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  • Writer's pictureNew Edge Solutions

Not So Surprising Results (At least to New Edge): Disease Management vs. Lifestyle Management

There’s a misconception that all wellness and well-being programs are created equal. That they are all inherently the same. Maybe that’s the problem with the terms “Wellness” or “Well-Being.” They’re too broad.

Let’s start with a little background. Most Americans access their healthcare through their employer's health insurance plans. What started as a tool offered by employers to attract and retain the best employees sometime around the end of WWII first became an expectation, and then a mandate, for some employers after the implementation of the Affordable Care Act in 2010. Over the years, employer-provided health insurance has increased in cost to the point that it has become one of the top line items on a business's balance sheet, often only second to salaries.

Back to wellness plans. With the increase in costs for workplace health insurance, wellness plans soon became one of the solutions presented to employers to reduce costs. The idea is simple; healthier employees are less likely to have big health events that cost a health plan big dollars. With fewer big-dollar health events, employers who help their employees stay healthier should see lower health insurance renewals. “Let’s introduce a program that helps employees get healthier!”

This idea has proven correct. It does, however, matter what type of program an employer has in place.

Wellness/wellbeing programs focus on two areas: lifestyle management and disease management.

Lifestyle management includes things like smoking cessation, 10,000 steps a day, healthy snacks in the breakroom, yoga at lunch, etc. These all make employees feel good, and there is value in that, but they don’t quite move the needle when it comes to cost.

Disease management takes a more focused approach to those that already have a chronic illness like Diabetes, Heart Disease, High Cholesterol, Asthma, and COPD.

The thought is that the most attention should be paid to the members that are at the highest risk to the plan. It can even focus on members with conditions like depression, bipolar disorder, and anxiety. Encouraging changes for these members has an outsized result on health plan costs which, you guessed it, results in lower future health plan costs.

These suggestions have been confirmed by a 2014 RAND study* that showed a return of $0.50 for every $1.00 invested in a lifestyle management program compared to $3.80 ROI for every $1.00 invested in a disease management program.

Our own patented Chronic Disease Management program supported by nurse coaches tracks 27 chronic conditions and has born similar fruit. These strategies have been applied to over 2.5 million members and have been statistically validated to deliver medical claims cost savings of between 11-17%.

At New Edge Solutions, we place our focus on the areas that make the biggest impact. It’s healthcare risk management that makes a difference to an employer’s bottom line. It’s not just the disease management that we implement, it’s in the fabric of all of the solutions that we bring to employers.

Let’s be more specific from now on: Disease management programs and lifestyle management programs. One is pointed and focused. Encouraging healthy behaviors amongst the health plan members drive the most costs. Proven to have a great impact on underlying health plan costs. The other is a feel-good program that people like. There’s a place for both but only one of them will have a significant impact on a business’ health insurance costs.

*If you want to read the full RAND study, it can be found here

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