Why Disease Management?

"I am under a lot of pressure to find solutions to rising healthcare costs. In just six months, Matria was able to show me evidence that the disease management program was saving money for my company."

Chronic Conditions Out of Control

More than 40 percent of the American population, or 125 million people, have a chronic illness, such as asthma, congestive heart failure, depression or diabetes. Patients with chronic conditions account for approximately 76 percent of all hospitalizations and cause 65 percent of all U.S. healthcare expenditures.

Healthcare spending, currently more than $1 trillion, is estimated to reach $2.8 trillion by 2011, about 17 percent of the nation's gross national product. A recent survey by the Society for Human Resource Management measured an 18 percent increase in medical costs for employers in 2003. Another double-digit increase is expected in 2004.

Key Cost Drivers

Most healthcare costs are driven by unnecessary hospitalizations, emergency room visits and prescriptions due to poor medication compliance, deviations from treatment plans and lack of patient self-management skills.

With 65 percent of the U.S. population either overweight or obese, more Americans are developing chronic conditions than ever before. Obesity is the leading cause of heart disease, cancer, strokes and diabetes, according to the Centers for Disease Control (CDC).

Other causes of chronic conditions are poor but preventable lifestyle behaviors, such as overeating, poor diet, lack of exercise and smoking, as well as lack of adequate medical care due to mounting costs and preventive programs for at-risk individuals.

Disease Management Seen as Cost-Control Strategy for Rising Healthcare Costs

Nearly 41 million sick days and $11 billion in lost productivity could be avoided if everyone had equal access to proven medical treatments and therapies. More companies and health plans are turning to disease management as a way to fill in quality gaps left by attempts to control costs by restricting patient access to a full range of diagnostic tests and treatment options.

Rather than managing the costs for healthcare, disease management programs manage the care of the patient to ensure better outcomes. Emphasis is placed on prevention, early detection, patient education and self-care to reduce the need for physician office visits and, more importantly, expensive hospital care. Program results clearly show enrollees in disease management programs have fewer hospital admissions, fewer emergency room visits and lower overall healthcare costs.