{"id":7059970,"date":"2026-09-17T12:19:47","date_gmt":"2026-09-17T12:19:47","guid":{"rendered":"https:\/\/peraltafinancing.com\/business\/insurance\/chronic-disease-management\/"},"modified":"2026-09-17T12:19:47","modified_gmt":"2026-09-17T12:19:47","slug":"chronic-disease-management","status":"publish","type":"post","link":"https:\/\/fivemor.com\/?p=7059970","title":{"rendered":"Chronic Disease Management"},"content":{"rendered":"


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Twenty percent of your employees are generating 80% of your healthcare costs. You know this pattern exists. What you probably don’t know is which twenty percent, what conditions are driving the spend, or what you can do about it.<\/p>\n<\/p><\/div>\n

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That’s by design.<\/p>\n<\/p><\/div>\n

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Fully insured carriers profit from keeping you in the dark. They aggregate claims, hide the data, and send you a renewal notice with double-digit increases. You can’t see the patterns. You can’t intervene, so you can’t control costs.<\/p>\n<\/p><\/div>\n

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Self-funded health insurance through a medical captive changes this completely.<\/p>\n<\/p><\/div>\n

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Why Chronic Disease Management Matters for Self-Funded Employers<\/h2>\n<\/p><\/div>\n
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Chronic conditions represent the single largest driver of healthcare spending for American employers. For self-funded employers, this concentration creates both a challenge and an opportunity.<\/p>\n<\/p><\/div>\n

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Unlike fully insured plans where you have no visibility into spending patterns, chronic disease management in self-funded plans puts you in control. You can identify which employees need support, put targeted programs in place, and directly benefit from every dollar saved.<\/p>\n<\/p><\/div>\n

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The Financial Impact of Chronic Disease on Healthcare Costs<\/h2>\n<\/p><\/div>\n
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According to the Centers for Disease Control and Prevention (CDC), six in ten Americans live with at least one chronic disease. These conditions account for 90% of the nation\u2019s $4.5 trillion in annual healthcare spending. They hit self-funded employers particularly hard because you pay these claims directly.<\/p>\n<\/p><\/div>\n

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Chronic conditions drive spending through multiple channels that compound over time:<\/p>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tTotal national impact: Chronic diseases and mental health conditions drive 90% of all U.S. healthcare expenditures.<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tDirect costs: Direct healthcare treatment for chronic conditions now exceeds $2.2 trillion annually.<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tEmployer productivity loss: Poor workforce health costs U.S. employers $575 billion annually<\/a> in lost productivity.<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tThe “hidden” cost: For every $1 spent on healthcare benefits, typically another $0.61 is lost to illness-related absence and reduced performance.<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tTime away: U.S. workers lose nearly 1.5 billion days annually to illness and injury.<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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Sources: <\/i>CDC<\/i><\/a> (2024), <\/i>Integrated Benefits Institute<\/i><\/a> (2020)<\/i><\/p>\n<\/p><\/div>\n

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How Recurring Care Costs Compound Over Time<\/h2>\n<\/p><\/div>\n
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Employees with diabetes, heart disease, or asthma require ongoing medication, regular specialist visits, and continuous monitoring. These aren’t one-time expenses. They’re recurring costs that compound month after month, year after year. When poorly managed, costs escalate dramatically.<\/p>\n<\/p><\/div>\n

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Preventing Complications That Drive Exponential Cost Increases<\/h2>\n<\/p><\/div>\n
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Poorly managed chronic conditions lead to emergency department visits and hospital admissions. An employee with poorly managed diabetes may develop kidney disease requiring dialysis or cardiovascular complications demanding extensive intervention. Each outcome costs exponentially more than proactive disease management.<\/p>\n<\/p><\/div>\n

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A single preventable hospitalization can cost more than years of proactive chronic disease management combined.<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n

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Data Sources:<\/i> American Diabetes Association<\/i><\/a> (2024); <\/i>American Heart Association<\/i><\/a> (2025 Update); <\/i>Alzheimer’s Association<\/i><\/a> (2024); <\/i>National Association of Chronic Disease Directors<\/i><\/a><\/p>\n<\/p><\/div>\n

