Key Takeaways

Managing a chronic condition isn’t only stressful and burdensome for patients — it’s also extremely expensive. 

One main reason for the excessive cost is the complexity inherent to treating chronic conditions. Patients often need to take multiple medications, arrange ongoing specialist visits, and undergo continuous medical interventions — all of which are time-consuming and expensive for everyone involved. 

With many chronic illnesses on the rise, the cost of treating them will only continue to go up. Health plans are looking to manage the cost of care, but want to do so without sacrificing quality or patient outcomes, and this is where healthtech can play a crucial role.

What are some of the most costly chronic conditions?

All chronic conditions are costly, but some stand out from the rest. Five of the most costly chronic conditions include:

  1. Heart disease and stroke - The total medical costs of heart disease and stroke in the U.S. are estimated to total $219 billion per year. And at the individual level, one study found the average out-of-pocket cost for Medicare beneficiaries to treat these conditions exceeds $2k per year. 
  1. Diabetes - The direct medical costs of diabetes in the U.S. — including hospitalizations, physician visits, and prescription medications — totaled $237 billion in 2017. 
  1. Cancer - Totalling around $147 billion per year, cancer care requires expensive treatments — like chemotherapy and radiation therapy — and presents unique challenges to patients and providers alike. In fact, some treatments can even exceed $1 million in price.
  1. Arthritis - This condition affects millions of Americans and can lead to costly medical interventions — like joint replacement surgery. Medical costs for treating arthritis in the U.S. total $140 billion per year.
  1. Alzheimer's and dementia - These are chronic conditions that can require expensive long-term care. Alzheimer's disease and other dementias in the U.S. cost an estimated $290 billion per year.

How can payors use digital healthcare to help manage chronic conditions while reducing costs?

Payors face mounting pressures to improve member experience and address snowballing costs associated with ballooning chronic conditions in the U.S. That’s why adopting digital healthcare tools built for simplifying chronic care management is imperative. 

Intelligent care enablement — scalable technology that supports both patients and care management teams through complex clinical episodes — is particularly well-positioned to help advance efforts to streamline chronic care management for members.

Here’s how these types of digital health solutions can help:

1. Scaling chronic care management

In an ideal world, every member with a chronic condition would have a 24/7 care assistant. With the number of individuals with chronic conditions on the rise, that might sound impossible. But healthtech innovations can help payors deliver always-on support. Digital healthcare platforms like Memora Health use AI-supported automation to streamline key elements of the care journey, including member education, appointment prompts and reminders, and symptom triage. For health plans, that means reaching and engaging with more members without hiring more care managers. And it also means more consistent and thorough support for members to improve satisfaction, cultivate loyalty, and help improve health outcomes.

2. Improving medication adherence

It’s widely accepted that medication adherence is essential for successfully managing chronic conditions. But 50% of patients don’t take their chronic long-term medications as prescribed. Fortunately, digital health platforms can help members stay on schedule. While many healthtech innovations simply remind members to take their meds, the most forward-thinking digital healthcare platforms can even respond to member requests for refills and answer questions about medication regimens using natural language processing (NLP).

3. Educating members with condition-specific information

One of the best ways to support members with chronic conditions is to help them self-manage their care. Providers do their best to educate individuals before they leave the medical office, hospital or virtual visit  to ensure they understand the details and instructions related to their care plans. But with over 50% of patients forgetting to ask important questions before or during hospital visits, how can payors help members understand their care journeys and what to expect? Healthtech can proactively engage members to help them understand their treatment, intelligently interpret member questions and respond using NLP and check in with members to identify any concerns before they develop into acute needs.

4. Providing consistent preventive care guidance

Although some chronic conditions can emerge unexpectedly, many are preventable. That’s why investing in prevention is one of the best ways for payors to reduce total cost of care. For example, the CDC cites that increasing the colorectal cancer screening prevalence to 70% could reduce Medicare spending by $14 billion in 2050. The right digital healthcare platform can send preventive care reminders to members, assist with appointment scheduling with in-network providers, and even help members find transportation to their appointments.

5. Assessing member needs and social determinants of health (SDoH)

SDoH contribute significantly to disparities in chronic conditions outcomes. If payors are to play an active role in helping members manage their chronic conditions, they must invest in solutions to address barriers that may prevent members from accessing needed care. Text-based digital health innovations can reach people from all backgrounds, regardless of their access to broadband or a smartphone. The most inclusive healthtech options help payors collect information they need to better understand their members — and even help connect members to resources to address gaps in care.

As the cost of healthcare in the U.S. continues to rise, payors need to map out concrete plans to simplify and improve chronic care management. By identifying ways to prevent and support managing these conditions effectively with digital health, payors can help reduce costs while delivering high-quality care for their members.

Interested in learning more about how your organization can use digital health to support chronic care management? Speak with one of our experts today!