Designing plans to manage comorbid conditions

Health plans that address and manage complex chronic conditions such as cardiovascular disease, obesity, and diabetes have a competitive advantage.

As more Americans cope with chronic conditions, health plans should focus on helping them manage not only individual conditions, but also complex comorbid conditions.

In the United States today, six in 10 adults have at least one chronic condition, and four in 10 have two or more chronic conditions. Comorbidities have become widespread.

Prominent among them is cardiodiabesity, the triple diagnosis of cardiovascular disease, diabetes, and obesity. On their own, these individual conditions drive costs and threaten patients’ health. Combined, they lead to greater expenses and worse health outcomes, which can include premature disability and death.

Health plans should address the combined effects and related nature of these conditions.

Cardiodiabesity on the rise

Having one of these individual conditions can lead to developing another, and ultimately to developing cardiodiabesity. With all three conditions on rise, cardiodiabesity is shaping up to become an epidemic with devastating consequences.

Lifting the administrative burden for clients

With chronic conditions becoming more common, health plans should provide simple, tailored solutions to address comorbidities. By creating a more cohesive benefit, they can spare clients from wading through the many point solutions available.

A health plan that takes an analytical, data-driven approach to these complex conditions can offer greater efficiency for clients and reduce their number of administrative steps. What’s more, it can help control expenses.

Reducing costs

Cardiovascular disease, diabetes, and obesity are complex, costly to manage conditions. Consider the financial burden of each on the U.S. health system, including doctor visits, hospital stays, and prescription medications.

More recently, people have been using glucagon-like peptide 1 (GLP-1) agonists, a class of diabetes medications, to lose weight. This trend has created supply shortages and disrupted plan forecasts and budgets, while many patients with diabetes already struggle to afford medications.

Better health outcomes through health plan design

Individuals and health plan providers will continue to bear the burden of chronic conditions, but the right benefit can be the key to solving the complexities of cardiodiabesity. It should draw on plan-data to do the following:

  • Identify opportunities for interventions
  • Close gaps in care
  • Better manage pharmacy spend through appropriate utilization management

All of this depends on the health plan’s design. It should have a holistic view of patients’ health, including any cardiodiabesity conditions they have. Based on this information, it should anticipate care needs while also keeping the patient engaged.

Using data-driven insights, a health plan can encourage lifestyle changes and support treatment to improve health outcomes and reduce expenses.

See how our solutions can help
EncircleRxSM: Cardiodiabesity
Evernorth’s EncircleRx is a data-driven solution portfolio that helps plan sponsors reduce costs and enhance outcomes. The EncircleRx: Cardiodiabesity solution gives clients optionality and predictability in managing cardiodiabesity – obesity, diabetes and cardiovascular disease with the first-ever GLP-1 financial guarantee from a PBM.