Preventing Chronic Disease


Since chronic diseases are the greatest driver of healthcare costs and lost productivity [1], you cannot afford to ignore their impact. As an employer or insurer, you need to know that 9 in 10 healthcare dollars in the United States are spent on chronic diseases and mental health conditions for a total annual cost of about $3 trillion [2]. You may be shouldering a large portion of the economic burden, but with the responsibility comes opportunity.

 

The Case for Chronic Disease Prevention


Chronic diseases and their risk factors are nearly certain to be prevalent in your covered population of employees or beneficiaries. About 2 in 3 adults are overweight or obese and at risk for multiple chronic conditions, and obesity costs about $147 billion each year. The majority of American adults have at least one chronic condition, and half are managing at least two [3].

  • Heart disease and stroke, with hypertension as a major risk factor, costs $316 billion annually in healthcare costs and lost productivity.

  • Diabetes costs $245 billion annually in healthcare costs and lost productivity.

  • Prediabetes affects 1 in 3 adults, and only 10% of people with prediabetes know that they have it [4].

Chronic disease is clearly a major problem, and there is another compelling reason to address it: Many of the top chronic diseases are preventable. From a public health perspective, they are preventable at the primary, secondary, and tertiary levels, as defined below and shown in the following examples.

  • Primary Prevention – prevention of a disease before it happens, often through education and promotion of healthy behaviors. Lark Wellness promotes weight loss among overweight users, along with better diet quality, increased physical activity, and other healthy behaviors, to reduce obesity and lower risk for diseases such as diabetes and cardiovascular disease.

  • Secondary Prevention – reduction of the effects of a disease. Lark Diabetes Prevention Program (DPP) lowers risk for type 2 diabetes among individuals with prediabetes through lifestyle changes that are known to reduce insulin resistance. Lark Hypertension Pro lowers risk for diseases such as cardiovascular disease, stroke, and kidney disease, through lifestyle changes and other behaviors that can lower blood pressure.

  • Tertiary Prevention – minimization of the impact of a disease. Lark Diabetes Care assists users with lifestyle behaviors and self-care habits that can manage blood sugar and reduce the chances of comorbidities, such as heart disease and hypertension, and complications, such as blindness and kidney disease.

An abundance of research supports the potential for lifestyle changes to lower the risk for many of the most common and expensive chronic diseases [5]. Losing weight, increasing physical activity, and getting adequate sleep are examples of strategies that are not only effective, but also relatively safe and inexpensive compared to treatments such as prescription medications, frequent medical appointments, or invasive medical procedures. 

 

Multifaceted Model for Population Health


With a busy schedule and a focus on your own products and services, your organization can benefit from contracting with disease prevention programs that offer comprehensive packages. One approach to finding a provider that can help is to find a provider that helps in multiple domains. The Workplace Health Model [6], developed by the Centers for Disease Control and Prevention (CDC), is one tool that can guide employers and insurers when searching for a chronic disease management program that can act at multiple levels for greater reach, impact, and efficiency.

Lark helps in each domain to provide easy-to-implement, cost-effective programs and has achieved Full CDC Recognition.

  1. Assessment. Lark checks for participant eligibility based on health risks and health conditions so you can target the right patients without doing the leg work.

  2. Planning and management. Lark allows you to provide programs without having dedicated staff from your organization, and it assists with marketing and other communication.

  3. Implementation. Lark has ready-to-use programs for wellness and weight loss, prediabetes, diabetes, and hypertension. The programs include education and counseling, as well as support for participants to improve success.

  4. Evaluation. Lark makes available key statistics on program effectiveness in your organization so you can be satisfied with the cost savings potential.

 

Evidence-Based Programs


To be effective, programs need to focus on evidence-based strategies[7]. In the area of chronic disease prevention and management, lifestyle changes are clearly effective. A team of health experts, with specializations in nutrition, physical activity, sleep, and other domains related to wellness, have applied their knowledge and the most recent and accepted research when developing Lark’s programs. 

Each program offers coaching on areas known to reduce risk and manage chronic conditions. Examples include the following.

  • Weight management. Each kilogram (2.2 lb.) of weight loss in obese individuals with prediabetes lowers diabetes risk by 16%.

