Managing Chronic Conditions Globally: Employer Considerations and Recommendations

This article aims to inform multinational employers’ strategic efforts to address chronic, high-cost conditions for employees regardless of location.

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June 03, 2024

Introduction

As the global landscape of health care continues to evolve, the burden of chronic conditions has emerged as a pressing concern affecting populations worldwide. Some multinational employers are already poised to focus on chronic (often referred to as “noncommunicable”) diseases such as cardiovascular and musculoskeletal (MSK) conditions as well as cancer. According to the 2024 Large Employer Health Care Strategy Survey, 62% of surveyed employers have reported observing or expecting to see increased chronic condition management needs due to the lingering effects of the pandemic.1 Further, in the U.S., cancer has maintained its position as the leading condition driving health care costs among surveyed employers for the second consecutive year.1

Meanwhile, by 2025, it is estimated that 167 million people living with obesity around the world will deal with associated health complications, and global cancer cases are predicted to rise by more than 75% by 2050, with a significant surge in prevalence among young adults.2,3 Interconnected and often preventable chronic illnesses such as cardiovascular disease, diabetes and obesity (sometimes collectively referred to as ”cardiodiabesity”) are similarly increasing around the world, with evidence suggesting that the total cost of these conditions is $719 billion each year.4,5 With these projected costs, the implications for employers providing health and well-being benefits across countries are profound. This burgeoning disease burden not only impacts workforce health and productivity but also underscores the imperative of a proactive investment in prevention and well-being programs as well as condition management initiatives. By empowering employees to screen for and manage chronic illnesses early on, employers can potentially mitigate the impact of time-consuming, high-cost care over the long term.

The value of having a globally nuanced and thoughtfully curated chronic disease management strategy in place to support employees worldwide is arguably greater than ever when considering the substantial impact of chronic diseases on workforce well-being and health care costs. This article provides an overview of key considerations, challenges and recommendations for multinational employers seeking to ensure that their health and well-being programs are equipped to effectively address noncommunicable conditions.

Key Considerations

When multinational employers consider ways to scale their well-being programs to address chronic conditions, understanding the different care models in any given country/market and how that intersects with employer-sponsored coverage is important. For example, the United Kingdom’s (UK) public health care system, the National Health Service (NHS), has three major cancer screening programs aimed at detecting cancer early and improving treatment outcomes for breast, bowel and cervical cancers.6 Despite providing ample coverage for screening and treatment, long wait times are pushing many patients toward the private insurance market for supplemental coverage to receive care faster than they would through NHS.7 This situation is further exacerbated by shortages in the UK’s health care workforce and an aging workforce.8

Below are some key questions to keep in mind for each major location/country where an employer is pursuing these efforts. These questions are categorized by market/infrastructure-related questions and employer-focused factors.

Market/Infrastructure-Related Questions

  • What is the health care infrastructure, and how are chronic conditions typically managed?
  • What government regulations and policies exist regarding health care coverage for chronic conditions, and how do they impact employer-sponsored coverage?
  • Are there any established Centers of Excellence (COEs) or specialized health care providers for managing chronic conditions? If so, how can they be leveraged within a well-being program framework?
  • Are there specific drugs, treatments and/or therapies that are commonly covered by the government, and how does this align with current offerings?
  • What unintended consequences might exist (e.g., cost shifting to employers)?

Employer-Focused Factors

  • How are chronic conditions addressed in your employer-sponsored insurance program, and how does that vary by country?
  • What are the chronic condition management needs/disease burden among your target population?
  • How do socioeconomic factors and disparities affect access to health care and participation in well-being programs, and how can those barriers be addressed effectively?
  • What cultural and/or translation supports should be considered when designing and implementing programs to address noncommunicable conditions?
  • How can partnerships with vendors, local health care providers, insurers and/or government agencies enhance the effectiveness of chronic condition management?

Challenges in Managing Noncommunicable Conditions Around the World

Employers face a litany of challenges when attempting to implement a chronic condition management strategy, including navigating the gaps driven by variations in health care infrastructure, coverage levels and access to specialized care around the world. To illustrate the various challenges employers may encounter in different geographies, listed below are some of the top challenges faced in India, the UK and Germany.

  • In India, where health care access is hindered by socioeconomic disparities, employers may face challenges obtaining engagement from employees located in rural areas as well as ensuring a culturally sensitive program design.9
  • While the NHS provides universal coverage in the UK, patients contend with long wait times for specialist care, requiring consideration of innovative strategies to supplement existing health care offerings.10
  • The German health care system is fragmented at times. which makes coordination and continuity of care more challenging for patients with chronic conditions.11 Poor information sharing worsens this issue, hindering timely and seamless transitions between different health care providers.

Along with the challenge of navigating gaps in coverage and access to various health care infrastructures, employers also have to grapple with the following ongoing challenges:

  • Inconsistent “reach” of vendor programs across borders;
  • A lack of awareness of screening/prevention initiatives;
  • Difficulty gaining organizational buy-in;
  • Competing priorities;
  • Language barriers;
  • Cultural stigma;
  • Lack of information/data; and
  • Various regulatory hurdles in collecting and managing data; for example, the General Data Protection Regulation (GDPR).

Multinational Employer in Action

Eaton Corporation established a program that identifies individuals with chronic medical diseases and performs targeted outreach based on that data analysis in select countries. “We conduct a competitive analysis based on what is offered within each country, looking to see if insurance offered by country is adequate and if not, how can we put something else in place. One challenge in this is getting data across the board from national health systems.” – Doug Grossman-McKee, Director, Health & Welfare at Eaton Corporation


Recommendations for Multinational Employers

  • 1 | Promote awareness of additional health and well-being resources and information available to support holistic health needs: Seek to improve employee outcomes holistically through all available care pathways including, but not limited to, addressing modifiable risk factors and encouraging a healthy diet and physical activity, tobacco cessation and providing patient care coordination and navigation resources. Leveraging emerging virtual engagement platforms where possible can also help overcome geographical barriers and enhance accessibility.
  • 2 | Require carriers and vendor partners to collaborate more effectively with the local/national health plan(s) to improve adoption of value- and evidence-based treatment guidelines: This includes leveraging resources from respected third parties such as the International Consortium for Health Outcomes Measurement (ICHOM) and the World Health Organization (WHO).
  • 3 | Monitor global claims data where possible: Work with relevant vendor partners (i.e., pharmacy benefit manager, local health plans) to obtain access to aggregated, de-identified data to gather insights and use in strategic planning. In addition, tracking migration between different risk states can provide an added level of insight into treatment outcomes.
  • 4 | Consider utilizing a captive: Implementing a captive can provide deeper, more timely insight into claims data for high-cost chronic conditions; it can also facilitate governance processes and oversight.
  • 5 | Cultivate a supportive workplace culture and address stigma associated with noncommunicable conditions: Given the tremendous physical, mental and financial stressors that accompany chronic condition diagnoses, ensuring a workplace culture of support and understanding is crucial.
  • 6 | Consider the role of other accommodations and wraparound support: A caregiver can make all the difference; therefore, consider expanding communication efforts to meet both patient and caregiver needs. This may include other offerings. such as increased flexibility, leave and time away accommodations to ensure that employees with needs related to their chronic conditions can continue working while receiving treatment and necessary follow-up care. Aspects of these services may already be available from existing vendor partner relationships.

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