Disease management

Disease management is the concept of reducing healthcare costs and improving quality of life for individuals with chronic disease conditions by preventing or minimizing the effects of a disease through integrative care. Also can be called care management, health management programs, or disease self-management.

In Medicine, Disease Management refers to the processes and people concerned with improving or maintaining health in large numbers of people. As opposed to epidemiology, which is generally concerned with sudden or persistent virulent outbreaks of disease, Disease Management is concerned with common chronic illnesses.

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

In the United States, Disease Management (DM) is a large industry with many vendors. DM is especially important to health insurers, 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. (cited in Landro, L. (October 20, 2004). Does disease management pay off? Wall Street Journal. D4.)

The idea is that with the right tools, experts, and equipment, insurance expenses can be minimized in the near term or that resources can be provided more efficiently.

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, physical therapists, and human resource professionals.

Equipment can include monitoring devices, telephonic or otherwise. Also prostheses, durable medical equipment, supplies, and other equipment.

The general idea is, again, to ease the disease path and not so much cure the disease. Improving quality and activities for daily living are first and foremost. Improving cost is a necessary component, as well.

Most disease management vendors offer a return on an investment in their program.

Disease Management has evolved from Managed Care, specialty capitation, and health service demand management.

Dan Johnson, BAcct MBA CDJ Consulting Inc.

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