Condition Management

Empowering people through education and access to resources

Condition Management Programs are designed to help empower people, in collaboration with physicians and other health care providers, to effectively manage their condition(s) and associated risk factors.

We help people living with heart failure, chronic obstructive pulmonary disease, coronary artery disease, diabetes and asthma, engage the right health care provider, take the right medications, receive the right evidence-based care and make the right lifestyle choices.

Heath care costs are skyrocketing:
  • U.S. spending on health care was $2.6 trillion in 2010, nearly $3 trillion in 2011 and a projected $4.4 trillion in 2018.1
  • More than 75 percent of these costs are due to chronic conditions that could be preventable.2

Our programs are designed to mitigate or reduce the impacts of common conditions by helping individuals take ownership of and manage their own health.

Condition Management Programs from Optum™ have a comprehensive approach that:
  • Identifies the right people at the right time
  • Attracts and enrolls individuals into programs
  • Delivers meaningful engagement to those enrolled
  • Reports on outcomes and identifies future opportunities

Our programs provide high-quality and personalized services designed to meet the unique challenges of every individual. Our programs are:

  • Integrated. Constant monitoring of population data allows us to build a holistic view of each individual. This data enables coordination of clinical resources and sharing of critical clinical information whenever and wherever it is needed. When Condition Management and Optum Rx are used together, our team approach can be supercharged with a pharmacist, and shared data and processes allow synchronization to improve outcomes and reduce cost.
  • Comprehensive. A whole-person approach including an assessment managed by a dedicated nurse addresses immediate needs, gaps in care and underlying issues, and screens for co-morbidities, risk factors and medication compliance. This information helps to develop an action plan with short- and long-term goals in line with their physician treatment plans. Every interaction is an opportunity to educate people about their condition(s) and their implications, and how to avoid triggers and reduce or eliminate risk factors. Outbound and responsive inbound calls help individuals achieve treatment goals, schedule physician appointments and learn about psychosocial and community resources.
  • Coordinated. Dedicated nurses focus on each individual’s physician treatment plans to address ways to positively impact care, medications and lifestyle. Coordinated communications, engagement activities and incentive plans drive meaningful improvement in health. Educational materials and resources are mailed and made available online to help people learn about their condition(s) and what they can do to manage and improve their health.
Heart Failure Program

The Heart Failure Program is a comprehensive solution that provides a unique combination of at-home daily monitoring, nurse support and education. Support is based on acuity level and nurse assessment. The program includes daily home biometric monitoring of weight and symptoms for high-risk individuals with immediate nurse support if weight or symptoms change and alert reports to physicians when issues are detected.

Chronic Obstructive Pulmonary Disease Program

The Chronic Obstructive Pulmonary Disease Program provides education on how to best manage the condition and risk factors, reduce hospitalizations and costs, and

improve quality of life. Support is based on acuity level and nurse assessment. For those at highest risk, daily home biometric monitoring of symptoms with immediate nurse support and alert reports to physicians when issues are detected are provided.

Coronary Artery Disease

The Coronary Artery Disease Program is designed to improve people’s ability to self- manage their condition and risk factors, and to change behaviors to prevent heart attacks, unnecessary hospitalizations and emergency room visits. Support is based on acuity level and nurse assessment

The program provides information and resources to:

  • Reduce or eliminate risk factors, such as high cholesterol, high blood pressure, diabetes, excess weight, cigarette smoking and lack of physical activity.
  • Maintain a healthy lifestyle, adhere to physician treatment plans and medication regimens including proper use of beta-blockers, ACE inhibitors, statins and antiplatelets.

Diabetes Program

The Diabetes Program helps people understand diabetes, its implications and how to take informed action to best manage their condition. Support is based on acuity level and nurse assessment. Information and resources help people to:

  • Achieve and maintain optimum blood glucose levels.
  • Manage co-morbidities related to diabetes, including hypertension, obesity, dyslipidemia and depression.
  • Prevent the onset of complications by receiving evidence-based care, including A1C tests and foot and eye exams.
  • Live life to its fullest by maintaining healthy lifestyles and adhering to recommended treatments and drug therapy regimens.

Asthma Program

The Asthma Program is designed to reduce unnecessary hospitalizations and health care costs, reduce absenteeism and improve quality of life. Support is based on acuity level and nurse assessment. We provide information and resources to help people:

  • Avoid triggers that could induce or aggravate asthma attacks.
  • Reduce or eliminate risk factors, such as smoking.
  • Manage their condition through adherence to medication regimens, peak flow meter use and other physician treatment plans.
  • Monitor their asthma so people can recognize warning signs of an attack and take appropriate actions to resolve it.

1Department of Health and Human Services, June 2009
2Centers for Disease Control and Prevention, 2009