Information for Insurers

Today one would not likely dispute that chronic conditions are the leading cause of illness, disability and mortality in the U.S. Evidence is strong that much can be done to prevent many chronic conditions and manage them once they occur. Additionally, individuals have a significant interest in their personal health and well-being.

Insurers are considering:

  • What interventions, supports or approaches are viable to reduce disease risks and enhance health status?
  • What is a reasonable investment to provide these interventions to enrollees?
  • How can we offer these types of supports to enrollees/members in ways that optimize the care networks we are already paying for?
  • How can we encourage patient self-management in ways that do not compromise quality of care?

The Morethansurviving® programs offer you innovative, simple and inexpensive platforms for delivering high-quality supports to your enrollees and their clinicians.

These interventions build on:

  • Scientific evidence on reducing disease risks
  • Sophisticated approaches for integrating behavioral medicine models and techniques
  • Mechanisms to utilize the influence of the enrollee’s physician and other clinicians to support change
  • Pricing structures that can be justified—even for enrollees with very low utilization or projected health risks
  • Simple consumer-friendly delivery platforms

How It Works: These intervention programs can provide your enrollees with tailored, actionable supports to self-manage disease risks and optimize their health. These supports focus on specific disease areas or health-related topics. For instance, an enrollee could begin with an assessment of factors related to risk reduction for diabetes or another condition. Upon completion of the assessment, the patient immediately receives feedback that is tailored to his or her unique needs, interests, and motivation.

Programs are designed so that the enrollee’s physicians and other clinicians can receive tailored information for that patient.

There are numerous ways in which these programs can be structured and delivered. Hence, many options to customize a program to your organization’s needs are available. For instance, in a community health center setting, patient information and counseling tips can go directly into the patient’s medical record. In settings where there is a distant relationship between your organizations and the patient’s provider, the patient has various options to direct their tailored data to his or her physician.

Design Components:

  • Each program is designed by a team of nationally recognized clinician/researchers.
  • Programs have a heavy emphasis on behavioral approaches which can enhance patient self-management and physician support.
  • Clear site layouts with no advertising or clutter.
  • Simple navigation systems and content which medically underserved patients can succeed with.
  • Interventions that optimize existing patient care networks.
  • Immediate tailored feedback.
  • Reassessment and progress reporting or next stage materials for subsequent use of programs.
  • Multiple languages (many programs)

Pricing and Value

As mentioned previously, evidence is strong that much can be done to manage or prevent chronic conditions. When determining the value of investments in programs to do this, some underlying considerations often are not adequately evaluated:

  1. Most of the base that disease and health management programs are built on is in the public domain. The amount of research and evidence related to best practice care and helping patients improve health lifestyles is vast and continually emerging. Implications are:  (a) As more competitive intervention strategies emerge, vendors will all gravitate toward them with program offerings that are more similar than different. (b) Price will be a significant value discriminator. (c) Proprietary claims of vendors will be narrow.
  2. Although the disease management programs we offer for higher-risk enrollees have significant value, the direct short-term economic value of preventive programs for lower-risk enrollees is limited. Once disease prevalence, incidence and enrollee turnover are considered, the amount of direct net $s saved by investments in prevention are likely to be small. Hence: (a) Program costs for prevention and well-being interventions need to be very low. (b) Indirect benefits of providing preventive supports to lower-risk individuals need to be considered. There are opportunities to strengthen brand, enhance consumer perceptions of quality and reduce enrollee turnover. (c) Low-cost preventive programs that have higher enrollee utilization or satisfaction have particular value. (d) Return on Investment (ROI) calculations produce limited insights—no matter what you include in an analysis, or how it is conducted. For instance, a very-low-cost intervention for lower-risk patients could easily produce a ROI of 10 when all direct and indirect impacts are considered. Yet the total dollars saved may not be significant.
  3. Integrating disease and health management initiatives into existing care networks makes tremendous economic sense. Although there are some exceptions, physicians typically have direct, current and accurate clinical data at their disposal. Additionally, they have strong relationships with their patients (at least patients consistently say this is true). Although physicians get discouraged with patients who do not fully implement their care advice, physicians have powerful influence with their patients.

Evidence suggests that, given supports that are realistic to integrate into usual care, physicians and other caregivers will support evidence-based programs.

Pricing:  PHCC is a private non-venture backed company that has been in business since 1993. Pricing is based on actual enrollee/member utilization. Depending on the number of enrollees covered and range of programs offered by your company, and specific programs offered, intervention program costs $1 – $15 per individual user.

You may have seen similar intervention approaches or content priced at higher levels which may cause you to question the value you receive from PHCC or our long-term stability. But as you will see from program demonstrations and the medical and behavioral science evidence used in developing our programs, these are robust, high-quality interventions.

  • The availability of interactive software and internet- and intranet-based delivery systems allow us to offer intervention supports at these prices.
  • We have received numerous grants from the National Institutes of Health over the past several years which have reduced our program development costs.
  • We have maintained a low-cost operating structure with very limited marketing expense.
  • We have considerable experience conducting evidence reviews, building software platforms and performing quality control checks, so we do this very efficiently.

PHCC has the organizational stability and program development expertise to address your future needs and advance our product offering as science advances.

Consider: If you were reviewing a medication for a formulary you would likely include a generic if it produced the same quality effect as a name brand medication—even if it was only 15% of the cost of the brand drug. Investments in disease management interventions can follow a similar logic/decision-making process.

For patients with more serious complications and frequent hospitalizations, we offer other competitive strategies not covered by our internet-based offerings.

Please explore the information on this site and contact us if you would like more details concerning these programs.