Question

Disease management is the concept of reducing health care costs and improving quality of life for individuals with chronic conditions by preventing or minimizing the effects of the disease through integrated care. Disease management programs are designed to improve the health of persons with chronic conditions and reduce associated costs from avoidable complications by identifying and treating chronic conditions more quickly and more effectively, however slowing the progression of those diseases.

Disease management inclueds

- members with a chronic disease

- supports the provider-patient relationship and plan of care

-optimizes patient care through prevention and proactive interventions based on evidence-based guidelines

Components of disease management programs include:

Population identification processes

Programs designed to target individuals with specific diseases

Chronic and costly conditions

References: https://www.amcp.org/about/managed-care-pharmacy-101/concepts-managed-care-pharmacy/disease-management

What else can be added to this

Answer 1

• Chronic and costly conditions:

Costly chronic conditions, including asthma, diabetes, congestive heart failure, coronary heart disease, end-stage renal disease, depression, high-risk pregnancy, hypertension, and arthritis, have been the focus of these programs. Individuals with multiple conditions may also benefit from a disease management program

• Goal of disease management:

The goal of disease management is to identify persons at risk for one or more chronic conditions, to promote self-management by patients and to address the illnesses or conditions with maximum clinical outcome, effectiveness and efficiency regardless of treatment setting(s) or typical reimbursement patterns

• Comprehensive disease management programs can:

Improve the safety and quality of care

1. Improve access to care
2. Improve patient self-management
3. Improve financial cost containment without sacrificing quality or patient satisfaction
4. Enhance efforts to provide health improvement programs on a population basis

• Health plans and employers:

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. Programs for diabetes, asthma, and congestive heart failure are the most common .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

• Disease management programs can reduce health care use and expenditures:

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.

• Quality of life outcomes vary across programs

Measures of quality of life include those related to health or functional status, such as mobility, presence of symptoms, and overall energy level. Quality of life is more subjective, and can be influenced by one’s confidence in their health and by their ability to control the condition affecting them. Disease management has resulted in some improvements in the quality of life for people with chronic conditions.

• Conclusion

Disease management is an approach to patient care that seeks to limit preventable events by maximizing patient adherence to prescribed treatment and health-promoting behaviors. These programs produce significant clinical improvements, as well as financial savings. Disease management programs provide opportunities to improve patient outcomes. True disease management can be achieved only with the complete commitment of the health care team.