Disease management

Aurora recognizes that the patient population consists of four segments with radically different health risks and needs:

We have developed health care management initiatives, systems and interventions that are designed to support network caregivers and reduce barriers to rapid change in clinical and administrative processes. You and your employees benefit from enhanced accessibility, improved quality of care and reduced costs.

Health and wellness

Nearly 85% of the population is considered healthy, so they consume only about 20% of the health care dollar. The focus on this group is to maintain health and wellness through preventive health activities and screening. Examples of our results include:

  • Typical organizations have many females between the ages of 42 and 69. Women in this age group should have a mammogram every 1-2 years. In preferred provider organizations 49% of women typically meet this preventive expectation.

Aurora has worked with many populations to increase this percentage to 70% or higher.

  • Of women over the age of 18, only 50-60% have been screened for cervical cancer over the last 3 years. National rates suggest this figure should be closer to 70%.

Aurora has worked with several organizations to increase their cervical cancer screening rates to greater than 77%.

  • Colorectal cancer screening also can significantly reduce the mortality and clinical utilization of resources when detected early. Of individuals over the age of 50 about 15% have been screened for colorectal cancer.

Aurora has raised that rate to 43% for other groups.

  • The flu is a common cause of lost work/school days for adults and children. This is especially true for older adults and individuals with chronic disease. Appropriate flu vaccination can reduce the incidence of flu and impact health care costs. It is suggested that for high risk individuals, approximately $117 in medical expenses is avoided per person for every flu vaccination.

Episodic disease management

Our medical management team for Aurora's 24,000 employees has reduced costs through the management of hospital, outpatient and specialty care.

Aurora saved $600,000 annually though redirection, avoided hospital days, and avoided unnecessary procedures and coordination of care with our hospital utilization management team.

Chronic disease management

The chronic population typically accounts for 2-5% of the overall population but they consume about 25%-30% of the health resources. They are the individuals who have been diagnosed with chronic diseases such as asthma, diabetes and congestive heart failure.

It has been shown that the more these people know about their disease and the things that impact it, the less often they will require medical care. The focus is to educate and manage their disease.

  • Typical organizations have 2-3% of their population with diabetes. Of these, only 37% had a record HbA1c (blood sugar) value in the past year. Aurora has worked with several groups to increase the number of people who get tested and helped lower that level from an average of 8% to 7.25%. A 1% absolute decrease in the HbA1c corresponds to a 17% reduction in mortality, 18% reduction in myocardial infarction (heart attack), and 15% reduction in stroke.

    Every absolute reduction in HbAic by 1% on average shows health savings worth $1000 a year.
  • Many individuals have coronary artery disease. Of these, 37% have their cholesterol levels tested. Cholesterol is important to measure and manage because of the direct relationship to heart attacks, angioplasty and heart surgery required. Aurora has worked with several groups and reduced the average cholesterol (LDL) level by 9%.

    This translates into a 12% reduction in major coronary events over a one-year period of time.

Catastrophic disease management

Most companies have cases that wind up costing more than $100,000. Our catastrophic case managers handle these situations and have helped Aurora avoid costs in excess of $1 million per year.

In addition, companies have individuals with multiple co-morbid conditions such as cardiovascular disease and renal disease along with diabetes and pulmonary disease. These individuals are likely to incur significant expenses on an annual basis. Our community-based case managers supervise these cases. In a sample of 45 patients in the Aurora patient population who were managed in this fashion, we spent 38% less.

That translates into a $1.4 million cost reduction to the plan for these 45 members.