  • Exercise. Physical activity lowers blood sugar and blood pressure and increases focus and ability to make healthy choices.

  • Healthy eating. Eating more vegetables and less fried food and processed meat can lower blood sugar and blood pressure.

  • Sleep. Inadequate sleep increases hunger, sugar cravings, and insulin resistance.

  • Stress. Stress management can lower blood pressure and make weight loss easier.

  • Medication adherence. Non-compliance is costly, widespread, and harmful for conditions such as high blood pressure and blood sugar.

  • Self-monitoring of blood glucose. This is linked to improved control in diabetes.

Lark’s programs are also designed for some of the most costly and prevalent conditions, based on the latest and most widely accepted research on effective lifestyle changes. For example, use of Lark DPP is associated with weight loss, which is one of the most effective ways to prevent type 2 diabetes, and Lark Hypertension Care includes coaching around Dietary Approaches to Stop Hypertension (DASH), which has been clinically shown to lower blood pressure within weeks. 

 

High-Impact Strategies


Disease prevention strategies, such as healthy eating, physical activity, and loss of excess weight, may be widely recognized, but they are hard for individuals to implement themselves without a carefully-designed program and plenty of support. 

Lark’s chronic disease prevention programs promote long-term healthy habits based on established theories of behavior change, such as cognitive behavioral theory and stages of change. Programs are delivered in a compassionate and empathetic manner to allow users to develop trust for their Lark coach. Strategies like these can have a higher impact as they continually inspire and enable healthy choices.

Lark health coach provides education, assists with goal-setting and tracking, and offers empathetic encouragement. Users can feel confident depending on Lark to be there as often as needed and without fear of running out of a limited number of sessions.

 

Instant Scalability at Cost


The most effective program is useless if it is unable to reach all who need it. Both small and large organizations need to be able to offer chronic disease prevention and management programs to all of their employees, employees’ families, and members who can benefit, but they may not have the necessary resources to develop, implement, manage, and evaluate the programs. For that reason, it can make far more sense to contract with a provider that has already developed proven programs and that will lead the way in making them work for your company.

Another major concern is scalability. It is only fair that all members be granted the opportunity to participate in a relevant program with the same high quality. Furthermore, you want to be sure that the program is equipped to grow with you, no matter how big and how fast, but without excessive costs or decreases in quality. Lark is a fully scalable chronic disease management solution that is ready to grow with your business without exponentially increasing costs.

 

Digital Solutions for Preventing Chronic Disease


The digital age is upon us, and healthcare needs to be cognizant of that. A digital program can address many of the problems in chronic disease management that may help contribute to poor outcomes.

Provider shortages. Doctors and other healthcare professionals are in short supply, with gaps between supply and demand projected to increase in coming years [8]. Patients may have trouble getting the care they need. An article published in the Journal of the American Medical Association (JAMA) estimates that a measly 1.1% of eligible individuals participate in a DPP [9]. Fully automated programs can help bridge the gap, allowing patients to receive more basic medical services than they might otherwise get if they were dependent solely on live consults with doctors. 

Out-of-reach costs. One look at the national costs of chronic diseases will raise suspicions that they are hurting your bottom line. Do the math, and you are sure to discover that these costs are dominating your healthcare budget. The cost of medical care is also out of reach for many patients, who are forced to limit their primary care and specialty visits at the cost of their health. Lark offers customized programs with unlimited accessibility for each patient at no additional cost and with no decrease in quality despite infinite expansion potential.

Patient responsibility. The nature of chronic disease management is that patient behaviors have the most impact on their health. Even if they have adequate doctor’s appointments and in-person provider support, patients affect their own health with the decisions they make, many times a day, about what they eat, whether they exercise and take their medications as prescribed, and how careful they are to take their health measurements as recommended. The CDC suggests “activating patient involvement through self-management.” [10] A health coach powered by artificial intelligence is in position to assist with the daily decisions due to its ability to customize programs and be available 24/7.

A digital program can be just as effective as in-person programs. For example, Lark has led to weight loss of 2.4%, on par with in-person programs [11]. Other Lark users have experienced a remarkable decrease of 11 mm Hg in systolic blood pressure [13]. As the CDC says, “a 1% annual reduction in the level of four health risks—weight, blood pressure, glucose, and cholesterol—has been shown to save $83 to $103 annually in medical costs per person.” 

