Disease management (health)

Disease management (DM) 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, or chronic condition through integrative care. DM is also often known as: care management, health management programs, or disease self-management.

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, Disease Management is concerned with common chronic illnesses, and the reduction of future complications associated with those diseases.

Illnesses that Disease Management would concern itself with would include: Coronary Artery Disease, Renal Failure, Hypertension, Congestive Heart Failure, Obesity, Diabetes, Asthma, Cancer, Arthritis, Depression, and other common ailments.

In the United States, Disease Management (DM) is a large industry with many vendors. DM 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.

Process

The underlying premise of DM is that when the right tools, experts, and equipment are applied to a population, then labor costs (specifically: abseenteeism, 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 DM systems believe that reductions in longer term problems may not be measureable today, but may warrant continuation of DM programs until better data is available in 10-20 years. Most disease management vendors offer return on investment (ROI) for their programs, although there are literally dozens of ways to measure ROI.

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.

External links

• HealthEconomics.Com - Resources for assessing disease management, quality, costs, and impact of healthcare interventions; also includes jobs in the field, journals, consulting companies, etc.
• 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
• Disease Management Association of America and their defintion of DM
• Disease Management Resources by State National Conference of State Legislatures
• Australian Disease Management Association