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 

When combined with claims connectivity, condition management programs allow a deeper look into data to successfully identify and target high-cost claimants on the plan. It also provides the opportunity to expand reach and engagement beyond wellness program participants with a 360° view of an organization’s health risks. 


Improves Self-Management of Chronic Conditions  

The leading cause of unmanaged disease can often be attributed to lack of understanding and education. Case management nurses promote self-management strategies that educate and empower participants to improve disease compliance and better understand how to control their condition.  


Increases Physician Engagement  

In addition to self-care skills, effective condition management solutions provide care coordination between the member and their physician by ensuring compliance and removing barriers to care. By better understanding their condition, the member is more equipped to ask questions and more likely to schedule appropriate follow-ups with their healthcare provider. 


Improves Preventive Care 

Proactively managing conditions through preventative care and early intervention means individuals are less likely to experience health-related issues that result in costly claims. In addition, appropriate preventive screenings can prevent future complications and identify conditions that may otherwise go undetected. This can not only lower 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 

Last, but certainly not least – successful programs improve health literacy by educating members about their health plan, prescription medications, and how to seek the appropriate level of care. Understanding how their decisions impact their health can lead to better lifestyle habits, improved disease compliance, and 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.