Disease Management

Disease Management:

  • A comprehensive, integrated approach to care and reimbursement
  • Treatment designed to address an illness with maximum effectiveness & efficiency
  • Based on the natural course of a specific disease (different care, different costs)
  • Based on a team approach (focus on total HC cost) & patient focus
  • Treatment is designed to address an illness with maximum effectiveness & efficiency
    • Based on best practice guidelines
    • Differed from previous attempts to control costs through component management
      • Component management was initiated by the government through DRG’s
      • Began in the 1980’s
      • Fails to recognize the HC costs are interrelated
      • Focus on service, not disease
      • Doctors didn’t like component management because it put non-healthcare people between doctors & patients
  • Doctors (especially capitated doctors) like disease management programs
  • PhRMA members began to incorporate disease management programs
    • But these were often superficial
    • Sole task of selling pharmaceuticals
  • Components of a comprehensive disease management program
    • Prevention & detection
    • Patient & provider education
    • LTC
    • Best practice guidelines
  • What diseases are “manageable”?
    • Chronic, preventable & easily identifiable diseases
    • High prevalence & cost
    • Consensus on proper treatment (best practice guidelines)
    • Examples:
      • AIDS, asthma, cancer, depression, diabetes, congestive heart failure, high cholesterol
  • Cognitive services: services provided by a pharmacist to, or for a patient of HC professional¬† that are either judgmental or educational in nature.
    • Basically a pharmacist doing DM
  • AMCP endorses disease management programs
  • Health promotion initiatives- gym membership discounts, healthy meals plans, employee newsletters, smoking cessation programs

Effectiveness of disease management programs is measured in terms of clinical, humanistic & economic outcomes

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: