- New research in the American Journal of Managed Care calls for payer-sponsored care management programs to improve chronic care management by including individualized health coaching elements.
Health payers have a financial impetus to improve chronic disease management. Approximately 50 percent of adult patients have a chronic illness, and studies show these chronic illnesses account for a substantial portion of healthcare spending due to high healthcare utilization and other mitigating factors.
“A major contributor to chronic diseases and their attendant costs is an individual’s poor health behaviors; additionally, patients with chronic disease often do not adhere to the medication or treatment plans designed by their providers,” wrote Reistroffer et al. “This lack of adherence frequently leads to clinical crisis, unnecessary death, and expensive treatment services, such as preventable emergency department (ED) visits and hospital admissions.”
According to the research team, care management programs offer one viable option for payers to support their chronically ill patient populations. And its study of a Midwest health plan, patients who receive health coaching based on their individual needs and level of patient activation tend to see better outcomes.
The 19-month study of nearly 18,000 adult plan enrollees compared patients receiving generalized care management services and those receiving health coaching based off of a patient activation measure. Patient activation was scored on a 100-point scale and at the start of the study to determine specific patient needs.
At the end of the study, the intervention arm showed lower healthcare utilization and better health outcomes. The usual care cohort had 18 percent more emergency department visits and 98 percent more hospital admissions. These patients also had higher glycated hemoglobin levels and higher systolic blood pressure.
The researchers found negligible difference in medication adherence between both usual care and intervention cohorts, potentially due to universal treatment coverage barriers.
According to the research team, these findings highlight the importance of health coaching based off of initial patient activation levels. While it is important for patients to have high patient activation levels, meaningful chronic care management improvements come when patients receive specific guidance on how to improve their health based on their level of readiness.
“These findings suggest that the care management program and patient activation may work synergistically to produce better outcomes,” the research team explained. “Patients may achieve the best outcomes when efforts to improve patient activation are supported by health plan coaching.”
In fact, the researchers said that the best use for patient activation assessments is informing coaching and patient engagement strategies.
“Coaching interventions that are based on activation level may help care managers engage in more effective interactions that strengthen a patient’s role in managing their healthcare,” the research team said.
“For sponsors and developers of care management programs, these findings suggest that the programs that are more targeted in their application—rather than uniformly developed and implemented—may be more effective at producing desired outcomes.”
Ultimately, these findings suggest that health payers should conduct regular patient activation screenings in order to effectively assign health coaches. In doing so, they can help improve chronic disease management, which both betters the health of patients and meets the payers’ financial goals.
“For sponsors and administrators of care management programs, the study findings suggest that bundling [care management] with [care coaching] might be beneficial for managing the health and healthcare of chronically ill populations,” the researchers concluded.
“Administrators may want to consider obtaining patient activation scores online as part of a health risk assessment for new enrollees, and annually upon reenrollment. Doing so is likely important for identifying whether care management and coaching are needed and for maximizing the effectiveness of implemented programs.”