Health insurers and self-insured employers are leading the adoption of more-personalized and holistic approaches to managing chronic conditions such as diabetes, COPD and depression. The new approaches aim to change patient behaviors with the aid of digital technologies, thereby lowering health care costs, according to Chilmark Research’s report, “Assessing the Market for Condition Management Solutions.”

However, provider organizations – many of which still operate under fee-for-service models – are slower to adopt more comprehensive programs, at least on a large-scale basis that also includes patients most at risk for developing chronic conditions, according to the report. But as the health care sector moves more toward “value-based reimbursement” and “risk-based contracting,” adoption of more-comprehensive chronic management programs by providers will increase.

“The status quo is primarily the episodic treatment of these conditions: Delivery of care in high-acuity, high-cost setting, followed by discharge, a vague set of instructions, and radio silence until a patient returns to receive more high-acuity, high-cost care,” the authors write. “This is an unsustainable, untenable, and unacceptable process for each key stakeholder: The healthcare organization delivering the cares, the payer -- and employer -- paying for the care, and above all the patient receiving the care.”

Over the past year and a half, an increasing number of digital health solutions targeting specific conditions has emerged, according to the report. These solutions go beyond episodic treatment, and provide more holistic and longitudinal interventions that use “low-cost, high-tech touchpoints” to help participants achieve sustained behavior change that slows or -- in some cases -- reverses the progression of their condition.

The most successful condition management programs require a blend of cognitive behavior theory (user experience), behavioral economics (incentive design), gamification (program design), and differentiation (subsets of patient populations).

Chilmark Research’s report profiles 10 vendors that are “market leaders,” including GLOOKO in Mountain View, Calif., whose diabetes management system allows patients to sync their monitoring devices with their smartphones and share this data with members of their care team. The Glooko mobile app and the MyGlooko Web app let users track blood glucose and insulin levels alongside data about exercise and diet. Using this data, the app analyzes patterns, showing users how physical activity, medication, and carbohydrate intake all affect blood glucose levels. The app also tracks when those good days occur, which helps users see what they did well or may need to avoid doing. Users can also set alarms that remind them to take medication, exercise, or have a snack.

Providers can use this data to optimize insulin management, flag at-risk patients based on glycemic control or lifestyle-related factors, and view recommendations for insulin pump changes. According to the company, roughly 60 percent of Glooko users decrease their risk of hypoglycemia and hyperglycemia by at least 10 percent, and nearly 30 percent increase their frequency of blood glucose testing once they begin the Glooko program.

Chilmark Research’s report ends with six conclusions: Expect condition management market activity to increase; view lifestyle management as a differentiator; address needs beyond the most common conditions; improve enrollment, engagement functionality; emphasize platforms instead of apps; and “understand that it will take a village.”

“Few providers, payers, employers, or vendors have the size, strength, and expertise to address the complex care management, lifestyle management, and engagement needs of chronic condition management on their own,” the authors write. “Strategic partnerships will be inevitable.”

Instant Insights /

Insurers adopting new approaches to managing chronic conditions

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