making health management services work in the gcc
TRANSCRIPT
Perspective Ramez ShehadiAli HashemiWalid TohmeJad Bitar
Making Health Management Services Work in the GCC
The growing prevalence of chronic diseases in Gulf Cooperation Council (GCC)1 nations generates higher healthcare costs, lowers productivity, and clogs healthcare service channels. Adopting health management services (HMS) can address the epidemic by helping chronically ill patients understand their disease, amend their behavior, adhere to treatment regimens, and navigate the healthcare system. But before GCC governments and healthcare organizations can put HMS programs into practice, they will need to start answering strategic questions about the objectives of these programs and how they will work in practice.
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THE CASE FOR HMS
services in their overall healthcare strategies. These services work primarily in two ways: They help mitigate the spread of chronic diseases by establishing wellness programs and other preventive strategies, and once a chronic disease has been diagnosed, they reduce the costs of treatment through ongoing monitoring and frequent interaction with the patient.
Health management services (HMS) programs bundle a prescribed set of healthcare services into condition-specific programs that are based on scientific evidence and data analysis. The healthcare services address patients’ needs in terms of risk identification, awareness and education, adherence to treatment regimen, monitoring of health indicators, and care coordination. The HMS program assists individual patients in improving their health by creating a support system that helps them manage their condition, providing critical guidance and employing incentives to encourage
healthy behavior. HMS also strengthens relationships between hospitals, physicians, and patients by creating a continuous view of patient care that competitors without such programs cannot match.
By supporting individuals in maintaining their health and helping chronic patients with their conditions, HMS programs have a direct impact on healthcare costs. Although such savings are often difficult to quantify, numerous studies have demonstrated the benefits of HMS to individuals’ health, as well as to overall healthcare costs. For instance, a study published in Health Affairs in 2004 showed an 8.1 percent drop in the hospitalization costs of diabetes patients after they were enrolled in an HMS program to help manage their treatment.2 Such success stories have led more health insurance companies and payors to adopt these services as a way of controlling their soaring healthcare costs.
Across the GCC, unhealthy lifestyles and aging populations are leading to a higher prevalence of chronic disease, which drive up healthcare costs and keep economies from performing at their true potential. Chronic diseases strain healthcare providers and the overall healthcare system by leading to frequent and costly trips to the emergency room and longer average stays. Long and resource-intensive treatment periods make patients with chronic disease heavy users of healthcare services, leading them to consume a disproportionate amount of the total available services.
To counter these trends, GCC governments, healthcare organizations, and private insurers can deploy health management
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MAkinG HMS WORk
There are three keys to success in deploying HMS programs, all of which are relevant to GCC markets:
incentives: Well-designed HMS programs provide consumers with a variety of incentives to ensure participation, such as reduced premiums, cash incentives, and redeemable reward points akin to the credits offered by various reward programs. HMS programs are also using negative incentives such as increased premiums or co-pays for patients who don’t enroll. Increasingly, programs are adopting a combination of both—negative incentives to ensure enrollment and positive incentives to effect behavioral change.
Physician involvement: Coordinating program interventions and other elements with the patient’s physician is another critical facilitator of program efficacy. In a case in which drug adherence is identified as a problem, for instance, involving the physician doesn’t just entail the communication of critical information; it also creates an opportunity for the physician to intervene and reinforce the importance of sticking to the drug regimen. Given the low level of
health literacy and awareness of health issues in GCC countries, patients in this region are more reliant on physicians than patients in other markets, making physician involvement all the more critical.
Personalization: Tailoring communications and incentives to the individual’s tastes and preferences is a new and evolving trend credited with increasing patient compliance with HMS programs. Incentives and other aspects of the plan’s design are customized to adjust to the individual participant’s ability to change. HMS providers are building large databases of consumer information to document the success of interventions, incentives, and communications, and to leverage these large data warehouses to personalize their interactions with other patients.
Healthcare insurers’ overall HMS strategy will determine the ways in which these building blocks are used. They will need to employ analysis, judgment, detailed design, and piloting of alternative concepts, as well as allocation of significant resources for implementation. To help jump-start the process and lay a sound foundation for successful implementation, GCC governments and healthcare organizations must assess their current overall healthcare strategy to address a number of strategic questions:
• What are the target objectives for the HMS program?
• Which segments of the population will be targeted? How will the program be designed to address the cultural characteristics of the population?
• What incentives will be required to ensure significant program adoption among targeted segments?
• How will health management services be funded? How will the costs (and risks) be distributed among the various stakeholders?
• Through which entity will the programs be offered? Will it be a public–private partnership between a GCC government and an international disease management/wellness company, or will it be an entirely private undertaking?
Chronic disease management is an issue that GCC nations can ill afford to ignore. Well-crafted HMS programs are a valuable tool that can help GCC nations stem the rising tide of chronic diseases by helping to identify unhealthy and risky behaviors, raise awareness of underlying lifestyle factors, improve adherence to treatment regimens, and strengthen the bonds between patients and physicians. However, GCC governments must start answering these strategic questions today in order to lay a strong foundation for health management services in the future.
1 The GCC includes Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. 2 Victor G. Villagra and Tamim Ahmed, “Effectiveness of a Disease Management Program for Patients with Diabetes,” Health Affairs, vol. 23, no. 4, 2004, 255–266.
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