Disease management generally entails using a multidisciplinary team of providers, including physicians, nurses, pharmacists, dieticians, respiratory therapists, and psychologists, to educate and help individuals manage their conditions. Health care providers may also work with support-service providers to fill in any gaps in the care team, such as the need for nutrition screening or remote-patient monitoring.
Disease management programs are based on the concept that individuals who are better educated about how to manage and control their condition receive better care. This could ultimately result in cost-savings.
Program enrollees may need additional support to stick to their medical regimen. Counseling, home visits, hour call centers, and appointment reminder systems have been used to support individuals who are managing their chronic conditions. A method for the measurement of outcomes, including health care service use, expenditures, and patient satisfaction, must be determined prior to the start of the program.
These measures are commonly compared to a baseline or a control group in order to measure the impact of the program. Routine reporting and feedback between patients, physicians, and other providers on the care team is often necessary to assure that patients are effectively managing their conditions and receiving the care they need.
Additionally, health plans need feedback from patients and providers in order to evaluate their programs. Disease management programs have been developed and implemented largely by managed health care plans. Almost all health care plans have implemented at least one type of disease management program, and many have multiple programs see Figure 2a.
Programs for diabetes, asthma, and congestive heart failure are the most common see Figure 2b. Health plans generally contract with vendors, also known as disease management organizations, to provide services. Some, however, choose to operate the program themselves. Employer-sponsored disease management programs are relatively rare, but some employers are using these programs to improve the health of their workforce. Additionally, employers believe that disease management can increase worker productivity and reduce medical insur-ance costs.
Between and , use of disease management among a group of employers, with some 12 million employees, increased from 31 percent to 43 percent. Thus, they worked with their health plans to implement programs that better meet the health care needs of their workforce. Almost half of states have implemented or are in the process of implementing Medicaid disease management programs.
Similar to health plans, states can hire a disease management organization to administer the program, or they can create their own program. Although research on the impact of state Medicaid disease management programs is somewhat limited, there has been some evidence of improvements in the quality of care being provided and limited cost-savings.
The Centers for Medicare and Medicaid Services CMS is currently conducting a series of disease management demonstration programs for Medicare beneficiaries with chronic conditions in traditional fee-for-service Medicare. In addition, about 11 percent of Medicare beneficiaries — 4. Many disease management programs have been successful at improving self-care practices and reducing use of various health care services, including hospital admissions and emergency room visits.
As a result, health care expenditures for certain populations with chronic conditions have decreased. Below are several programs that have improved self-care practices and reduced health care use and costs. While many programs have succeeded at reducing health care expenditures, the potential for long-term savings is still not known. This is due, in part, to the fact that to date, studies that have found substantial cost-savings are generally confined to a short duration of time, and are typically based on the experiences of a single plan or program or are restricted to certain areas of the country.
A health plan in Seattle, for example, found that only one of its programs — a prenatal care program for high-risk pregnancies — produced a positive return on investment and improved patient outcomes. The other programs were costly to administer and did not serve many members.
Measures of quality of life include those related to health or functional status, such as mobility, presence of symptoms, and overall energy level.
Disease management has resulted in some improvements in the quality of life for people with chronic conditions. Collaborative practice models to include physician and support service providers in treatment planning for members.
Process and outcomes measurement, evaluation and management. Ongoing communication with primary and ancillary providers regarding patient status. Disease management services include: A holistic, member-centered approach to disease management focusing on the needs of the member. Motivational interviewing techniques used in conjunction with member self-empowerment. The ability to manage more than one disease to meet the changing health care needs of our member population.
Weight management and smoking cessation education. Who is eligible? Note: Programs offered are subject to change. Disease Management Referral Form Get help with treatment plans As we work with patients, we would like your input for patient treatment plans. Receive feedback on your patients Providers can access Patient to obtain feedback on their patients regarding their care plans and condition management while enrolled in disease management programs.
Contacting us Please call to reach a care manager. The goal of disease management is to encourage patients to use medications properly, to understand and monitor their symptoms more effectively, and possibly, to change behavior. In traditional fee-for-service settings, health care professionals typically focus on specific, isolated medical events and the health care status of individual patients. For example, a physician who diagnoses and treats a patient with congestive heart failure CHF may believe he or she has fulfilled their responsibility once the patient's symptoms are resolved.
The physician would then prescribe appropriate medications and suggest ways to manage CHF symptoms. Generally, physicians or other health care professionals only have the opportunity to evaluate patients when the patient complains of symptoms, when the patient is seen during an office visit or when the patient is hospitalized.
By contrast, disease management programs focus on multiple facets of patient care and maximize the health status of defined patient populations. Successful disease management programs coordinate care for the disease among all providers, physicians, pharmacists, hospitals and laboratories. They also develop and implement a partnership with patients, because all of these individuals understand the value and relative contribution each brings to the program.
Managed care organizations are well positioned to practice disease management because they are dedicated to comprehensive, coordinated care. They focus on improving the health of entire patient populations, use available resources effectively, and are held accountable by patients, purchasers and regulators for the quality of their medical services. Managed care organizations integrate key health care services, including patient and health care professional education, as well as ambulatory care, acute care, home health care and nursing home services.
Such integration provides greater continuity of patient care, leading to better health care outcomes. Health outcomes affect both the quality of life and the use of health care services. Disease management programs are objectively evaluated based on previously defined outcome points and the collection of baseline data on the natural course of the targeted disease. Performance indicators and outcome measures should be analyzed to determine if the program is achieving quality improvement.
Performance indicators assess a specific performance at regular intervals and compare performance to predefined indicators. These indicators measure the intermediate success of an action or intervention. Outcome measures determine the end result of an action or intervention. Obtaining meaningful outcomes should improve the overall quality of the program. Health outcomes can be measured from several perspectives:. Sign Up. What are your concerns? Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles.
Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Dewan NA, et al. COPD 8 3 : —9. American Journal of Managed Care 13 12 : —6. McCall N, Cromwell J N Engl J Med 18 : — Related Articles.
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