Sterling Wellness Employee Wellness total solution with health screenings, health coaching and wellbing platform

How Condition Management Lowers Rising Claims

Condition Management nurses can help you understand how your results impact your health

Chronic Condition Management is nothing new in the world of workplace wellness, yet more and more organizations are jumping aboard. And the reason is clear — with an increased level of care and clinical support, condition management can make a significant impact to population health and rising claims. 

Not sure how it can help your organization? Check out these five ways we’ve seen condition management impact our client partners.  


Diverts High-Cost Utilizers 

Condition management programs, when integrated with claims connectivity, offer a comprehensive approach to analyzing data in order to effectively pinpoint and address high-cost claimants within a health plan. By leveraging this combination, organizations can gain valuable insights into the health status and needs of their members, allowing for targeted interventions and support.

This integrated approach also enables organizations to extend their reach and engagement beyond just participants in wellness programs. By obtaining a 360° view of an organization’s health risks, they can identify individuals who may benefit from additional support and resources to improve their health outcomes.

When combined with claims connectivity, condition management programs not only enhance the effectiveness of identifying high-cost claimants, but also allow for a more holistic approach to managing health risks and promoting overall well-being within an organization. 


Improves Self-Management of Chronic Conditions  

One of the primary reasons diseases go unmanaged is due to a lack of understanding and education. Many individuals may not fully comprehend their condition, the necessary treatments, or how to effectively manage their symptoms. This lack of knowledge can lead to poor disease compliance and ultimately worsen their health outcomes.

Case management nurses play a crucial role in addressing this issue by promoting self-management strategies. These nurses work closely with patients to educate them about their condition, treatment options, and lifestyle changes that can help improve their health. By empowering patients with the knowledge and skills to manage their disease, case management nurses help individuals take control of their health and make informed decisions about their care.

Through education and support, case management nurses help patients better understand their condition and how to effectively control it. By promoting self-management strategies, these nurses empower individuals to take an active role in their health and improve their overall well-being. Ultimately, by increasing understanding and education, case management nurses play a vital role in helping individuals better manage their diseases and live healthier lives.  


Increases Physician Engagement  

Condition management goes beyond just self-care skills and encompasses a comprehensive approach to managing a member’s health condition. This includes providing care coordination between the member and their physician to ensure that the member is following their treatment plan and receiving the necessary care. Care coordination involves removing any barriers that may prevent the member from accessing care, such as transportation issues or financial constraints.

By actively participating in their condition management, the member gains a better understanding of their health condition and how it can be managed. This knowledge empowers the member to ask informed questions during medical appointments and advocate for their own health needs. Additionally, being more knowledgeable about their condition makes the member more likely to schedule and attend appropriate follow-up appointments with their healthcare provider.


Improves Preventive Care 

Proactively managing conditions through preventative care involves taking steps to maintain good health and prevent the onset of illnesses or diseases. This can include regular check-ups with healthcare providers, staying up-to-date on vaccinations, maintaining a healthy diet and exercise routine, and avoiding harmful habits such as smoking or excessive drinking. By addressing potential health concerns early on, individuals can reduce their risk of developing serious health issues that may require costly medical treatments or interventions.

Early intervention is also crucial in preventing health-related issues from escalating. By identifying and addressing health concerns at an early stage, individuals can often avoid more serious complications or long-term consequences. This can involve seeking medical attention promptly when symptoms arise, following recommended treatment plans, and making necessary lifestyle changes to improve overall health and well-being.

Preventive screenings play a key role in detecting potential health problems before they become more serious. These screenings can help identify conditions such as high blood pressure, diabetes, cancer, and other diseases that may not present symptoms in the early stages. By undergoing regular screenings as recommended by healthcare providers, individuals can take proactive steps to address any health issues that may arise and prevent them from progressing further.

This not only lowers the likelihood of emergency room visits, but it can also mitigate more expensive treatments for diseases that have progressed beyond regular management.  


Builds Better Healthcare Consumers 

Successful programs that focus on improving health literacy play a crucial role in educating members about various aspects of their health plan. Case management nurses provide information on coverage details, benefits, and how to effectively utilize their plan to access necessary healthcare services. By increasing awareness and understanding of their health plan, members are better equipped to make informed decisions about their healthcare needs.

In addition, these programs also aim to educate members about prescription medications, including proper usage, potential side effects, and the importance of medication adherence. By empowering individuals with knowledge about their medications, they are more likely to take them as prescribed, leading to improved health outcomes and reduced risks of complications.

Educating members on how to seek the appropriate level of care is essential in promoting proactive healthcare management. By understanding when to visit a primary care physician, seek urgent care, or go to the emergency room, individuals can receive timely and appropriate treatment for their health concerns. This not only improves health outcomes but also helps to prevent unnecessary healthcare costs and reduce the burden on the healthcare system.

Increasing health literacy can have a significant impact on individuals’ health and well-being. By empowering members with knowledge and understanding of their health plan, medications, and healthcare options, they are better equipped to make informed decisions that can lead to better lifestyle habits, improved disease management, and ultimately, reduced healthcare spending. 


What’s the verdict?  

When employers integrate condition management into their existing wellbeing program, they can empower employees to make better, more informed decisions about their health. It also allows an organization to build strategies to effectively address prevalent conditions. With effective strategies and ongoing support, these programs can increase patient adherence and lead to reduced healthcare expenditures. 

Sterling’s high-touch approach to condition management combines claims connectivity and health screening data to assess the health of your full population. Through claims analytics our team of expert nurses are able to identify high-cost drivers on the plan and target individuals who need care the most.

Connect with us to learn how our condition management programs can impact your organization.