Chronic obstructive pulmonary disease (COPD) remains a growing population health issue from a clinical effectiveness perspective and from an economic efficiency perspective, given our lifestyles and the aging US population.
In their current review, Blanchette and colleagues highlight key outcome drivers to address when considering health plan design elements or coverage frameworks to improve and sustain health status goals. For example, employer-sponsored plans should focus on plan designs that align with their business goals of productivity and reduced absenteeism, while providing benefit designs that are attractive for their employees, including patients with chronic conditions, such as COPD.
Aligning health plan coverage through care management that optimizes maintenance therapies remains an elusive goal, yet this presents a significant opportunity to enhance patient outcomes and improve the plan’s financial performance. Blanchette and colleagues provide insight on how to address this challenge, which now needs to be followed up with action.
PATIENTS: The growth in high-deductible plans creates a potential economic barrier for patients with a chronic disease (such as COPD), who require long-term therapy. The underutilization of maintenance therapy by patients and the lack of incentives to change this behavior are barriers to be overcome, as well as plan-imposed barriers.
Finding the appropriate balance between meeting the treatment needs of patients and aligning plan designs to create opportunities to reward health status improvement remains a challenge. Building on the health reform focus on disease prevention, the challenge is how best to engage patients in the care of their chronic condition, and how best to inform healthcare providers about the optimal strategies that will have a positive impact on their patients to reinforce successes without penalty from using poor plan design.