Proactive Care Strategy Today

Obesity is more prevalent than previously reported, affecting an estimated three in four U.S. adults, and it is a chronic disease with risk rising as waist circumference increases. It drives significant medical costs and productivity losses. While weight loss is possible, obesity cannot be cured and requires ongoing management, similar to type 1 diabetes. Environmental changes, healthy eating, and physical activity can reduce weight, but disease-related physiological factors

Want to reverse the trend in escalating medical costs? Start by reducing avoidable inpatient utilization for heart attack, stroke, and heart failure through earlier identification and management of chronic underlying conditions such as obesity, diabetes, hypertension, and hyperlipidemia. This is not a groundbreaking strategy, but few have executed it well. Success requires removing barriers that delay access to high-value care, especially primary care, and eliminating adminis

Is hidden cardiovascular disease already costing employers through reduced productivity, or does it only matter once a claim occurs? Even if employers expect to retain workers for only three to four years, the case for proactively optimizing weight (including waist circumference), blood pressure, cholesterol, and blood sugar remains strong. Progressive atherosclerosis and the resulting arterial stenosis can reduce blood flow to the brain, contributing to presenteeism through

There are always risks and benefits to any medical intervention, and they are both clinical and financial. In today’s healthcare environment, a strong provider–patient relationship can minimize clinical risk and maximize therapeutic benefit, but it rarely addresses the financial dimension, raising important questions about whether cost should be part of treatment decisions and whether patients should be supported to act as informed consumers alongside those bearing financial

Diabetes, hypertension, and hyperlipidemia are all associated with increased risk of earlier mortality, yet we have been far more effective at creating urgency around blood sugar control than we have around managing blood pressure or blood lipids. This imbalance in perceived risk shows up in patient behavior, as evidence suggests people are more reluctant to discontinue diabetes medications, particularly insulin, than statins or antihypertensives, even though all three condit

Dementia should scare everyone into more proactive action, it certainly scares us, because brain disease carries a far greater potential for lifelong burden than many other chronic conditions, including heart disease. One of the most practical strategies we have is setting realistic and achievable healthy movement goals, while immediately removing the myths around “fitness” created by the industry, because it does not take much movement to generate meaningful health benefits.

When we review quarterly and annual benefits data, we often group by place of service, clinical category, or average member total cost, which is valuable only if it is paired with a deeper understanding of the unique whole people seeking care and creating those costs. Continually looking for ways to better understand each person is essential: is it hypertension or chronic pain, depression or chronic pain, or chronic pain leading to depression? Medical trainees are taught to “

We have discussed why including waist circumference is valuable in creating definitions of obesity for better PROACTIVE CARE strategy and better health outcomes for members, not to create cliques or judgment, but to define cohorts who carry increased risk for morbidity and mortality due to higher amounts of adipose tissue. In medicine, we create cohorts to create action, diagnosing appropriately so we can treat appropriately and attribute limited healthcare resources to thos

Every medical intervention carries both potential benefits and risks, and expecting individuals to diagnose and manage their own care based primarily on advertising or consumer marketing is neither realistic nor appropriate. Over time, increasing barriers to care and the erosion of the doctor–patient relationship have diminished the role of medical expertise, leaving many health decisions influenced more by digital media than by clinicians. Women using GLP-1 receptor agonists

Much of the current high-cost category spend (claims) is preventable with PROACTIVE CARE , yet we often think of chronic diseases as solitary, separate, and unavoidable parts of the human condition when this isn't always true. In many cases, they are the result of multiple, interrelated, and self-imposed factors that can be influenced by reducing environmental exposures such as poor diet and sedentary behavior, where even small decreases can yield significant risk reduction a

Part of a sound PROACTIVE CARE benefit strategy is removing all barriers to acute treatment and maintenance of symptoms like chronic musculoskeletal pain by making physical therapy and cognitive behavioral therapy as easy as possible for members. If people feel they cannot get their pain addressed efficiently, they will end up utilizing higher-acuity, higher-cost care such as the emergency department and specialty services, while also generating a significant amount of occul

When looking to reduce cardiovascular (heart attack, arrhythmias, etc.) and neurovascular (stroke) spend, it is critical to remember that you are serving whole people, not isolated conditions; mental health strategies should be included from the very beginning. When working with limited budgets, investing wisely in behavioral health upfront can positively influence downstream spend across all other high-cost categories, because with behavioral health you can see the total val

Many of the top drivers of medical spending and high-cost claimants trace back to five root causes, most of which stem from lifestyle...

Even if behavioral health isn’t among your top five highest-spend clinical categories, it’s a critical area for strategic investment....

Have you noticed your Circulatory Health Condition Category per member per month (PMPM) cost trend rising more each year? This may be due...

How much should we spend to treat obesity? How much should the plan pay? How much should the member pay? These questions cannot be...

Choosing whether to launch or sustain an employee wellness program can be a tough call for benefits teams, especially amid tight budgets...

As benefits teams increasingly pursue value-based care models with medical providers—paying for quality and outcomes rather than volume...

Understanding how decisions like the new COVID-19 vaccine access limits will affect population health and subsequent health plan...

When aiming to improve population health and reduce the incidence of high-cost, high-impact conditions like coronary artery disease,...