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The Hidden Costs: Productivity Loss and Absenteeism<\/h2>\n<\/p><\/div>\n
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The Integrated Benefits Institute<\/a> reports that poor health costs the U.S. economy $575 billion annually, with chronic disease driving much of this loss through absenteeism and reduced productivity. That’s lost output your company absorbs.<\/p>\n<\/p><\/div>\n

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Comorbidities compound the problem. Employees with diabetes often develop hypertension, cardiovascular disease, or depression. Each additional condition adds medical expenses while reducing productivity and increasing time away from work.<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n

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Turning Predictable Risks into Cost Containment Opportunities<\/h2>\n<\/p><\/div>\n
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Here’s the opportunity: chronic disease spending follows identifiable patterns. You can see these patterns in your claims data. That means you can interrupt them before costs spiral out of control.<\/p>\n<\/p><\/div>\n

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This is where cost containment in healthcare<\/a> becomes most effective. With claims transparency, you spot the high-risk employees early and intervene strategically.<\/p>\n<\/p><\/div>\n

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Strategic interventions reduce expenses while improving employee quality of life, a rare win-win in healthcare finance.<\/p>\n<\/p><\/div>\n

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Chronic disease management is a proactive, data-driven system for keeping employees with ongoing conditions stable and out of the hospital. Instead of waiting for expensive episodes like ER visits, uncontrolled diabetes, or unmanaged hypertension, you identify risks early, intervene quickly, and maintain steady health over time.<\/p>\n<\/p><\/div>\n

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The shift is simple but powerful: from reactive sick care to continuous health management. Fully insured plans hide the claims data you need to do this. Self-funded plans make it possible.<\/p>\n<\/p><\/div>\n

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To learn more about what fully insured carriers won\u2019t tell you, download our free guide.<\/i><\/p>\n<\/p><\/div>\n

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Implementing Clinical Care Management for Chronic Conditions<\/h2>\n<\/p><\/div>\n
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Once you have access to real claims visibility, clinical care management is the expert layer that turns data into action. Registered nurses<\/a> and healthcare professionals step in as care navigators for employees with complex or chronic needs, preventing the small issues that become catastrophic claims.<\/p>\n<\/p><\/div>\n

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Care Coordination by Medical Professionals<\/h2>\n<\/p><\/div>\n
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Care managers guide employees through the healthcare system. They coordinate appointments, see that providers share information, and help employees understand their conditions. The Agency for Healthcare Research and Quality shows coordinated care reduces medical errors and improves outcomes, which directly reduces high-cost claims.<\/p>\n<\/p><\/div>\n

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Personalized Health Assessments<\/h2>\n<\/p><\/div>\n
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Generic wellness programs alone don\u2019t move numbers. Clinical managers work with physicians to build individualized plans tailored to each employee\u2019s condition and medical history. This personalized approach allows for evidence-based interventions.<\/p>\n<\/p><\/div>\n

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Medication Management<\/h2>\n<\/p><\/div>\n
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Medication non-adherence costs the U.S. system between $100 billion and $289 billion annually, according to the National Council for Mental Wellbeing. Care managers make sure employees stay on track, manage side effects, and access financial assistance to avoid hospitalizations and worsening chronic disease.<\/p>\n<\/p><\/div>\n

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Preventive Care and Early Intervention<\/h2>\n<\/p><\/div>\n
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Continuous monitoring catches issues early. When warning signs are addressed before they escalate, you avoid the ER visits and inpatient admissions that drive the majority of claims.<\/p>\n<\/p><\/div>\n

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Clinical care management is how health plans actually bend the cost curve to reduce cost-shifting to employees and keep people healthier at the same time.<\/p>\n<\/p><\/div>\n

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Direct Primary Care (DPC): A Proactive Approach to Disease Management<\/h2>\n<\/p><\/div>\n
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Direct primary care<\/a> (DPC) gives employees unlimited access to their primary care physician for a flat monthly fee, typically $50 to $150, with no copays or claim forms. With insurance billing out of the picture, physicians can focus on care instead of throughput.<\/p>\n<\/p><\/div>\n

