This project aims to collect relevant data related to chronic condition management. The topic of this project is chronic disease management and the problem is that Anthem has 85% of diabetes readmission rates while the national standard is set at 56.8%. Data review will be done by examining empirical research on chronic condition management. The nature of the findings will allow Anthem to invest in quality improvement initiatives that will help enhance diabetes management practices and reduce reimbursement payments.
I am examining chronic disease management because currently, readmission rates for diabetes are estimated at 85% despite the standard set at 56.8% (AHRQ, n.d.). I will examine empirical data and will assess the data by measuring hospitalization rates due to complications, readmissions within 30 days, self-reported quality of life. The project will add value to Anthem by improving quality of disease management and minimizing costs associated with it. This project aligns with my professional and career goals because it enhances my understanding of process improvement and its impact on patient’s lives.
Chronic conditions are an increasing concern globally because they affect a large population of people both worldwide and in the US. However, one element of these conditions is the fact that they can be prevented or successfully managed at home by patients without a need to continuously visit hospitals. For Anthem as an insurer, such practice can lead to a significant improvement of the company’s bottom line because of a decrease in reimbursement payments provided to medical establishments for their services. This paper aims to outline the framework for examining relevant data, explain how the project adds value in four areas of the balanced scorecard, and propose a method for visual display of raw data.
Statement of the Problem
85% of Anthem’s patients who have diabetes were readmitted within a year when compared to a benchmark of 56.8% set by the Agency for Healthcare Research and Quality (AHRQ, n.d.).
Literature evaluation was performed to determine the scope of the issue. Rubin (2015) focuses the research on readmission rates connected to diabetes, which corresponds with the aim of this project. Chronic conditions result in vast financial spending within the industry and the issue will continue to burden the health insurance sector. Chouvarda, Goulis, Lambrinoudaki, and Maglaveras (2015) and Milani and Lavie (2015) offer new models of care that will help improve patient outcomes. In the context of this paper, these findings will help shape the quality improvement strategy that can be implemented by Anthem.
Wallace, Smith, Fahey, and Roland (2016) offer strategies for reducing readmission through community programs, which contributes to the understanding of this problem. In essence, these resources cite that over 70% of costs within healthcare are associated with chronic conditions, and the current trend is to implement strategies of self-management.
Next, the following sources were examined to determine the consequences of not addressing chronic disease management in regards to Anthem’s revenue. Ostling et al. (2017) and Hicks et al. (2016) provide valuable information regarding the prevalence of diabetes and implications of readmission rates, that help this project by providing relevant data about the burden of diabetes for health establishments. This source relates to the topic because it provides a description of readmissions and specifics of diabetes management.
Client Value Proposition
The framework chosen for investigating the type of data that will be examined within this project is a balanced scorecard, which is presented in Table 1. Due to the fact that this proposal outlines a new service line that will be a part of Anthem’s services, an approach that helps define the benefits of this novel model is required. Behrouzi, Shaharoun, and Ma’aram (2014) state that because of “changing demands on business due to many internal and external changes in the healthcare industry, it is argued that the key to achieving the targeted level of performance is to adopt new approaches of performance measurement” (p. 209). In addition, balanced scorecards dedicate specific attention to performance indicators, which are crucial for this project and measurement of outcomes.
Thus, by using the framework of the balanced scorecard Anthem will be able to leverage the implications of this project and mitigate the constraints by linking this outline with core business elements. Kaplan and Norton (1996) state that a balanced scorecard incorporates a variety of non-financial indicators, including performance measures that present a better understanding of the company’s activity. Thus, the criteria based on which the choice of the framework was made are applicability in regards to the purpose of the chronic disease management project, availability of essential performance indicators that allow assessing the outcomes, and ability to connect the data with the business processes of Anthem.
This chronic condition management project addresses and adds value in all four areas of organizational balanced scorecard by improving business operations through an introduction of a new service line, which is also helpful in the domain of organizational learning and growth.
The financial aspect will benefit because of the increase in revenue and customer service should see an enhancement of satisfaction rates because of a new product that improves the quality of life for patients. This is substantiated by Chouvardaet al. (2015) who argue that technology can be a driving force behind significant changes in healthcare and more specifically in the means of addressing chronic conditions. The authors cite personal health systems as a new strategy for addressing healthcare issues, which are the focus of this proposal.
As for the value that this project will provide to Anthem in regards to the financial benefits, it should be noted that according to Milani and Lavie (2015) over 75% of reimbursements in the US are dedicated towards chronic disease care. The authors state that currently, the healthcare system is unprepared to efficiently manage this issue, which creates an ability to gain a competitive advantage over those that fail to address chronic disease care.
Evidence, such as an article by Milani and Lavie (2015) and Chouvarda et al. (2015) suggest that Anthem has to pay more attention to the issue of chronic condition care. The data management and analytics that are a part of this process will help the company significantly improve its operations.
