Nearly 60% of Americans live with a chronic disease, such as heart disease, cancer and diabetes, that impacts their quality of life and requires active daily management.

While patients have historically relied on their physicians to help them manage long-term conditions, this has become more burdensome for providers due to the complexities of comorbidities, growing life expectancies and larger patient panels. 

In addition to the burden placed on providers, chronic disease is a significant, and largely preventable cost burden, especially for older patients with multiple chronic conditions. More than half (53%) of Medicare's annual spend can be attributed to the 18% of the Medicare population with six or more chronic diseases.

When you layer a nationwide provider shortage and the ongoing shift of costs from payers to providers on top of them, it’s clear chronic care management (CCM) is overdue for innovation.

The need for comprehensive care models 

Traditional care models have always attempted to make patients active and accountable participants in their own wellness journeys, but results have been mixed. 

For example, diabetes management requires extensive education and behavioral interventions – including medication, nutrition, exercise and self care. Maintaining these habits over time can be challenging, even for the most motivated patients.

“Almost half of patients with diabetes are coping with some form of chronic depression due to the complexity and 24/7 nature of the condition, so mental health care is a vital element of the care program,” says David Weingard, Chief Strategy Officer and founding team member of a stealth company incubated at Redesign Health that empowers endocrinology practices to deliver comprehensive, value-based diabetes care.

The most effective CCM programs must holistically address the social and environmental factors that impact patients’ health, through both primary and specialty care. But many provider organizations lack the time and administrative resources to stand up such a comprehensive and billable CCM program. 

Why healthcare startups are poised to improve CCM for all

A new type of patient-centered, wraparound care offers a solution to these challenges. In this model, providers work alongside patients, using tech-enabled tools across multiple specialties and conditions. 

Third-party innovators, like Redesign Health’s Operating Companies, are uniquely positioned to develop a comprehensive approach to CCM that helps patients stay as healthy as possible and reduces the burden on physicians.

1. Innovation offers a clear path forward.

The rise in telehealth utilization and the maturation of communication technologies open the door to infuse innovation within CCM journeys. “Furthermore, the CCM cohort of CPT codes that are available since 2014 from CMS have provided opportunities for start-up companies to structure a support network for patients, coordinate care across the healthcare ecosystem and communicate effectively across the network so all caregivers are engaged and set to optimize care for the patient,” says Scott W. Disch, a Venture Advisor at Redesign Health.

2. Health plans need strong partners to deliver deeper CCM insights to their members.

Health plans and employers are improving CCM by expanding reimbursement models and offering patient-facing programs designed to work across disease states. But health plans can’t take a deep dive into a disease state or identify specific behavior adjustments to improve their member’s overall health, because of this focus on breadth over depth. Oftentimes, these call centers are staffed by coaches or clinicians who are primarily trained to triage immediate needs for high volumes of members. 

“A partnership with a healthcare startup can supply the domain expertise at scale to ‘go deep’ within a disease state,” Weingard says. “The complementary value of the startup world—coupled with the health plan’s real-world expertise and access to members—can provide significant opportunities for scaled and improved patient care.”

3. The transition to value-based care will require proven use cases.

A comprehensive CCM solution enhances outcomes in the current fee-for-service environment. It also provides proof points which can be used to build case studies which support a seamless transition toward value-based care models for all stakeholders.

Our approach to building CCM-focused operating companies

While some startups provide point solutions for CCM with one or two direct care interventions, this approach is too limited. Delivering true wraparound care is critical to improving outcomes and increasing billable provider revenue.

To this end, we’ve already launched eight Operating Companies that provide wraparound care across multiple specialties —heart disease, cancer, behavioral health —and we have nearly a dozen more in our pipeline. 

Our operating companies strive to enhance CCM across the board by:

• Improving the patient experience with real-time medication adjustments, care coordination and supportive touch points between appointments
• Enhancing patient adherence to their care plan, driving measurement-based care decisions and encouraging patients to use less costly sites of care
• Engaging all of a patient’s caregivers to reduce the chances of unneeded tests, delays in care or poorly aligned treatment
• Reducing provider workload and enabling them to practice at the top of their licenses
• Making it easier for providers to infuse social services into the CCM process
• Integrating automation to reduce documentation shortfalls, improve compliance and engage a wider patient base

“Combining a CCM program with direct care interventions helps patients and caregivers connect with their provider network in a meaningful way, while offering providers an ‘air-traffic controller’ of healthcare to hotspot issues before they arise, engage in and improve quality care outcomes, and be an ombudsman for the patient as they navigate decisions with their chronic illness,” Disch says.

Final thoughts

When providers must rely on office visits alone to manage patients’ chronic conditions, it creates insurmountable burdens for both providers and their patients. Wraparound care fills in the gaps, giving primary care providers and specialists the people, processes and technology they need to improve their patients’ outcomes across multiple disease states.