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How Payers Address the Four Domains of Chronic Disease Prevention

Payers can address chronic disease prevention with the use of beneficiary health data, population management tactics, and community program investments.

How payers address chronic disease prevention

Source: Thinkstock

By Thomas Beaton

- Payers have an opportunity to improve chronic disease prevention and limit chronic disease spending by addressing the both medical and non-medical factors of chronic conditions. Payers can determine their chronic disease costs, and lower those costs, with efforts that identify chronic disease prevalence within beneficiary populations.

Payers are especially primed to support and develop chronic disease management because they already use tactics that fall in line with the CDC’s four domains of chronic disease prevention.

The domains for successfully managing chronic disease include surveillance of at risk patients, the development of systems that address environmental access to care, supporting patient engagement methods, and creating community programs that address non-medical health factors.

How are payers able to address the four domains of chronic disease prevention, and what have payers done to prove their ability prevent chronic diseases?  

Identifying risk in patients with available data

The first domain of the CDC’s chronic disease prevention strategy requires that healthcare stakeholders identify patients at risk for a chronic disease to determine which prevention efforts will work best. The CDC added that the use of available datasets will be a significant driver for making chronic disease prevention decisions.

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Anthem has been able to collect internal claims data and clinical data in order to create personalized member experiences based on a beneficiary's health condition. Anthem has also been able to use the data to help providers learn about the specific high-cost conditions of their patients, said Patrick McIntyre, Senior Vice President of Health Care Analytics at Anthem.

“As part of our value-based provider contracting approach, we deliver a set of capabilities to providers called our Enhanced Personal Healthcare Program.” McIntyre said “This includes reports that identify members with specific conditions or those members that are incurring unnecessarily high costs.”

Payers have also sought out third-party experts to develop population management analytics and data systems to collect the information data for identifying at-risk patients.

Developing environmental interventions that provide daily healthcare access

The focus of the CDC’s second domain of care involves making sure that individuals who may develop chronic conditions have healthcare access in their daily lives. Providing healthcare services closer to where people work and live will help address and identify chronic diseases as they emerge.

Payers and employer sponsored health plans already support environmental healthcare interventions with on-site clinics. Willis Watson Towers data found that 75 percent of employers sponsoring health plans are doing so in order to increase productivity and as part of their efforts to improve access to preventive care.

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Cigna previously partnered with CVS Health in order to develop retail clinics that allow individuals to receive pharmacy benefits and other care services. Executives at Cigna said these clinics are an effort to provide healthcare access.

“The goal of this healthcare delivery system is to meet the member where they are in their day to day lifestyle,” Michele Paige, Vice President and General Manager of Cigna Onsite Health said.

“What we have noticed is that more people are using and accessing lower cost care because a lot of people have high deductible plans, and they really need to watch their healthcare dollars,” said Paige.   

Assisting providers in wellness programs and population health

The CDC’s third domain for preventing chronic diseases requires a broad effort from payers and providers to create population-wide efforts that reduce disease prevalence and  improve the payment of preventive care.

Payers can leverage population health management strategies such as adjusting the price of preventive services, value-based insurance design, and consumer engagement are accessible ways for payers to prevent chronic diseases among populations.

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Payers can also develop wellness programs that are affordable, accessible, and readily available  for at-risk beneficiaries. Targeted benefits and communications allow payers to help patients use healthcare services when needed, and determine the most useful benefits for populations.

Linking community programs to patient health outcomes, improvements in social health determinants

The fourth domain of chronic disease prevention involves developing community programs that boost preventive care access and encourage individuals to participate in healthy behaviors. Programs aimed at lowering the effects social health determinants include smoking cessation services, healthy food collaboratives, and community wellness groups.

Payers have actively collaborated with providers and community workers in order to develop community programs. Payers including Harvard Pilgrim, UPMC Health Plan, and HealthNet have been able to bring wellness initiatives to community and increase their community’s access to care.

UnitedHealthcare, Humana, and Aetna have also invested in community programs aimed at lowering chronic disease prevalence through the improvement of societal conditions and healthier behaviors.

Smaller payers with specialized beneficiary populations have developed housing programs to address living-related social health determinants to lower the chances that beneficiaries exacerbate chronic diseases.

Payers can lead the way towards a holistic approach of managing chronic diseases that compound high healthcare spending volume and drive up the cost of care utilization. 


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