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Until recently, the health care and insurance industries have
been primarily crisis-oriented. In most cases, chronic diseases
are managed only after they have surfaced, resulting in major
medical expenses from emergency visits, hospitalizations,
intensive care services and other procedures. The majority
of these costs are spent on preventable or manageable disease
categories such as cardiovascular, respiratory, metabolic
(diabetes, obesity, etc.), neurological, musculo-skeletal
and cancer.
Relying on managed care organizations and physicians as gatekeepers,
this cumbersome system often alienates the patient population,
in addition to driving up costs for both employees and employers.
The nation’s urgent need to contain health care costs
has initiated a new focus on wellness and disease control,
as well as a new challenge to the medical profession. Medical
professionals need to use health risk assessment data more
effectively to create a predictive model of cost-effective
utilization. This model must unite the available health resources
with the targeted, employee at-risk population. A well-defined
and disciplined approach to wellness is comprised of health
risk assessment, screening tests, health education, lifestyle
modification, self-care, disease protocols and disease case
management.
Employers and other payers are continually seeking new ways
to reduce costs associated with health benefits. In today's
market, shifting costs to providers and employees is a short-term,
marginal solution. Effective management of these costs involves
four important dimensions:
• Identifying major problems
• Effective risk management
• Effective administration
• Economical risk financing
The focus of managed care has been on risk financing, with
little attention given to risk management and loss avoidance.
Managed care programs have typically been characterized as
controlling the use of services and negotiating lower payments
to providers. Known as "post-occurrence" management,
this model of cost management no longer provides cost-effective
savings in our healthcare delivery system.
In order for payers to effectively optimize their health care
expenditures, they must aggressively address health risk management,
or loss avoidance. Attention must be placed on wellness and
prevention as integral components of health benefits.
Unlike risk financing activities, wellness programs must be
designed to assure active participation by individuals whose
health status is at stake. Employers have an interest and
an economic stake in having their employees make wise choices.
The most cost-effective means for employers to satisfy the
need for disease prevention and chronic disease management
is through an aggressive, pre-occurrence intervention program.
Properly designed, Web-based communication and health management
information systems provide logical, cost-effective solutions.
An equally important cost saving tool to the employer is a
real-time, web-based, benefit information management program.
These applications bring about greater accessibility, convenience,
and efficiency, and produce cost savings that cannot be realized
by legacy software applications, one-on-one encounter-based
systems, or traditional managed care approaches.
As the nation’s employers and insurers drive the health
care industry from occurrence-driven to pre-occurrence-based
health care delivery, the need for effective web-based benefit
management and wellness solutions – eCare solutions –
will continue to increase.
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