Three trends affecting managed care

August 4, 2015

As the healthcare system undergoes rapid change, there are three important trends that managed care executives should keep an eye on.

The healthcare system in the U.S. is undergoing rapid and dramatic transformations. Health insurers are facing changes due to healthcare reform, continued growth in healthcare spending, an aging population, and an increasing number of people with chronic diseases.

READ: Top 5 ACA trends affecting health plans, providers

Here are three important trends that will impact the care management industry in the next three to five years.

Trend 1: Chronic Condition Management

In 2012, the baby boomer population-those people born between mid-1946 and mid-1964-numbered 77 million people according to the U.S. Census Bureau. The first of that group turned 65 in 2011, and the over-65 age group reached 43.1 million people by 2012. By the year 2020, baby boomers will make up just over 15% of the total U.S. population.

According to a 2013 National Centers for Disease Control and Prevention report, two-thirds of the over-65 age group is affected by chronic disease, and most of their healthcare costs are devoted to treating these illnesses.

As the population continues to age, we expect that chronic conditions will affect more and more individuals. Managing these conditions becomes increasingly important to support improved outcomes and keep costs in check.

Current estimates are that chronic conditions account for 75% of our nearly $3 trillion healthcare spending in this country. However, the impact of an aging population goes far beyond bending the cost trend for chronic conditions.

Care management must deal with appropriate predictive risk stratification of members who will be impacted; address individualized care planning for multiple co-morbidities; integrate physical, social and behavioral health; and improve plan adherence.

Next: Trend 2: Mobile Health

 

 

Trend 2: Mobile Health

A second key trend is the increasing use of mobile technologies, as both younger and older generations enthusiastically want to be able to access their information anytime, anywhere, on any device.

A Pew Research Center survey on self-tracking data found that 21% of respondents use some form of technology to track their health data, including medical meters, apps, websites and other online tools.

Care management is shifting from a one-way communication of education and orders to a personalized dialogue that is member-directed. Engaging patients in this dialogue requires more than telephonic connections; it must encompass face-to-face interactions, secure e-mail, texts, and social media.

As the use of mobile technology for healthcare expands, the industry must respond with technology solutions to engage with patients in a variety of modalities.

Next: Trend 3: Medication Therapy Management and Adherence

 

 

Trend 3: Medication Therapy Management and Adherence

A Centers for Medicare and Medicaid Services research study observed that medication non-adherence in 2000 was the cause of 33% to 69% of medication-related hospital admissions.

That year, the price to the U.S. of medication non-adherence was over $177 billion, and 70%of that amount was for hospital admissions. The study found that medication therapy management programs consistently improve medication adherence in patients.

Chronic conditions almost always require medications for control, and current adherence statistics are alarming-only one out of four patients take their prescription medications as directed, yet 70% of Americans take at least one prescription drug and 20% take five or more.

The medication cannot work if it is not taken properly, meaning that patient engagement around medication adherence becomes critical for better outcomes and reduced costs. Engaging with community pharmacists at the point of care must be considered if we are to optimize medication therapy.

Addressing these three trends-chronic condition management, mobile health, and medication therapy management services-is key to health insurers successfully managing the health of the populations they serve in a financially sustainable manner.

Mike Myers, is EVP, solution delivery at AxisPoint Health