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How DPC Cuts Costs<\/h2>\n<\/p><\/div>\n
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According to GoodRx<\/a>, DPC physicians typically care for 600 patients instead of 2,500+. That means:<\/p>\n<\/p><\/div>\n

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\n\t\t\t\t\t\t30\u201360 minute visits instead of 7\u201310<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tSame-day or next-day appointments<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tMore time for chronic disease coaching<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tEarly intervention before costly care is needed<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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The Society of Actuaries<\/a> reported roughly 40% fewer emergency department visits and 53% lower ER spending for employees in a direct primary care-style model compared with traditional plans.<\/p>\n<\/p><\/div>\n

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Sources: <\/i>Rowe et al<\/i><\/a>., 2017; <\/i>Brekke<\/i><\/a>, 2016; <\/i>Colorado Health Institut<\/i><\/a>e, 2018; <\/i>Society of Actuaries<\/i><\/a>, 2016\u20132020; <\/i>Mercatus Center<\/i><\/a>, 2019.<\/i><\/p>\n<\/p><\/div>\n

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Integrating DPC With Self-Funded Plans<\/h2>\n<\/p><\/div>\n
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In a self-funded plan, DPC becomes a strategic asset. Data flows to your third-party administrator<\/a> (TPA) and clinical care management team<\/a>, giving them earlier signals and faster opportunities to intervene. You have the flexibility to choose DPC partners based on your claims trends rather than a carrier\u2019s network limitations.<\/p>\n<\/p><\/div>\n

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Read<\/i> 8 Secrets to Finding a TPA That Fits Your Self-Funding Needs<\/i><\/a> to learn how to evaluate these partners.<\/i><\/p>\n<\/p><\/div>\n

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How Self-Funded Plans Enable Effective Chronic Disease Management <\/h2>\n<\/p><\/div>\n
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Self-funded health insurance<\/a> provides structural advantages unavailable in traditional fully insured arrangements.<\/p>\n<\/p><\/div>\n

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Using Claims Data Transparency to Identify Risks<\/h2>\n<\/p><\/div>\n
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You get detailed information showing which chronic conditions affect your population, medication adherence patterns, and opportunities for intervention. Roundstone Reporting<\/a> provides actionable insights into chronic disease populations, letting you measure program effectiveness and adjust strategies in real time.<\/p>\n<\/p><\/div>\n

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With fully insured plans, you’re flying blind. With self-funding, you see exactly where your healthcare dollars are going and can act on that information immediately.<\/p>\n<\/p><\/div>\n

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Flexibility to Customize Programs<\/h2>\n<\/p><\/div>\n
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You can put targeted interventions in place based on your population’s specific needs. If claims data reveals high costs from poorly controlled diabetes, you can add a diabetes management program mid-year without waiting for renewal.<\/p>\n<\/p><\/div>\n

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This flexibility means you’re not stuck with one-size-fits-all solutions that don’t address your actual cost drivers.<\/p>\n<\/p><\/div>\n

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Vendor Choice and Integration<\/h2>\n<\/p><\/div>\n
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You select best-in-class chronic disease management partners rather than accepting dictated vendors from fully insured carriers.<\/p>\n<\/p><\/div>\n

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Want to work with a specific direct primary care provider? Need a specialized diabetes management program? You have the freedom to choose partners that deliver real results for your population.<\/p>\n<\/p><\/div>\n

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Financial Incentives Aligned with Outcomes<\/h2>\n<\/p><\/div>\n
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You directly benefit from every dollar saved through chronic disease programs. In fully insured plans, carriers keep all savings while you pay increasing premiums.<\/p>\n<\/p><\/div>\n

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When your chronic disease management program prevents a hospitalization, that savings stays with your company. When medication adherence improves and complications decrease, you see those cost reductions in your bottom line.<\/p>\n<\/p><\/div>\n

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Implementing Chronic Disease Management Programs: 4 Practical Steps<\/h2>\n<\/p><\/div>\n
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Effective chronic disease management requires a systematic approach that builds on data insights and gets employees involved proactively.<\/p>\n<\/p><\/div>\n