A digital program can not only be effective, but more cost-effective than in-person programs. There is no need to set aside or rent facility space for coaching sessions. Patients may depend less on healthcare providers if they can get simple questions answered in the app. Furthermore, since it does not depend on live coaches or providers to coach patients each day, a fully automated program can be scaled indefinitely without requiring excess costs due to extra support staff.

 

Easy Startup without Risk


Taking the first step does not require a big investment of time, energy, and cost on your part. You can get ready to fight chronic disease and avoid the exorbitant costs of healthcare and lost productivity by contacting Lark. You will receive the support you need to get set up, and seamless device delivery and patient enrollment are a given. You can rest easy because of performance-based billing without the need to pay for patients who may never use the program. Lark is also Fully CDC Recognized.

 

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Reference

  1.  National Center for Chronic Disease Prevention and Health Promotion. Health and Economic Costs of Chronic Diseases. https://www.cdc.gov/chronicdisease/about/costs/index.htm. Reviewed February 2, 2017. Accessed February 4, 2019.

  2.  National Center for Chronic Disease Prevention and Health Promotion. Workplace Health Promotion. https://www.cdc.gov/chronicdisease/resources/publications/aag/workplace-health.htm. Reviewed February 2, 2017. Accessed February 4, 2019.

  3.  Buttorff C, Ruder T, Bauman M. Multiple Chronic Conditions in the United States. Santa Monica, CA: Rand Corp.; 2017. https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL221/RAND_TL221.pdf.

  4.  National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. National Diabetes Statistics Report, 2017: Estimates of Diabetes and Its Burden in the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf 

  5.  Walter C. Willett, Jeffrey P. Koplan, Rachel Nugent, Courtenay Dusenbury, Pekka Puska, and Thomas A. Gaziano. Chapter 44: Prevention of Chronic Disease by Means of Diet and Lifestyle Changes. Disease Control Priorities in Developing Countries. 2nd edition. Jamison DT, Breman JG, Measham AR, et al., editors. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; New York: Oxford University Press; 2006.

  6.  National Center for Chronic Disease Prevention and Health Promotion. Workplace Health Promotion. https://www.cdc.gov/chronicdisease/resources/publications/aag/workplace-health.htm. Reviewed February 2, 2017. Accessed February 4, 2019.

  7.  Centers for Disease Control and Prevention. Best practices for cardiovascular disease prevention programs: A guide to effective health care system interventions and community programs linked to clinical services. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2017. https://www.cdc.gov/dhdsp/pubs/docs/Best-Practices-Guide-508.pdf

  8.  IHS Markit Ltd. The Complexities of Physician Supply and Demand: Projections from 2016 to 2030. Association of American Medical Colleges. March 2018. https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf

  9.  Prevalence and Correlates of Diabetes Prevention Program Referral and Participation. Venkataramani, Maya et al. American Journal of Preventive Medicine, Volume 0, Issue 0. https://www.ajpmonline.org/article/S0749-3797(18)32334-1/fulltext

  10.  Centers for Disease Control and Prevention. Best practices for cardiovascular disease prevention programs: A guide to effective health care system interventions and community programs linked to clinical services. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2017. https://www.cdc.gov/dhdsp/pubs/docs/Best-Practices-Guide-508.pdf

  11.  Stein N, Brooks K. A Fully Automated Conversational Artificial Intelligence for Weight Loss: Longitudinal Observational Study Among Overweight and Obese Adults. JMIR Diabetes 2017;2(2):e28. DOI: 10.2196/diabetes.8590

  12.  Lark. Measurable outcomes. https://www.lark.com/outcomes/ Accessed February 4, 2019.

  13.  National Center for Chronic Disease Prevention and Health Promotion. Workplace Health Promotion. https://www.cdc.gov/chronicdisease/resources/publications/aag/workplace-health.htm. Reviewed February 2, 2017. Accessed February 4, 2019.

Natalie Stein

Exercise, Fitness & Nutrition Expert | Assistant Professor of Public Health