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Disease management is the concept of reducing healthcare costs and/or improving quality of life for individuals with chronic disease conditions by preventing or minimizing the effects of a disease, usually a chronic condition, through integrative care. It is also often known as: demand management, health management programs, or disease self-management.
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Background
Disease management has evolved from managed care, specialty capitation, and health service demand management, and refers to the processes and people concerned with improving or maintaining health in large populations. As opposed to epidemiology, which is generally concerned with sudden or persistent virulent outbreaks of disease, it is concerned with common chronic illnesses, and the reduction of future complications associated with those diseases. See also chronic care management.
Illnesses that disease management would concern itself with would include: Coronary heart disease, kidney failure, hypertension, heart failure, obesity, diabetes mellitus, asthma, cancer, arthritis, clinical depression, sleep apnea, osteoporosis, and other common ailments.
In the United States, disease management is a large industry with many vendors. It is of particular importance to health plans, agencies, trusts, associations and employers who offer health insurance. A Mercer Consulting study indicated that the percentage of employer-sponsored health plans offering disease management programs grew to 58% in 2003, up from 41% in 2002.[1]
Process
The underlying premise of disease management is that when the right tools, experts, and equipment are applied to a population, then labor costs (specifically: absenteeism, presenteeism, and direct insurance expenses) can be minimized in the near term, or resources can be provided more efficiently. The general idea is to ease the disease path, rather than cure the disease. Improving quality and activities for daily living are first and foremost. Improving cost, in some programs, is a necessary component, as well. However, some disease management systems believe that reductions in longer term problems may not be measureable today, but may warrant continuation of disease management programs until better data is available in 10-20 years. Most disease management vendors offer return on investment (ROI) for their programs, although over the years there have been dozens of ways to measure ROI. Responding to this inconsistency, an industry trade association, DMAA: The Care Continuum Alliance, convened industry leaders to develop consensus guidelines for measuring clinical and financial outcomes in disease management, wellness and other population-based programs. Contributing to the work were public and private health and quality organizations, including the federal Agency for Healthcare Research and Quality, the National Committee for Quality Assurance, URAC and the Joint Commission. The project produced the first volume of a now three-volume Outcomes Guidelines Report, which details industry-consensus approaches to measuring outcomes.
Tools include web-based assessment tools, clinical guidelines, health risk assessments, outbound and inbound call-center-based triage, best practices, formularies, and numerous other devices, systems and protocols.
Experts include actuaries, physicians, medical economists, nurses, nutritionists, physical therapists, statisticians, epidemiologists, and human resources professionals. Equipment can include mailing systems, web-based applications (with or without interactive modes), monitoring devices, or telephonic systems.
See also
References
- ^ cited in Landro, L. (October 20, 2004). Does disease management pay off? Wall Street Journal. D4.
External links
- Disease Management Findings from State Programs
- Evaluating ROI in State Disease Management Programs
- Managed Care Magazine - DM section
- America’s Health Insurance Plans (April 2004). 2002 AHIP Survey of Health Insurance Plans: Chartbook of Findings. Washington, D.C.
- Disease Management in Medicare: Data Analysis and Benefit Design Issues Testimony before the Special Committee on Aging, United States Senate
- DMAA: The Care Continuum Alliance and its defintion of population health improvement
- Disease Management Resources by State National Conference of State Legislatures
- Australian Disease Management Association
Wikipedia content modification information:
- This page was last modified on 9 September 2008, at 15:38.
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