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1. Analyze Your Claims Data<\/h2>\n<\/p><\/div>\n
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Work with your TPA and clinical team to identify which chronic conditions are most common, which drive the highest costs, emergency department use patterns, medication adherence rates, and high-risk individuals who may benefit from intervention.<\/p>\n<\/p><\/div>\n

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2. Select Evidence-Based Interventions<\/h2>\n<\/p><\/div>\n
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The National Association of Chronic Disease Directors<\/a> maintains resources on evidence-based programs. Effective interventions include clinical care management with nurse coordinators, direct primary care partnerships, condition-specific programs, pharmacy optimization through PBMs as your self-funded plan’s secret weapon<\/a>, and behavioral health integration.<\/p>\n<\/p><\/div>\n

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3. Engage Employees Proactively<\/h2>\n<\/p><\/div>\n
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Programs only succeed when employees participate. Use personal outreach from clinical staff, eliminate financial barriers by removing copays for chronic disease care, provide convenient access through telemedicine and DPC, communicate clear benefits, and make sure participation is voluntary with strict HIPAA protections.<\/p>\n<\/p><\/div>\n

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4. Coordinate Care and Monitor Outcomes<\/h2>\n<\/p><\/div>\n
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Make sure your TPA, clinical team, PBM, and specialty vendors share data and coordinate interventions. Track cost trends, clinical outcomes, engagement levels, and employee satisfaction using Roundstone Reporting and regular reviews.<\/p>\n<\/p><\/div>\n

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Cost containment strategies for managing catastrophic diagnoses<\/a> provide additional frameworks for tracking outcomes.<\/p>\n<\/p><\/div>\n

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Benefits advisors: Lead your clients to real savings while you grow your business.<\/i><\/p>\n<\/p><\/div>\n

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Roundstone’s Integrated Approach to Chronic Disease Management<\/h2>\n<\/p><\/div>\n
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Roundstone’s model uniquely supports complete chronic disease management through integrated components that work seamlessly together. Here’s how each piece contributes to better outcomes and lower costs:<\/p>\n<\/p><\/div>\n

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Group Medical Captive Structure<\/h2>\n<\/p><\/div>\n
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The group medical captive pools risk across hundreds of employers, providing stability that makes long-term investment in chronic disease programs possible without punitive rate increases.<\/p>\n<\/p><\/div>\n

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When you invest in proactive chronic disease management, you’re not penalized with higher premiums the following year. The captive structure protects you from volatility while you build healthier, more cost-effective outcomes.<\/p>\n<\/p><\/div>\n

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Bywater TPA Integration<\/h2>\n<\/p><\/div>\n
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Bywater TPA integration provides claims administration with clinical expertise built in, making sure interventions are put in place quickly without friction.<\/p>\n<\/p><\/div>\n

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There’s no delay between identifying an opportunity and taking action. The clinical team and administrative team work as one unit, streamlining everything from data analysis to program implementation.<\/p>\n<\/p><\/div>\n

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Roundstone Reporting<\/h2>\n<\/p><\/div>\n
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Roundstone Reporting provides dedicated support to analyze claims data, identify chronic disease opportunities, and recommend evidence-based interventions with real-time visibility into program performance.<\/p>\n<\/p><\/div>\n

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You’re not left to figure out the data on your own. Expert analysts identify your highest-impact opportunities and track results as programs are implemented.<\/p>\n<\/p><\/div>\n

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Vendor Flexibility<\/h2>\n<\/p><\/div>\n
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You select chronic disease management vendors that best fit your population. Want a specific diabetes management program? Prefer a particular direct primary care provider? You have the freedom to build the right solution for your employees.<\/p>\n<\/p><\/div>\n

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Proven Results<\/h2>\n<\/p><\/div>\n
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Roundstone members putting complete programs in place achieve meaningful cost reductions while maintaining or improving quality of care. Self-funded employee satisfaction<\/a> improves when chronic disease management provides tangible support. They benefit from better health, easier access to care, and lower out-of-pocket costs.<\/p>\n<\/p><\/div>\n

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Learn how Roundstone employees had no premium increase for 8 straight years.<\/i><\/p>\n<\/p><\/div>\n