From a strategic perspective, better management of chronic conditions will relieve the burden associated with hospitalization of patients that can manage their disease at home, for which Anthem has to pay a provider. From a systems perspective, the healthcare industry in the US requires changes that would both access, which involves innovation from healthcare organizations. Chouvarda et al. (2015) insist on a need for changing the current strategies to meet the increasing number of patients with chronic conditions. Adequate chronic condition care requires the involvement of a patient in the process of monitoring and reporting his or her health state.
Additional information that can strengthen the value proposition is data illustrating the burden of chronic diseases on health insurers in the US, which would help substantiate the need for further examination of relevant data. All in all, this project aligns with the mission and vision of the organization because it offers an innovational strategy for managing chronic conditions, which will significantly improve the lives of patients. Anthem should provide input into this project by assisting with data collection and presenting feedback to ensure that performance indicators align with the needs of the company.
Table 1. The balanced scorecard (created by the author).
|Business Operations||Finance||Customer Service||Organizational Learning and Growth|
|Engage patients into participation in this disease management program and integrate it as a new service line (performance indicator – number of enrolled individuals)||Diminish the amount of reimbursement for chronic care hospitalization by 15%||Improve customer satisfaction rates by enabling easy access to chronic condition care information and advice||Expand operations towards chronic condition management|
|Minimize the number of manageable chronic conditions that can be cared for at home, diminish the number of cases by 10%||Improve the bottom line by enhancing the efficiency of operations||Implement a patient-centred approach that considers personal preferences and educates customers on the issue of chronic conditions||Apply new strategies and technologies to improve chronic condition management|
Expected Outcomes and Precise Performance Measurement
A proposed structure for visual data display, in this case, is a histogram graph because it will allow one to compare all three criteria of Anthem with benchmark data in one screen. Graph 1 presents the histogram displaying the currently available information about hospital admissions and will be completed in the final stages of this project. Performance indicators are the number of people engaged in the management program and their hospital visits over a year.
Units of measurement are patients and the number of hospitalizations, while the time frame is one year. Type of organization in question is a for-profit health insurance company operating in the United States – Anthem. Thus, the proposed title is as follows – examining the number of Anthem’s clients who use technology to improve their chronic disease management over a year.
My responsibilities in leading the effort consist of assessing Anthem’s data and comparing it to the national standard. Within the Execution domain, I will practice the competency of change leadership by accessing information from different individuals and actively seeking feedback. With Transformation, I will practice result orientation by aiming to provide Anthem with a valid solution to the chronic disease management problem. In the domain of People, I will practice professionalism by thoroughly researching the topic and communicating with people working in this industry.
Table 2. Timeframe for the project (created by the author).
|Week||Task Description||Start and End||Responsible||Due Date|
|1||Collect relevant information form scholarly journals and national health agencies||From Jul 15th till Jul 19th||Learner||Jul. 20|
|2||Review Anthem’s statistics regarding diabetes||From Jul 20th till Jul 30th||Learner||Jul 30.|
|3||Assess the existing strategies of chronic disease management at Anthem||From Aug 1st till Aug 9th||Learner||Aug. 10|
|4||Compare data from authoritative sources with Anthem’s statistics and measure performance||From Aug 10th till Aug 14th||Learner||Aug. 15|
|5||Provide quality improvement recommendations based on the findings||From Aug 14th till Aug 15.||Learner||Aug. 15|
- On-site contact
- Personal contact information
- Instructor’s contact information
- Statement of confidentiality
AHRQ. (n.d.). Diabetes quality measures compared to achievable benchmarks. Web.
Behrouzi, F., Shaharoun, A. M., & Ma’aram, A. (2014). Applications of the balanced scorecard for strategic management and performance measurement in the health sector. Australian Health Review, 38(2), 208–217. Web.
Chouvarda, I., Goulis, D., Lambrinoudaki, I., & Maglaveras, N. (2015). Connected health and integrated care: Toward new models for chronic disease management. Maturitas, 82(1), 22-27. Web.
Hicks, C. W., Selvarajah, S., Mathioudakis, N., Sherman, R. E., Hines, K. F., Black, J. H., & Abularrage, C. J. (2016). Burden of infected diabetic foot ulcers on hospital admissions and costs. Annals of Vascular Surgery, 33, 149–158. Web.
Kaplan, R. S., & Norton D. P. (1996). Using the balanced scorecard as a strategic management system. Harvard Business Review, 74(1), 75–85.
Milani, R., & Lavie, C. (2015). Health care 2020: Reengineering health care delivery to combat chronic disease. The American Journal of Medicine, 128(4), 337-343. Web.
Ostling, S., Wyckoff, J., Ciarkowski, S., Pai, C., Choe, H., Bahl, V., & Gianchandani, R. (2017). The relationship between diabetes mellitus and 30-day readmission rates. Clinical Diabetes and Endocrinology, 3(1), 1-8. Web.
Rubin, D. (2015). Hospital readmission of patients with diabetes. Current Diabetes Reports, 15(4), 5-9. Web.
Wallace, E., Smith, S., Fahey, T., & Roland, M. (2016). Reducing emergency admissions through community based interventions. BMJ, 352(6817), 1-7. Web.