Patients with chronic diseases such as diabetes and heart disease can experience a range of challenges as they manage these conditions. Unfortunately, many providers underestimate the toll that chronic conditions have on a personâ€™s mental health and the countless other obstacles they encounter daily.
A lack of education is one of the most significant barriers to successful disease management. Many patients do not have a firm understanding of their condition and the steps they must take to properly address their symptoms.
This not only leads to poor compliance but can also prevent them from taking advantage of community resources and medical services such as care management. These services can prevent future complications, so not using them can lead to increased payer costs.
Many internal factors, such as cultural norms, adjustment to their condition, age, and self-perception, can impact a personâ€™s ability to comply with their treatment. If clinicians neglect to identify and address these concerns, patients are more likely to disengage with their treatment, increasing service utilization rates and health care costs resulting from disease complications.
Clinicians and insurers can improve patient outcomes, achieve better service utilization, and decrease costs by addressing these barriers. Offering more screenings and routine check-ins from nurses, care managers, and other health care providers are all effective strategies to reduce overhead.
Insurers can drive better care management utilization by offering increased reimbursement for these prevention-based services. Insurance companies should also consider increasing marketing for these services to drive awareness for members who need them most. This will help providers with early detection to lower costs and prevent costly, medically complex concerns from arising.
If you are concerned that your service offerings are not sufficiently safeguarding your bottom line, you may need to focus on expanding and strengthening your provider network. Contact TOG today for a consultation to explore your options.