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Interest in Condition Management Is Rising – But Not For Everyone Yet

by Brian Eastwood | September 20, 2017

Latest Chilmark Market Scan Report looks at the continued growth – and continues HCO reticence – of the condition management space.

Chilmark Research’s latest report, Assessing the Market for Condition Management Solutions, identifies many reasons that key healthcare stakeholders are beginning to invest in solutions that help people manage their lives with common chronic conditions such as diabetes and hypertension:

  • Ongoing pressure to cut costs has payers and self-insured employers looking for solutions with demonstrated results.
  • The Diabetes Prevention Program (DPP) has shown the effectiveness of a more holistic approach to condition management, with many interventions in a short period of time, in reducing costs and improving outcomes.
  • The sheer scale of the problem – 75 million American adults with hypertension, more than 80 million with prediabetes, nearly 45 million experiencing mental illness – has suggested the unsustainability of treating symptoms without addressing their underlying causes.

One of the most telling tidbits in the report, though, pinpoints why some stakeholders – namely, healthcare providers – are still so hesitant to invest. Namely, there hasn’t been enough progress made toward expanding value-based care models. According to Deloitte, 86% of all care is still administered in a FFS model, and that percentage hasn’t budged in three years. The implications are obvious: For the typical practice, the roughly 33% of patients with prediabetes is greater than the 14% of patients covered under VBC.

In other words, a holistic condition management program with an end goal of reducing in-person interventions will still directly reduce a provider’s revenue today. It’s no surprise that vendors such as Twine Health say that selling to providers is not “a sustainable business path.” They claim that even the risk-based contracts for leading accountable care organizations aren’t risky enough to incentive provider adoption of these solutions.

As noted in the report, and further detailed in the accompanying webinar, provider reticence is but one of several obstacles that stand in the way of more widespread adoption. Other challenges include overcoming program churn, avoiding selection bias, achieving behavior change, and addressing the interwoven complexities of comorbidities.

Nonetheless, Chilmark Research sees reason to believe that condition management is a healthcare disruption that just might stick. Providers may be reluctant now, but external forces – just like the frequent interventions and incremental goals of the typical condition management solution – will nudge them forward:

  • Increased adoption of solutions among payers and employers will give providers the outcomes data they need to justify investing their resources in these solutions – not to mention a list of potential partners with proven results.
  • Pressure to improve outcomes under MACRA and MIPS (as the programs are currently constituted at least) will start to force providers’ hands toward signing risk-based contracts with public and private payers that reward outcomes.
  • The convergence of payer and provider business lines will increasingly require coordinated engagement efforts – and employers will want to play a role as well. Providers that fail to take an active role in condition management under these coordinated, converged efforts risk having a condition management strategy dictated to them.

We expect the market for condition management solutions to continue to move forward – provided it continues to take the pragmatic and practical approach that has fueled its growth so far. Read the full report for further insight into the steps that vendor, payer, employer, and provider stakeholders can take to help ensure that this happens.

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