Health plans' current wellness initiatives and disease/case management programs may be leaving members who fall outside of the "very sick" and "healthy" categories unengaged.
The "emergent-risk" population includes consumers with one or more pre-chronic or early-stage chronic conditions. Living with a diagnosed condition such as pred-iabetes, arthritis or heart-disease, these individuals interact with the healthcare system often, take medication, undergo lab tests and see clinicians regularly. But they have not progressed to the point of a late-stage chronic illness that requires intensive clinical management.
Instead, they primarily experience a condition as it impacts their life, personally and professionally. Someone with early-stage arthritis has more in common as a healthcare consumer to someone with early-stage diabetes than either would have with someone in later stages of their same conditions. As a result, all early-stage individuals share a common need: to lessen the impact of chronic illness on their personal, professional and social lives.
Today's health management strategies are designed for healthy and very sick populations, with wellness programs striving to reduce risk factors and prevent chronic illness down the road. Serving healthy populations, these programs reinforce healthy behaviors and reward appropriate utilization choices.
But the emergent-risk populations are already ill with chronic conditions; even successful wellness strategies are not able to arrest disease processes that have already begun. At the opposite end of the spectrum, disease and case Management programs have one primary objective: improve adherence to prescribed clinical care. For the very sick, whose conditions have progressed to late-stages, this approach minimizes hospitalizations and ER utilization. However, those with emergent-risk don't have excessive hospital or ER use, and they do have time to improve their health, reverse or slow the progression of their diseases, and prevent the future need for a disease management service.
Years of research and emerging patient programs suggest that digital health self-management interventions can make a significant impact on emergent-risk populations. Population analysis shows that without intervention, emergent-risk individuals progress along a number of disease trajectories--simultaneously.
Each year 15-20 percent transition to the high-cost category, and along the way, each individual contracts, on average, one new condition every 2-3 years. Post-intervention analysis shows that digital health self-management programs improve health and prevent the long-term "compounding effect" of chronic illness--compounding chronic conditions, compounding declines in quality of life, and compounding increases in cost of care.
The key to this long-term impact is member engagement: members take charge of their own health self-management journeys. They adopt and sustain three types of health self-management behaviors: Lifestyle, stress, and condition self-management.
Adam Kaufman is the president and CEO of Canary Health.