Disease Management

Definition of Disease Management

Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. Disease management:

• Supports the physician or practitioner/patient relationship and plan of care;
• Emphasizes prevention of exacerbations and complications utilizing evidence-based practice guidelines and patient empowerment strategies; and

• Evaluates clinical, humanistic, and economic outcomes on an on-going basis with the goal of improving overall health.

Disease Management Components Include

• Population identification processes;
• Evidence-based practice guidelines;
• Collaborative practice models to include physician and support-service providers;
• Patient self-management education (may include primary prevention; behavior modification programs, and compliance/surveillance);
• Process and outcomes measurement, evaluation, and management;

• Routine reporting/feedback loop (may include communication with patient, physician, health plan and ancillary providers, and practice profiling).

Goals of Disease Management

• To identify individuals with specific chronic conditions
• To evaluate risk levels
• To develop and implement interventions to reduce risk

• To measure effectiveness

Operating Disease Management Programs

Health plans’ medical professionals use disease management to support the care provided by personal physicians, to ensure that chronic conditions are properly addressed, and to improve patients overall health. Disease management programs employ a number of methods, including:

• Evidence-based practice guidelines
• Patient self-management education

• Regular communications with patients, physicians, and ancillary providers

Chronic Conditions Addressed by Disease Management

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Congestive heart failure
• Depression
• Diabetes

• Many others

Benefits of Disease Management

As more and more individuals face the symptoms, complications, and difficulties of chronic disease, disease management makes these challenges easier to manage, by helping individuals improve their health and avoid complications. A DM program can utilize proactive educational programs, proven clinical best practices and rigorously reviewed interventions to address the specific needs of each participant, promoting healthy changes that last and significantly reducing healthcare expenditures.

Ingredients of Disease Management Programs

Disease management programs are designed to provide the right help at the right time in the right way. Participants in disease management programs should have access to a range of resources and interventions. The intensity and frequency of interventions each participant receives is dependent on their needs and condition. The spectrum of services available to each participant may include:

• Welcome packets featuring a program description and action plan, a comprehensive educational condition-specific clinical guide, a useful health information tracking calendar and program reminder magnet
• Welcome call to engage and enroll participants in the program
• Mental and physical assessments that define both physical and mental risk on a real time basis to drive intervention frequency and intensity
• A toll-free 24/7 line providing live responses by registered nurses
• Online source for reliable and navigable health information and self-management tools
• An array of targeted print educational media, including regular disease specific newsletters
• For participants with the most acute needs, individualized outbound telephonic coaching and education by a registered nurse
• Coordination of care with primary physicans
• Medication monitoring through pharmacy claims with physician follow up as needed to promote compliance with guidelines
• Screening for depression and physician alerts for patients identified as possible depression risks

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