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Measuring Success: ROI and Key Metrics<\/h2>\n<\/p><\/div>\n
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Complete measurement captures cost, clinical, and engagement outcomes. Here’s what to track to understand whether your chronic disease management programs are delivering results:<\/p>\n<\/p><\/div>\n

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Cost Metrics<\/h2>\n<\/p><\/div>\n
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These numbers show the financial impact of your chronic disease management efforts:<\/p>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tPer-employee-per-year costs for chronic disease populations<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tEmergency department use and costs<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tHospital admission rates<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tPharmacy spend for chronic conditions<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tTotal medical cost trends year over year<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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When these metrics trend downward while quality stays consistent or improves, you know your programs are working.<\/p>\n<\/p><\/div>\n

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Clinical Metrics<\/h2>\n<\/p><\/div>\n
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These indicators measure whether employees with chronic conditions are getting healthier:<\/p>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tMedication adherence rates<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tCondition control measures like HbA1c for diabetics<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tPreventable complication rates<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t<\/div>\n
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\n\t\t\t\t\t\tPrimary care engagement<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t<\/div>\n
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\n\t\t\t\t\t\tSpecialist visit appropriateness<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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Better clinical outcomes directly translate to lower costs and healthier, more productive employees.<\/p>\n<\/p><\/div>\n

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Engagement Metrics<\/h2>\n<\/p><\/div>\n
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Programs only work when employees participate. Track these measures to understand adoption:<\/p>\n<\/p><\/div>\n

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\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t<\/div>\n
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\n\t\t\t\t\t\tEnrollment rates in chronic disease programs<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t<\/div>\n
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\n\t\t\t\t\t\tCare plan completion<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t<\/div>\n
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\n\t\t\t\t\t\tEmployee satisfaction with chronic disease support<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t<\/div>\n
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\n\t\t\t\t\t\tHealth risk assessment participation<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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High engagement typically predicts strong cost and clinical outcomes within 18 to 24 months.<\/p>\n<\/p><\/div>\n

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\n\t\t\t\t\t\t\t\"Roundstone\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n
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HR professionals: Learn why switching to self-funding is easier than you think.\u00a0<\/i><\/p>\n<\/p><\/div>\n

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Overcoming Challenges in Chronic Disease Management Implementation<\/h2>\n<\/p><\/div>\n
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Implementing chronic disease management programs comes with predictable obstacles. Here’s how to address the most common concerns:<\/p>\n<\/p><\/div>\n

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Employee Privacy Concerns<\/h2>\n<\/p><\/div>\n
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Employees worry about who sees their health information. Address this head-on through strict HIPAA protections, de-identified aggregate data, and voluntary programs that are supportive rather than punitive.<\/p>\n<\/p><\/div>\n

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Make it clear: participation is always voluntary, health information stays private, and the goal is to help\u2014never to penalize employees for health conditions.<\/p>\n<\/p><\/div>\n

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Low Participation Rates<\/h2>\n<\/p><\/div>\n
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Programs only work when employees engage. Boost participation by:<\/p>\n<\/p><\/div>\n

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\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t<\/div>\n
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\n\t\t\t\t\t\tEliminating all financial barriers (no copays for chronic disease management visits)
\n<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\t\t\t<\/span>\n\t\t\t<\/div>\n
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\n\t\t\t\t\t\tProviding convenient access through telemedicine and direct primary care<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tUsing personal outreach from trusted clinical staff, not automated emails<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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\n\t\t\t\t\t\tCommunicating benefits in terms employees care about\u2014feeling better, spending less on medications, avoiding complications<\/b>\t\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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When employees see tangible benefits without added costs or hassle, participation rates climb.<\/p>\n<\/p><\/div>\n

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Measuring Impact Takes Time<\/h2>\n<\/p><\/div>\n
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Don’t expect overnight results. Many payers and vendors report achieving positive ROI from population health initiatives within roughly 2\u20133 years, depending on program scope and baseline risk, but timelines vary widely.<\/p>\n<\/p><\/div>\n

\n

Set appropriate expectations with leadership and highlight early indicators like improved engagement rates, reduced emergency visits, and better medication adherence. These leading indicators predict long-term cost savings.<\/p>\n<\/p><\/div>\n

