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Managing health in an age of reform

January 26, 2011
Joseph Berardo
From the January 2011 issue of HealthCare Business News magazine
This report originally appeared in the January 2011 issue of DOTmed Business News

By Joseph Berardo

The good news about health care reform is it provides new reimbursement models and behavior incentives for both patients and physicians – paving the way for innovative wellness and prevention strategies. Specifically, new grant programs support the delivery of evidence-based and community-based services aimed at reducing chronic disease rates and addressing health disparities.

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This gives businesses, organizations and communities an opportunity to jumpstart cost-cutting initiatives. In terms of health care, the critical focus lies in controlling chronic illness and adopting health information technology that generates supportive data. With this in hand, it’s much simpler to track individual health costs and implement appropriate interventions or behavioral changes.

For example, consider two patients with diabetes: The first one manages his diabetes well. He gets his hemoglobin A1c levels tested; he exercises; he watches what he eats. As a result, his monthly costs are roughly $147 for the plan. The second diabetic patient is a different story. He does not watch his diet, exercise or take any other steps to manage his illness. He has admissions to the hospital and other co-morbidities as a result. His price tag is closer to $1,800 a month.

Two people with the same disease can exhibit different behaviors, resulting in a huge cost differential. A strong technological infrastructure provides health data that are easy to use when assessing individual health needs. It’s the first step toward helping every individual make better health and lifestyle choices, from a quality perspective as well as a cost perspective.

The role of health management
A physician’s ability to closely monitor a patient, including an individual’s progress over time, can improve an individual’s care and the overall health of a population. With the right data analytics, health managers can determine gaps in care and intervene when necessary by, for example, prescribing appropriate medication, recommending a diet or outlining an exercise program.

A robust health management program combined with data analytics technology optimizes fiscal sustainability over the long run. Health information can be quickly sifted and sorted by age, medical conditions, chronic illnesses, risk factors, lab results, and drug interactions. On a large scale, this allows health managers to take action and provide optimal prevention and wellness programs.