Managing both health and disease is enjoying a major surge in popularity, along with some major shifts in focus. While federal government insurance plans seem to continue getting mixed results at best, in terms of sickness care cost reductions compared to costs of interventions, commercial insurers and particularly employers are finding broadly, if not universally positive ROI from their investments in these proactive intervention programs.

One of the biggest trends affecting both is that they are merging, as employer-sponsored worksite wellness programs and insurer-sponsored disease management programs expend in each other’s direction. “Disease” is coming to include risk conditions, rather than just already existing chronic illness, for example, while wellness is moving beyond general health and fitness promotion to include risk behavior and condition management.

Another equally important trend is the expansion of health, risk and disease management — from their traditional limited focus on reducing sickness care costs for self-insured employers, and insurance premiums for their non-self-insured counterparts – to examining the total economic impact of employee and dependent health on employers’ financial performance and employees’ lives. After numerous studies have found such impact to be many times as great as are sickness costs or savings, and that the behaviors and conditions causing such impact are different from those causing most sickness care costs and savings, what is being managed is changing dramatically.

This means that where disease management primarily enrolled a small minority of health plan members, and worksite wellness a modest percentage of employees, new proactive initiatives are aiming to include practically everyone. Employers are offering incentives to achieve participation rates above 90%, for example, compared to below 20% when no incentives are offered. Employees are creating or joining “healthy communities” online or in person to support each other in quests for specific health improvements, adding to success at minimal cost.

We can only guess at how widely health and disease management investments will be made by which payers, how broadly they will be adopted by consumers, and how much that will affect the current primarily “sickness care” system. But it seems clear that the effects will be substantial, since they have the support of so many stakeholders. The big question is the extent to which the traditional sickness care system will be involved in this trend or merely devastated by it.

The positive economic impact that health and disease management has emerges primarily from reducing the incidence and prevalence of disease – a goal that ideally all organizations and individuals could embrace. Unfortunately, such reduction threatens the very existence of the sickness care system, though it will be many years, even decades before real devastation is likely. And as employers, all providers who are part of the sickness care system stand to benefit from health and disease management addressing their own workforces, and may depend on the increased productivity and improved performance that healthy employees tend to contribute for providers’ survival in the first place.