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Serious conditions programs

Serious conditions management programs are structured advisory interventions hosted by Althalia’s medical team for treatment planning, patient and caregiver empowerment, medical orientation, and meeting management that aim to help patients and their caregivers to better manage their disease and access appropriate specialists and hospitals to obtain the optimal treatments.

For employers

For brokers & insurers

Description


Defining serious conditions is difficult and depends on the institution (e.g., employer, broker, insurer) that hosts the program for their beneficiaries.

A number of criteria can be used to describe medical conditions as serious and complex, including severity of the illness, degree of impairment or disability, and level of need for comprehensive care management.

Regarding the following examples of descriptive criteria for serious and complex medical conditions, it is important to recognize that such conditions might be serious and complex for some patients only at some points during the course of their disease or disability.

  • Conditions that are life threatening: Cancer, heart disease, stroke, and HIV/AIDS
  • Conditions that cause serious disability without necessarily being life threatening: Stroke, closed head or spinal cord injuries, mental retardation, and congenital malformations
  • Conditions that cause significant pain or discomfort that can cause serious interruptions to life activities: Allergies, migraine, arthritis, and sickle cell anemia
  • Conditions that require major commitments of time and effort from caregivers for a substantial period: Mobility disorders, blindness, Alzheimer’s disease and other dementias, chronic obstructive pulmonary disease, paraplegia or quadriplegia, Down syndrome, and depression
  • Conditions whose management requires the coordination of multiple specialties: Most cancers, multiple sclerosis, and cerebral palsy
  • Conditions whose treatment poses a risk of serious complications: Most cancers and conditions requiring complex surgery

Individual Patient Treatment Strategy


Althalia’s medical team provides a personalized treatment strategy for each patient that involves:

  • Educating patients and caregivers about the condition and treatment options
  • Developing a plan of care established by the specialist in full collaboration with the physicians involved
  • Proposing several high-quality medical providers according to the treatment options and discussions with the patient regarding preference
  • Organizing all consultations
  • Ensuring follow-up with the healthcare team and the continuity of medical information about the patient among the different medical providers
  • Collecting and reporting information about how the patient’s status by opening and managing a personal medical file

Steps to Implement a Serious Conditions Management Program


1. Determining the needs of the employer, employees, insurer, and beneficiaries

We discuss all social components at the employer level or take into account necessity in terms of population management according to brokers and insurers to develop programs that best fit the needs of our clients. Statistics about the historical medical expenditure of the company or the insurer for the past 3–5 years can help to identify major conditions that affect the population. The aim is to understand who can benefit most in the population and according to a defined budget.

2. Structuring the program

Two major decisions have to be made by our clients: which conditions and which kind of activity Althalia has to take for (e.g., empowerment, psychological support) for patients and for caregivers (e.g., orientation, organization)

3. Communicating with the beneficiary population

Communication about the program is a key element for the success of the program with clients in the population base. Employers and insurers will work with Althalia to create a communication plan that lays out the program’s framework, methods, and schedule for communicating information to employees and insurers and maintain confidentiality and privacy.

4. Managing patients

The programs take several factors into consideration:

  • Patient and family medical history
  • Available information about how patients respond to various methods of treatment, which is evaluated on the basis of the patient population as well as according to the responses of individuals
  • Options available at every stage of the healing process—that is, diagnosis, treatment, and recovery.
  • The cost of various treatment management strategies
  • The ease with which patient can choose and access specialists and treatments

5. Measuring and reporting to all the employer’s components (e.g., human resources departments, employee representatives)

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