Three trends affecting managed care
The healthcare system in the U.S. is undergoing rapid and dramatic transformations. Health insurers are facing changes due to healthcare reform, continued growth in healthcare spending, an aging population, and an increasing number of people with chronic diseases.
Here are three important trends that will impact the care management industry in the next three to five years.
Trend 1: Chronic Condition Management
In 2012, the baby boomer population—those people born between mid-1946 and mid-1964—numbered 77 million people according to the U.S. Census Bureau. The first of that group turned 65 in 2011, and the over-65 age group reached 43.1 million people by 2012. By the year 2020, baby boomers will make up just over 15% of the total U.S. population.
According to a 2013 National Centers for Disease Control and Prevention report, two-thirds of the over-65 age group is affected by chronic disease, and most of their healthcare costs are devoted to treating these illnesses.
As the population continues to age, we expect that chronic conditions will affect more and more individuals. Managing these conditions becomes increasingly important to support improved outcomes and keep costs in check.
Current estimates are that chronic conditions account for 75% of our nearly $3 trillion healthcare spending in this country. However, the impact of an aging population goes far beyond bending the cost trend for chronic conditions.
Care management must deal with appropriate predictive risk stratification of members who will be impacted; address individualized care planning for multiple co-morbidities; integrate physical, social and behavioral health; and improve plan adherence.