Industry Voices—The counterintuitive way to lower costs for complex chronic diseases

While management tools can be highly effective for diseases like diabetes and hypertension, they come up short for more complex chronic conditions. (Alona Siniehina/Getty Images)

Chronic diseases are the most costly healthcare problem in the U.S. They account for 90% of the nation’s $3.8 trillion in annual healthcare spending, according to the Centers for Disease Control and Prevention. And they’ve long been a target of healthcare reform and digital innovation, from accountable care organizations to virtual programs that nudge and coach patients to better health.

While these efforts can be highly effective for diseases like diabetes and hypertension, they come up short for more complex chronic conditions like inflammatory bowel disease (IBD).

That’s because the best way to manage complex chronic diseases runs counter to existing solutions—limiting specialty care to drive down costs isn't part of the equation, nor is relying on patient education and behavior change. Instead, staying ahead of complex chronic diseases calls for a condition-specific, specialist-led population health management program.

Here’s why:

  • Like other chronic conditions, complex chronic diseases have an outsized impact on healthcare spending. IBD, which includes Crohn’s disease and ulcerative colitis, affects just 1.3% of the population but accounts for 3% of medical and 6% of pharmacy spend.
  • Complex chronic diseases are also highly variable in cost. IBD, for example, is responsible for over half the variable cost of care in gastroenterology.

That’s because symptoms of complex chronic diseases like IBD can come on gradually and flare up with no obvious triggers, making it difficult for patients accustomed to living with symptomatic chronic illness to recognize disease progression. This leads to serious complications that require more costly medical interventions.  

  • Symptoms of complex chronic disease also evade simple quantitative measurement and straightforward connections to patient behaviors.

Patients with diabetes can test blood sugar and hemoglobin A1c at home and directly impact those results with diet and exercise. Managing a patient with Crohn’s disease requires careful, longitudinal tracking of patient-reported outcomes and more hands-on clinical care than a primary care-oriented population health model or a digital-only solution can provide alone.

At first blush, bringing in specialists to manage complex chronic conditions hardly seems efficient. After all, specialist-led care for complex chronic diseases accounts for an estimated $937 billion in annual U.S. healthcare spending, not including the costs of specialty pharmaceuticals. However, as we’ve seen with IBD, more than half of the $6.3 billion spent each year on treatment goes toward hospital care. If the goal is to proactively manage disease and keep patients out of the hospital, there’s no better way to do that than to engage the experts in managing those disease systems.   

At SonarMD, we have evidence that methodical, specialist-led population health management can engage patients and keep them out of the hospital. We work with payers and specialists to align clinical and financial incentives, allowing us to remotely monitor patients and improve access to specialists when needed—driving down the overall cost of care. Our program tracks patient-reported outcomes and assigns a numerical value correlated to symptom intensity, so we can monitor patients over time and identify those who are deteriorating. We proactively connect patients to their specialists as soon as intervention is needed before symptoms escalate to emergency.

We’ve found patients are ready and enthusiastic to engage in this kind of physician-led, longitudinal care management. At MNGI Digestive Health, a Minnesota-based gastroenterology practice, we reached out to enroll patients in our co-branded IBD management program and enrolled 75% of eligible patients in the first three weeks of the collaboration. These patients see the program as a safety net; they are not required to determine when their symptoms are significant enough—the program does it for them.

Engagement is a critical first step to better managing chronic diseases and driving down costs. But the evidence goes beyond engagement. We’ve also shown our longitudinal, high-engagement program translates to better clinical outcomes and lower costs. For patients with Crohn’s disease, our solution reduced ER visits by 77% and hospital stays by 59%. It has helped lower the total cost of care by 15% per member per year.

The success of this program shows that not all chronic conditions are created equal. Some chronic diseases, especially those associated with a symptomatic chronic illness like IBD, are best managed with a hybrid solution—one that leverages the expertise of specialist physicians and allows for longitudinal patient monitoring. Only then can we begin to solve America’s biggest healthcare cost problem.

Beth Houck is the CEO of SonarMD.