program efficacy. With the low level of health awareness issues in GCC countries, patients are more reliant on physicians than in other markets, making involvement more critical.
Personalization: Tailoring communications and incentives to the individual’s tastes and preferences increases patient compliance with HMS programs. “HMS providers are building large databases of consumer information to document the success of interventions, incentives, and communications, and to leverage these data to personalize their interactions with other patients,” Shehadi explained.
Healthcare insurers’ overall HMS strategy will need to employ analysis, judgment, detailed design, piloting of alternative concepts, and allocation of significant resources for implementation. GCC governments and healthcare organizations must assess their current overall healthcare strategy and address a number of strategic questions, including who the HMS program will target, how and by whom they will be provided, what incentives are required for users, what policy initiatives are required for rollout, and how will they be successfully managed?
Chronic disease management is an issue that GCC nations cannot afford to ignore. Well-crafted HMS programs are a valuable tool that can help GCC nations stem the rising tide of these diseases by helping identify unhealthy and risky behaviors, raise awareness of underlying lifestyle factors, improve adherence to treatment regimens, and strengthen the bonds between patients and physicians. As GCC nations prepare for robust economic recovery, their leaders will need to put a premium on “smart growth” strategies. When it comes to managing the population’s most serious and costly illnesses, there is no smarter healthcare strategy than HMS.