Chronic Condition Management
Helping members manage chronic conditions, improving outcomes while controlling costs
What Is Chronic Condition Management?
Innovative Care Management’s chronic condition management program, also known as disease management, provides ongoing clinical support for members living with chronic health conditions such as cardiac disease, pulmonary disorders, and diabetes. The program is designed to help members better understand and manage their conditions, reduce preventable complications, and support long-term stability.
For plans, chronic condition management supports more appropriate utilization of healthcare services and reduced long term costs by improving member engagement, adherence, and continuity of care.
How We Do It
Clinically focused, practical, and member-centered.
Our approach includes:
Nurse-led assessment and outreach for members with chronic conditions
Customized education to support self-management, symptom recognition, and adherence
Coordination with providers to reinforce care plans and follow-up
Monitoring for changes in condition that may require additional clinical support
Collaboration with case management or utilization management when appropriate
Nurse-led assessment and outreach for members with chronic conditions
Customized education to support self-management, symptom recognition, and adherence
Coordination with providers to reinforce care plans and follow-up
Monitoring for changes in condition that may require additional clinical support
Why Is Chronic Condition Management Necessary?
Chronic conditions are surprisingly common, and they can drive up healthcare costs while also detracting from a person’s wellbeing and ability to work.
According to the CDC, approximately 60% of young adults and 80% of midlife adults report one or more chronic conditions. Between 2013 and 2023, young working-age adults saw an increase in chronic conditions.
Diabetes is a particularly serious and common chronic condition, affecting 14.7% of U.S. adults in the U.S., according to the CDC.
18.9% of people between the ages of 45 and 64 in the U.S. have either diagnosed or undiagnosed diabetes.
What Is the Cost of Diabetes?
Healthcare costs are 2.6 times higher for those diagnosed with diabetes. On top of medical costs, reduced work productivity results in annual indirect costs of $35.8 billion, while missed workdays result in annual indirect costs of $5.4 billion.
Source: American Diabetes Association
Chronic Condition Management in Action
Improving Diabetes Management Through Education and Care Coordination
A woman is diagnosed with diabetes at age 45. Her grandfather had diabetes that progressed into serious complications, leaving him with no option but to go on disability and leaving his wife to care for him until his early death. The woman is worried that she’ll follow in her grandfather’s footsteps, so she enrolls in ICM’s Chronic Condition Management program.
She learns more about her condition and how to manage it. ICM also helps her connect with an optometrist, podiatrist, nutritionist and endocrinologist and offers guidance on coordinating care. She’s still having trouble controlling her glucose levels, a problem that could lead to serious complications, but she learns about continuous glucose monitors and how they can help, and that her plan covers one.
After significant effort on her part, she’s able to manage her diabetes effectively. She feels better than she has in years, and this helps her thrive in both her personal and professional life.
When not managed effectively, diabetes can trigger many health problems, including:
- Eye disease, including diabetic retinopathy, which is the leading cause of blindness among American adults.
- Foot problems due to diabetic neuropathy, which can lead to serious infections.
- Gum disease
- Heart disease and stroke
- Kidney disease
Source: Medline Plus
Reducing Emergency Department Visits in Heart Failure Management
A member with heart failure had a history of frequent emergency department visits related to shortness of breath and fluid overload.
During the initial chronic condition management assessment, an ICM nurse identified that the member did not have a scale at home, limiting her ability to monitor daily weight changes that signal worsening symptoms. The nurse helped the member obtain a scale and provided education on daily weight monitoring, low-sodium dietary choices, and the appropriate use of diuretics to manage early changes in her condition.
With ongoing education and nursing support, the member was able to recognize warning signs and take action earlier—remaining out of the emergency department and managing her condition more effectively at home.
Chronic Care Management in Action
Improving Diabetes Management Through Education and Care Coordination
A woman is diagnosed with diabetes at age 45. Her grandfather had diabetes that progressed into serious complications, leaving him with no option but to go on disability and leaving his wife to care for him until his early death. The woman is worried that she’ll follow in her grandfather’s footsteps, so she enrolls in ICM’s Chronic Care Management program.
She learns more about her condition and how to manage it. ICM also helps her connect with an optometrist, podiatrist, nutritionist and endocrinologist and offers guidance on coordinating care. She’s still having trouble controlling her glucose levels, a problem that could lead to serious complications, but she learns about continuous glucose monitors and how they can help, and that her plan covers one.
After significant effort on her part, she’s able to manage her diabetes effectively. She feels better than she has in years, and this helps her thrive in both her personal and professional life.
When not managed effectively, diabetes can trigger many health problems, including:
- Eye disease, including diabetic retinopathy, which is the leading cause of blindness among American adults.
- Foot problems due to diabetic neuropathy, which can lead to serious infections.
- Gum disease
- Heart disease and stroke
Kidney disease
Source: Medline Plus
Reducing Emergency Department Visits in Heart Failure Management
A member with heart failure had a history of frequent emergency department visits related to shortness of breath and fluid overload.
During the initial chronic condition management assessment, an ICM nurse identified that the member did not have a scale at home, limiting her ability to monitor daily weight changes that signal worsening symptoms. The nurse helped the member obtain a scale and provided education on daily weight monitoring, low-sodium dietary choices, and the appropriate use of diuretics to manage early changes in her condition.
With ongoing education and nursing support, the member was able to recognize warning signs and take action earlier—remaining out of the emergency department and managing her condition more effectively at home.
Additional Services to Consider
ICM’s Chronic Condition Management services are part of our commitment to making healthcare feel more human. Additional services include:
Utilization Management
Our prior authorization services shield members from unexpected medical bills while ensuring that care is safe, effective and medically necessary.
Case Management
When members are facing catastrophic or complex medical conditions, our Case Management program provides education, guidance and compassion.
Healthy Mother Baby Management
Our maternity management program supports expecting mothers with education and one-on-one guidance to promote healthy pregnancies and deliveries.
Frequently Asked Questions
How are eligible participants identified?
ICM may identify eligible participants through its other services, such as its Utilization Management, or through coordination with the Plan and claims activity. ICM then invites eligible members to participate. Plan members with this benefit can also reach out to ICM if they think they qualify and would like assistance managing a chronic disease.
How does ICM support people with chronic conditions?
ICM provides education in the form of personalized coaching, tips and resources, and tailored education materials delivered on a regular basis. People with chronic conditions often need to see multiple providers, which can get complicated, so ICM also provides assistance coordinating care with doctors and guidance on specialist referrals and medical equipment.
What can participants do if they need additional help or have questions?
Participants are never on their own. Program nurses are available to provide personalized support and answer health-related questions. In addition, they can explain how the program works, respond to general questions, and help non-enrolled individuals determine whether the program is a good fit for them.
Is the Chronic Condition Management program available to people experiencing conditions like stroke or a cancer diagnosis?
ICM’s Chronic Condition Management program is designed for chronic diseases such as diabetes and respiratory or cardiac diseases. Our Case Management program may be more appropriate for people experiencing health problems like cancer and stroke. In some cases, a member may qualify for both programs. Reach out to ICM for help determining which program is best suited for your needs.
Why should employers add Chronic Condition Management as a benefit?
ICM’s Chronic Condition Management delivers a strong return on investment at $4.06 for every $1 spent. This makes it a smart investment for health plans and the labor or employer sponsors. By helping workers manage common chronic diseases, the program can lower disability rates, support productivity and reduce the rate of absenteeism. Beyond the financial impact, the program helps foster a healthier, more supported workforce.