Chronic Disease Management for Medicare Advantage Populations

Chronic disease management is a necessity, not a choice, for Medicare Advantage Plans. Chronic diseases affect 60% of adults and place, by far, the biggest burden on the Medicare Advantage cost structure. They can require expensive medications and other treatment, frequent doctor visits, and inpatient, outpatient, and emergency room visits. Improving chronic disease management processes and outcomes in your Medicare Advantage Plans could lower your costs and improve productivity.

Medicare Advantage payors need to think again and, if necessary, reevaluate their strategies, since all adults have also been hit by the chronic disease epidemic. Older adults undeniably have higher chronic disease rates and risks, with 81% of adults 65 and older having multiple chronic conditions.

However, 18%, or nearly one in five, younger adults aged 18-44 have at least two chronic conditions. [1] Half of adults 45-64 have multiple chronic conditions. These are adults who are of age to be in the workforce, so their chronic disease management is paid for largely by private insurers. Their chronic conditions are also costly because of lost productivity from absenteeism and presenteeism.

The Need for Thoughtful Chronic Disease Management Programs in Medicare Advantage Populations

Chronic diseases are prevalent, with 3 in 5 adults managing at least 1, and 42%, or more than two in five, managing at least two chronic conditions. [2] Management is necessary and expensive, but there can be many different approaches to different diseases. They may:

• Target diseases at different stages: such as a Diabetes Prevention Program (DPP) among patients with prediabetes and high risk for type 2 diabetes, a hypertension management program to reduce risk for complications such as stroke, or a provision of dialysis to end stage renal disease patients.
• Focus on certain aspects of the disease or disease management: such as providing all recommended screenings for diabetes patients, or organizing education on nutrition, physical activity, and home blood pressure monitoring for hypertension patients.
• Rely to different degrees on medical providers: such as a patient-centered care model with a care coordinator to improve communication between doctors when managing multiple conditions, or a diabetes management team with educators, nurses, a nutritionist, and doctors to develop and facilitate implementation of a care plan.
• Use technology to support patient management: such as a health coaching app for weight loss, or a diabetes or hypertension app that is designed to improve proven effective behaviors, such as getting good nutrition and adhering to medications.

The cost and effectiveness of chronic disease management programs vary. Treatments that target diseases at their later stages, such as dialysis in end-stage renal disease, or that are a response to an acute event, such as a stroke, cost more than preventative measures, such as weight loss programs to lower blood pressure.

Chronic Disease Management Models in Medicare Advantage Plans

Many chronic disease management models have been used and researched, and they may have potential to improve or maintain health. The Chronic Care Model (CCM) and Stanford Model are two of the more established ones. [3]

Chronic Care Model: This model shifts the focus from reactive, urgent care in response to an acute health event to ongoing management for chronic diseases. It involves five elements.

1. Health system or organization including providers.
2. Clinical information systems to facilitate information exchange.
3. Decision support using evidence-based guidelines.
4. Delivery system design to improve delivery and staffing of care.
5. Self-management support such as education and counseling.

Stanford Model: This model acknowledges that chronic disease management often falls short when it comes to patient self-management. It includes six elements that patients can focus on to enable better self-management of chronic conditions.

1. Solving problems.
2. Making decisions.
3. Utilizing resources.
4. Forming a patient-provider partnership.
5. Making action plans for health behavior change.
6. Self-tailoring.

Disease Management

Disease management programs are increasingly common. There are a variety of approaches to promoting chronic disease management. Apps may connect patients to healthcare providers when certain criteria are met, such as experiencing specific symptoms or recording an out-of-range blood glucose or blood pressure measurement that could be dangerous or indicate the possibility of problems such as missing medications.

