Corporate health management: is it worth investing in programs focused on chronic diseases?

We know that balancing the cost and value of corporate health plans is currently one of the top priorities in the business world. This is because it represents a significant expense for companies while also being one of the most valued benefits by employees.

Therefore, understanding the effectiveness of initiatives aimed at improving the efficiency of corporate health management—such as health promotion and prevention programs—is essential for strategic decision-making in this area.

Although these programs are widely adopted by companies and implemented by health insurers, decision-makers often question their effectiveness, especially due to the per capita cost added to the insurance policy.

With this in mind, our team at Horiens, through Risk Labs—our AI-based risk analysis lab—conducted a predictive study to measure the real impact of a Chronic Disease Program, one of the most relevant topics for effective health management.

What Is the Chronic Disease Program?

To begin with, it’s important to understand the goals of a Chronic Disease Program. It’s no secret that cardiovascular and respiratory diseases, as well as diabetes, are among the most prevalent health conditions affecting the Brazilian population.

To grasp the impact of these conditions on health insurance policies, data from ANS and studies by the Institute for Supplementary Health Studies (IESS) show that about 1% of beneficiaries account for up to 20% of plan costs—most of them being chronic patients affected by the conditions mentioned above.

This happens because such conditions require continuous medical monitoring and, when poorly managed, lead to hospitalizations and high-cost treatments, affecting claim rates and the balance of group health insurance policies.

In this context, health promotion and prevention initiatives focused on integrated care for beneficiaries are increasingly sought after by companies.

These programs aim to closely monitor beneficiaries’ health, offering guidance and awareness that drive habit changes, improve health condition control, and consequently enhance the efficient use of health plan resources and policy balance.

Case Study: Using AI to Visualize Effectiveness Evidence

To assess the effectiveness of a Chronic Disease Program in a large industrial company, Horiens analyzed data from its insured group, focusing on those eligible for the program.

The study was based on data from over 2,100 individuals—both participants and non-participants—from January 2017 to July 2024. The group consisted of 54% men and 46% women, aged 19 and older, with 88.9% being over 59 years old.

Using tools like machine learning and probabilistic simulations—advanced and reliable methods for correlating risk and health—we compared the variation in average monthly per capita medical claim costs.

This type of modeling allows historical data to be correlated with future scenarios involving multiple interdependent variables, making complex risk analysis more tangible.

Key Findings:

• Female participants showed a significant reduction in average monthly usage costs.
• Insured individuals under 60, regardless of gender, also showed positive and statistically significant results.
• Men over 60 increased outpatient visits but did not show proportional improvement in hospitalization severity, indicating opportunities to enhance engagement strategies for this group.

These findings show that this type of program is a worthwhile investment, reducing medical costs, preventing complications, improving disease control, and enhancing quality of life.

Moreover, the study suggests that the earlier eligible beneficiaries engage in the program, the better—highlighting the importance of awareness efforts to encourage prevention and monitoring for better health management.

Data-Driven Health Management: A Path to Better Decisions

By using advanced AI tools in data analysis, we’ve been able to bring previously “abstract” information to the decision-making table.

This supports our clients in designing customized strategies that contribute to more efficient, transparent, and adaptable corporate health management.

Does your company invest in health promotion and prevention programs? What do you know about their effectiveness? Let’s talk about it!