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Integration Complexity<\/h2>\n<\/p><\/div>\n
\n

Coordinating between your TPA, clinical team, PBM, and specialty vendors can get complicated fast. Roundstone’s integrated model solves this challenge\u2014Bywater, the CSI Team, and clinical partners coordinate seamlessly from shared data.<\/p>\n<\/p><\/div>\n

\n

You get one team working from one data source with one goal: better health outcomes at lower costs without data gaps or coordination headaches.<\/p>\n<\/p><\/div>\n

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Why Investing in Employee Health Pays Off<\/h2>\n<\/p><\/div>\n
\n

In a traditional fully insured model, effective chronic disease management creates a perverse incentive: If you successfully lower claims by keeping employees healthy, the carrier keeps the savings and likely still raises your rates.<\/p>\n<\/p><\/div>\n

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Your hard work increases their profit margin, not your bottom line.<\/p>\n<\/p><\/div>\n

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Roundstone\u2019s Group Medical Captive changes the financial equation entirely. By self-funding with Roundstone, you align your company\u2019s financial incentives with your employees\u2019 health.<\/p>\n<\/p><\/div>\n

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You Keep the Savings<\/h2>\n<\/p><\/div>\n
\n

When proactive management prevents a $100,000 hospitalization, that capital stays in your plan rather than disappearing into a carrier\u2019s black box.<\/p>\n<\/p><\/div>\n

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You Share in the Success<\/h2>\n<\/p><\/div>\n
\n

Because you are part of a captive, effective risk management across the pool leads to annual distributions. When the group performs well, you get a check back. Unused premium is returned to you, not kept by an insurance giant.<\/p>\n<\/p><\/div>\n

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You Stop the Trend<\/h2>\n<\/p><\/div>\n
\n

Instead of accepting a 15% annual increase as “market trend,” you actively bend your own cost curve, stabilizing expenses for the long term.<\/p>\n<\/p><\/div>\n

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Partner With Roundstone for Proactive Cost Containment<\/h2>\n<\/p><\/div>\n
\n

It takes more than good intentions to implement a chronic disease management program. You need the right data, the right partners, and the right infrastructure.<\/p>\n<\/p><\/div>\n

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You don\u2019t have to build this alone.<\/p>\n<\/p><\/div>\n

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Roundstone empowers you to move from reactive “sick care” to continuous health management. We provide the claims transparency to spot risks early, the clinical care management to support your most vulnerable employees, and Roundstone Reporting to help you implement best-in-class solutions.<\/p>\n<\/p><\/div>\n

\n

Stop paying for preventable complications and start investing in a system that rewards you for a healthier workforce.<\/p>\n<\/p><\/div>\n

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Contact Roundstone<\/a> today to request a proposal and see how active chronic disease management can lower your costs.<\/p>\n<\/p><\/div>\n

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\n\t\t\t\t\t\t\t\t\t\t\t\tReferences<\/a>\n\t\t\t\t\t<\/div>\n
\n

Alzheimer\u2019s Association. \u201c2024 Alzheimer\u2019s Disease Facts and Figures.<\/a>\u201d Alzheimer\u2019s Association, 2024. Accessed 23 Jan. 2026. <\/p>\n<\/p>\n

<\/p>\n

American Diabetes Association. \u201cEconomic Costs of Diabetes in the U.S. in 2022<\/a>.\u201d Diabetes Care, 2024. Accessed 23 Jan. 2026. <\/p>\n<\/p>\n

<\/p>\n

American Heart Association. \u201cHeart Disease and Stroke Statistics \u2013 2025 Update<\/a>.\u201d American Heart Association, 2025. Accessed 23 Jan. 2026. <\/p>\n

<\/p>\n<\/p>\n

Brekke, K. \u201cDirect Primary Care: Evaluating an Emerging Model<\/a>.\u201d Health Watch Newsletter, Society of Actuaries, May 2016. Accessed 23 Jan. 2026. <\/p>\n

