United Regional Health Care Gets Creative to Tackle Chronic Care Costs

The Texas health system is using a diabetes care management program that tracks engagement and pushes targeted resources and interactions to address care gaps and costs.

Editor's note:This article appears in the March 2023 edition of HealthLeaders magazine.

United Regional Health Care is seeing good results from a digital health program that ties together prescriptions and supplies, access to education and other resources, and connections to care providers for employees living with diabetes.

Through the program, the Texas-based health system can track per-member costs along with medication adherence and provider-patient interactions, allowing administrators to get ahead of the cost curve on chronic care management. They can spot gaps in care and personalize messages, resources, and incentives tied to lifestyle and care management.

As a result, they're seeing reductions in ED visits and hospitalizations and improvements in short- and long-term clinical outcomes.

"It's been a very positive program for us," says Heather Hormel, senior director of human resources for the health system. "It's a good way for us to remove barriers for people [who live with] diabetes and for those who manage care for people with diabetes."

Healthcare organizations, including health systems and payers, have long sought to improve chronic care management through technology and strategies that focus on more frequent interactions. Many are turning to remote patient monitoring platforms that allow care providers to interact with patients on demand at home, alongside other channels that can handle tasks such as supplies and education.

Heather Hormel, senior director of human resources for United Regional Health Care. Photo courtesy URHC.

United Regional Health Care works with Dallas-based CCS on this program, a partnership that has been in place since 2016. CCS, which began in the home-delivered medical supply business, has more recently expanded into education, monitoring, and clinical support through its LivingConnected program, in which it partners with digital health companies Welldoc and ZeOmega.

"The experience for those living with chronic diseases is fragmented, at best. At worst, it's negatively impacting the health outcomes and actual lives of patients," Marian Lowe, CCS' executive vice president and general manager of digital health, said in a press release. "That's why we're excited to bring together connected device data and marry that to the member's healthcare utilization through this partnership. Only then can we truly do more to help maximize preventive care and minimize unnecessary use of costly emergency department visits and hospitalizations."

To Hormel, the LivingConnected platform gives United Health an opportunity to help manage care for employees who might have difficulty integrating daily health and wellness habits to stay on top of a chronic disease that, if not managed properly, can lead to worsening health and death.

"It's all about engagement," she says. "Doctors are still very much driven by volume, and there are limits to their interactions. Health plans are sometimes able to coordinate those interactions better and can even be more proactive."

Diabetes care might be an ideal test case for this platform. Some 34.2 million Americans are now diagnosed with the disease, and the Centers for Disease Control and Prevention (CDC) estimates roughly one-quarter of all US healthcare costs are tied to diabetes care. Care management, meanwhile, is very much affected by lifestyle choices, including diet and exercise, making it vital that providers work with their patients on care management.

Experts estimate some 90% of people newly diagnosed with diabetes don't get the education they need within the first year to manage their condition properly. That includes learning how and when to test their blood sugar, how and when to administer insulin, how diabetes affects their health (including vision, circulation, and moods), how to spot dangerous health concerns like high or low blood sugars, and even how food choices and exercise affects their health.

"It's very expensive just to get the basics," says Hormel. "And that's before you factor in [lifestyle]. Unless you have diabetes, you probably don’t fully understand what it takes to treat it and manage it correctly."

Programs like LivingConnected also represent a point of confluence for payers and care providers, who can work together to manage a consumer's healthcare needs and costs. There are no delays when a member runs low on testing strips or insulin, or when a visit to a primary care provider or specialist is needed.

An important piece of the puzzle, Hormel says, is coaching.

"That's the key to making all of this work," she says. Members who aren't actively engaged in their care management tend to lose track of what they need to do every day, skipping tests or medication, and falling into bad habits that eventually lead to health issues. A member of the care team can connect through digital health channels and offer encouragement or advice, keeping members engaged in their care.

The concept isn't new or ground-breaking, save for the inclusion of digital health tools that improve home monitoring. These types of programs have been slow to gain traction because of the effort involved to produce patient engagement. But as payers and providers look to manage risk in tandem and get a handle on chronic care costs, they're more willing to fine-tune these programs and invest the time and effort into getting the technology and the frequency of interactions right.

"You have to take a leap of faith on this," says Hormel, who cites the cost of medication and diabetic supplies as a pain point that can be tackled through better care management (and one often overlooked in care management programs). "The more flexibility you can add to the program, the better chance you have of making that connection."

A program like LivingConnected, she says, can look at the data for each member and apply incentives to reach certain participation or wellness goals, funnel personalized education and resources, and even set up a coaching plan that kicks in when a specific member is most likely to need that support. The technology, be it AI software that can sift through a patient's insurance claims or smart devices that can track key physiological signs, activity, or medication use, helps to set parameters for those targeted messages or interactions.

As the healthcare industry continues to struggle with costs, they'll be more willing to adopt programs that combine care and cost management and use technology to improve engagement.

"We're learning a lot [through LivingConnected] about how we can improve engagement," Hormel says. "And we have a lot more to learn. But this is a very good way to learn."