The current opioid epidemic has shed light on the shortcomings of many wellness programs and the lack of preparedness by case management teams to handle chronic conditions and or patient behavior, such as addictive tendencies or duplicate therapy. But are case management teams solely to blame for lack of effective response to this costly health crisis? The simple answer is, no.
Many case managers do not have access to the data or tools required to employ a compelling and value-driven prevention model. Hence, what we see today is very little accountability or effective case management. What’s needed most is quality data to guide active engagement with patients.
Engaging and educating healthcare consumers on plan benefits, cost-saving options, health risks, as well as the benefits of closing gaps in care can spur action and the desired results. But disconnected messaging via multiple outreaches can cause aggravation and discontent. Even leading to member attrition.
What if you could impact liver health and keep some plan members / employees from progressing to more serious, life altering, expensive liver disease; like liver cirrhosis and ultimately liver cancer, failure or a liver transplant?
Most people are not aware of fatty liver disease until they are told that they have this potentially deadly, life-sapping condition. Even once diagnosed, people often don’t know how to address the situation and reduce their risk. This is why APH is taking a proactive stance in broadcasting the prevalence and risks of fatty liver disease, which impacts at least a quarter of our population1, and can be prevented or slowed by addressing sedentary lifestyles and poor eating habits, and encouraging those impacted to work with their healthcare provider and nurse health coach / nurse navigator to manage health risks and chronic disease conditions.
Kidney failure and life-saving dialysis are both a catastrophic health plan expense and life-changing experience that impact health plans and lives through probability. The incidence of chronic kidney / renal disease is about 2 to 2.5 per 1,000 members across the APH customer base. Because lady luck is elusive, lightning can strike twice for the same health plan, resulting in typical annual health plan expenditures between $350,000 and $700,000 for each member on dialysis.According to the National Kidney Foundation, more than 660,000 Americans have end stage renal disease (ESRD), meaning that their kidneys have permanently failed, and dialysis is required to cleanse the toxins from their bodies.
This is a multi-part blog series. Part two will cover – Preparing for a Kidney Transplant or Dialysis.
Members who are in chronic kidney disease at Stage 3 or 4 need to be approached about their plan of treatment. At this point the member may be in denial or unable to determine if they would like to be listed for a transplant, but it is not too early to start the process. The member needs to know about the importance of an early transplant listing decision, because it takes eligible individuals 24 months or longer on the transplant list to get a kidney. They can always change their minds and remove themselves from a transplant list, or list with more than one Center of Excellence to improve their chances for receiving a kidney.
This is a multi-part blog series. Part three will cover – The Cost of Dialysis and TPA and Medical Management Practices