Your healthcare vendor’s chronic disease management program should begin with identifying individuals with high-risk health conditions. This can be accomplished by risk stratifying the population using claims, biometric screenings, and Health Risk Assessment data. The population is then grouped into three risk levels: high, medium, and low. The thresholds for these levels are based on criteria outlined in ATP IV, JNC8, ADA, and Framingham Heart Study.

As part of the initial stratification, the vendor should track how many individuals outside normal ranges have progressed on key health status measures such as blood pressure, lipids, body mass index, blood sugar, tobacco and alcohol use, and stress. It is also advisable to measure how many individuals with chronic diseases are at the standard of care for their conditions (e.g., diabetes, asthma, heart disease, COPD).

Dr. Terry Layman, SVP & Corporate Medical Director, Marathon Health

As SVP, Corporate Medical Director, Dr. Layman serves on the senior leadership team and provides clinical leadership for our 200+ health centers. Dr. Layman is passionate about delivering patient-centered primary care and continues to dedicate some of his time as a provider in one of our health centers.