Disease Management—A Great Concept, but Can You Implement It?

Abstract

Disease management (DM) is a compelling concept. For many chronic conditions, DM programs can simultaneously improve clinical outcomes and patient satisfaction while reducing the net cost of medical care. However, many programs are ultimately abandoned or fail to achieve their full potential due to difficulties encountered in implementing what seems like a sound program design. Implementation issues and barriers can be grouped into three major categories: (1) lack of strong physician leadership; (2) failure to align incentives; and (3) failure to identify and address operational issues. Organizations that wish to implement DM programs should develop a comprehensive plan that fosters physician leadership, rewards all stakeholders, and proactively identifies and resolves operational issues. By addressing these critical areas, organizations will greatly increase the likelihood that their programs will succeed and be implemented in a reasonable period of time. 111

Informatics Application Challenges for Managed Care Organizations

“…Disease management programs utilize both cost-based and health-based rationales for prevention and health promotion, emphasizing medical best practices and evidence-based medicine. Usually, outcomes are evaluated on the basis of clinical/therapeutic improvement or compliance, financial/cost reduction, and behavioral/emotional enrichment (Hunter & Fairfield, 1997;Leider & Krizan, 2001). Ultimately, the success of disease management programs often depends upon the ability to target an appropriate intervention to the appropriate patient, where population segmentation enhances MCOs' ability to accomplish this.…”

Care Management Program Evaluation: Constituents, Conflicts, and Moves toward Standardization

“…Typical outcomes of interest fall into four categories: clinical improvement, treatment compliance, cost reduction, and quality of life enrichment. 3 Early managed care organization programs were largely designed and run by carriers. Seeing the profit-making opportunities associated with lowering short-term medical costs, however, entrepreneurs pulled the industry into the open marketplace.…”

Emerging Technology for At-Risk Chronically Ill Veterans

“…Use of the Health Buddy helps reduce risk of chronic disease exacerbations by providing the veteran and caregiver with patient education on disease condition(s), advice 011 how to self-manage these conditions, and symptom and vital sign data for care management. The hallmark of a successful disease management program is getting the patient to accept responsibility for his or her care and to participate in appropriate self-management behaviors (Leider & Krizan, 2001). The Health Buddy connects daily to the Internet from the patient's home via a toll-free telephone number and is an easy-to-use device requiring the veteran or caregiver to press one button to answer each question.…”