obesity-993126_640Chronic disease has never been more of a burden for the US healthcare system than it is today. In 2005, it was estimated that 1 out of every 2 adults had at least one chronic illness. Episodic care is not a viable approach for managing chronic disease patients who require sustained treatment. Already, more than 75% of healthcare costs is spent on people with chronic conditions. To take control of spiraling healthcare costs, patients need human-powered programs and digital tools that encourage them to better manage their disease(s) and engage in self-care.

Many at risk providers and payors are launching technology-enabled case management and patient support services. These programs are led by nurses, patient navigators, medical social workers, lay healthcare professionals and in some cases even volunteers or peers. We’ve highlighted a few of the ways these programs are engaging chronic disease patients so that they improve their health outcomes.
 

Engaging extremely high risk patients

For extremely high risk high cost patients, many healthcare organizations are implementing complex case management programs. Their case managers make regularly scheduled home visits, such that this program is the most labor intensive. Many of these healthcare organizations also are giving patients home health monitoring devices that communicate important health vitals to their providers, and at-home access to their Electronic Medical Records and their personal health records. Although these programs have a high upfront cost, research has shown that the savings generated due to improvements in these difficult patients’ health outcomes is significant.

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Engaging high risk patients

To engage high risk chronic disease patients, the majority healthcare organizations are employing nurse navigators to either engage patients telephonically or through video conferencing. These nurse navigators ensure that patients understand how to follow their treatment plan and encourage them to follow evidence-based disease management strategies. By using technology to communicate, nurse navigators are still able to encourage and engage patients one-on-one in a more cost-effective manner than home visits.

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Engaging moderate to low risk patients

Chronic disease patients who are classified as low- or moderate-risk need continued and systematic support to ensure that they don’t become the high risk, high cost patients of tomorrow. Although currently underutilized, social media is an effective channel for engaging and ultimately improving the health outcomes of chronic disease patients. As it stands, 40% of consumers find health-related information via social media and 30% say they would share medical information on social media platforms.

Without overburdening providers, healthcare organizations can engage these populations at a manageable cost. Social media communities that focus on disease management can give chronic disease sufferers the peer support, guidance and information they need to engage in self care. By becoming activated members of social media communities, patients’ emotional well-being, psychosocial state and disease management skills can gradually improve.

When social media communities are monitored by medical social workers and nurses, it merges the benefits of peer support and professional guidance to patients. Without burdening physicians, these health community coaches have the ability to increase awareness of community resources and supportive care services, and even strengthen patient-provider relationships. This less resource-intensive medium complements at-risk providers’ and payors’ complex case management programs and allows them to continuously support a broader population of patients.

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