Some of the most effective strategies for managing chronic disease in Medicare Advantage populations involve getting patients to take matters into their own hands on a daily basis. Certain lifestyle changes can significantly lower blood sugar in diabetes, blood pressure in hypertension, and cholesterol in heart disease, for starters. These behaviors include losing weight, getting active, eating more nutritious diets, taking medications as prescribed, and, often, measuring glucose or blood pressure at home. Lark is a chronic disease management program that provides coaching on these behaviors and aims to turn them into habits through behavior change techniques. In addition, Lark stores data so patients can see progress and share it with their healthcare providers and has achieved Full CDC Recognition.

Well-designed disease management programs like Lark have the potential to increase engagement in Medicare Advantage populations, and, with that, success, compared to other disease management programs. They offer customized, unlimited coaching at the patient’s convenience, allowing patients to develop a perceived connection with their digital coach. There is no risk of embarrassment, so patients can be honest and invest their efforts into their health programs.

Chronic disease management programs can be more desirable from a Medicare Advantage payor’s perspective, too. They are relatively easy to implement as programs for their participants when compared to developing traditional, in-person management programs. Coaching powered by AI offers the expertise of the health professionals behind the program, without the excess costs or inconveniences, such as scheduling or hiring dilemmas, associated with using live professionals for each patient.

Disease management programs can have some limitations if they are not chosen carefully. For example, they may be independent of healthcare providers or, at the other extreme, rely too heavily on them. In addition, many of them present problems such as[4]:

• Privacy concerns, such as violation of HIPAA.
• Lack of research on effectiveness.
• Misleading expectations or claims.

Still, careful selection of the health coach programs you use can help avoid these problems. Lark offers chronic disease management programs, for weight loss and conditions such as prediabetes, diabetes, and hypertension, that can suggest when to contact a medical professional, but provide their coaching without the need for live help. In addition, Lark is proven effective and is compliant with health privacy rules.

Lark is an example of a disease management program that is built using principles from chronic disease management models. For example, in keeping with the CCM, Lark is designed to be used by patients on a daily basis to manage conditions and prevent acute events whenever possible. In addition, it facilitates information exchange between patients and providers by storing patient data, uses evidence-based guidelines to guide coaching, and provides education and counseling.

Lark also draws on the Stanford Model as it enables patients to improve their self-management abilities. The AI coach offers a tailored program for patients as they set goals and work towards achieving them.

How to Prevent Diabetes in Medicare Advantage Populations

Type 2 diabetes is among the most expensive and prevalent chronic conditions in Medicare Advantage populations, but it is also one of the most preventable. The National Diabetes Prevention Recognition Program (DPRP) is sponsored by the Centers for the Disease Control and Prevention (CDC) and it provides an example of how chronic disease management can be used in preventing diabetes. This program is targeted towards patients with type 2 diabetes risk factors, such as prediabetes, obesity, or a history of gestational diabetes.

The Diabetes Prevention Program (DPP) is a simple chronic disease management program that focuses on making lifestyle behavior changes and goals of losing 5 to 7 percent of body weight and increasing physical activity to at least 150 minutes per week. It can lower risk for type 2 diabetes by 58% or more. [5]

A DPP that meets certain criteria may apply for CDC recognition. Lark DPP has achieved full CDC recognition and is the only AI-driven platform to do so. This status is the result of accomplishments such as successfully presenting a CDC-approved curriculum, reaching and engaging enough eligible participants, and attaining specific outcomes such as weight loss[6].

These are some characteristics of Lark DPP’s chronic disease management model.

• Presentation of the CDC’s PreventT2 DPP curriculum for weight loss and physical activity along with coaching on sleep, stress management, and other behaviors to manage blood sugar.
• 24/7 availability to patients.
• Healthy habit-building based on evidenced-based behavior change theories.
• Customized coaching for each patient using artificial intelligence backed by health experts.
• Immediate and infinite scalability at cost.

These same principles are used in other Lark programs for chronic disease management. Medicare Advantage payors can learn more as soon as they are ready by contacting Lark. There is no need to neglect consistent management in favor of urgent treatment when affordable, feasible, and effective management programs are available.