<\/p>\n<\/p>\n

Centers for Disease Control and Prevention. \u201cAbout Chronic Diseases.<\/a>\u201d CDC, updated 12 Jan. 2026. Accessed 23 Jan. 2026. <\/p>\n

<\/p>\n<\/p>\n

Centers for Disease Control and Prevention. \u201cFast Facts: Health and Economic Costs of Chronic Conditions<\/a>.\u201d CDC, 2025. Accessed 23 Jan. 2026. <\/p>\n

<\/p>\n<\/p>\n

Colorado Health Institute. \u201cDirect Primary Care: An Innovative Alternative to Traditional Health Insurance<\/a>.\u201d Colorado Health Institute, 2018. Accessed 23 Jan. 2026. <\/p>\n

<\/p>\n<\/p>\n

GoodRx Health. \u201cWhat Is Direct Primary Care (DPC)?<\/a>\u201d GoodRx, n.d. Accessed 23 Jan. 2026.<\/p>\n

<\/p>\n<\/p>\n

Integrated Benefits Institute. \u201cPoor Health Costs U.S. Employers $575 Billion in 2019<\/a>.\u201d Integrated Benefits Institute, 2020. Accessed 23 Jan. 2026. <\/p>\n

<\/p>\n<\/p>\n

Mercatus Center at George Mason University. \u201cThe Benefits of Direct Primary Care: Improving Quality and Reducing Costs<\/a>.\u201d Mercatus Center, 2019. Accessed 23 Jan. 2026. <\/p>\n

<\/p>\n<\/p>\n

National Association of Chronic Disease Directors. \u201cArthritis: A Chronic Disease Fact Sheet<\/a>.\u201d National Association of Chronic Disease Directors, 2025. Accessed 23 Jan. 2026.<\/p>\n

<\/p>\n<\/p>\n

National Association of Chronic Disease Directors. \u201cResources: Evidence-Based Public Health Programs and Practices<\/a>.\u201d National Association of Chronic Disease Directors, n.d. Accessed 23 Jan. 2026.<\/p>\n

<\/p>\n<\/p>\n

National Council for Mental Wellbeing. \u201cMedication Adherence and the Cost of Nonadherence<\/a>.\u201d National Council for Mental Wellbeing, n.d. Accessed 23 Jan. 2026. <\/p>\n

<\/p>\n<\/p>\n

Rowe, K., et al. \u201cDirect Primary Care: An Innovative Alternative to Traditional Health Insurance<\/a>.\u201d Journal of the American Board of Family Medicine, 2017. Accessed 23 Jan. 2026.<\/p>\n

<\/p>\n<\/p>\n

Society of Actuaries. \u201cDirect Primary Care Evaluation Model<\/a>.\u201d Society of Actuaries, 2016. Accessed 23 Jan. 2026.<\/p>\n

<\/p>\n<\/p>\n

Society of Actuaries. \u201cEvaluating the Impact of Direct Primary Care: An Actuarial Model<\/a>.\u201d Society of Actuaries, 2020. Accessed 23 Jan. 2026. <\/p>\n

<\/p>\n<\/p>\n

U.S. Agency for Healthcare Research and Quality. \u201cCare Coordination<\/a>.\u201d AHRQ, n.d. Accessed 23 Jan. 2026. <\/p>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n

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The post Chronic Disease Management<\/a> appeared first on Roundstone Insurance<\/a>.<\/p>\n\n","protected":false},"excerpt":{"rendered":"

Twenty percent of your employees are generating 80% of your healthcare costs. You know this pattern exists. What you probably don’t know is which twenty percent, what conditions are driving the spend, or what you can do about it. That’s by design. Fully insured carriers profit from keeping you in the dark. They aggregate claims, […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[94],"tags":[17444,13375,5984],"dealstore":[],"offerexpiration":[],"class_list":["post-7059970","post","type-post","status-publish","format-standard","hentry","category-insurance","tag-chronic","tag-disease","tag-management"],"yoast_head":"\nChronic Disease Management - Som2ny Network<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/fivemor.com\/?p=7059970\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Chronic Disease Management - Som2ny Network\" \/>\n<meta property=\"og:description\" content=\"Twenty percent of your employees are generating 80% of your healthcare costs. 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