What is Disease Management?
Disease management is a strategy of delivering health care services using
interdisciplinary clinical teams, continuous analysis of relevant data,
and cost-effective technology to improve the health outcomes of patients
with specific diseases. It includes self-care management techniques, patient
education, and provider training. Disease management provides individualized
care plans based on clinical guidelines to manage individuals with treatable
chronic diseases.
Disease management has traditionally been part of the comprehensive care
furnished by managed care organizations. Today, there are a multitude
of strategies being used to bring disease management to Medicaid fee-for-service
(FFS) populations. To learn more about Medicaid disease management, follow
the links below.
Resources
Disease Management for Asthma, 2004
Asthma, one of the first disease management targets, is often selected for managed intervention because high-cost patients can be easily identified via their frequent medication refills, consistent clinical practice guidelines and validated outcome measures are available that can help assess the effectiveness of the interventions, and educational interventions have been
developed to help improve the behavior of both patients and health care practitioners. This bibliography presents 69 studies demonstrating the impact of educational interventions on asthma treatment and management. Fact sheet available.
Disease Management for Chronic Obstructive Pulmonary Disease, 2003
This bibliography of disease management and educational interventions focuses on a relatively new disease target for such programs, chronic
obstructive pulmonary disease (COPD). In the year 2000, an estimated 10 million Americans were diagnosed with COPD and another 14 million were undiagnosed. The high mortality and cost associated with COPD, as well as a lack of awareness regarding the disease, are incentives to apply disease management strategies. Further education of health care providers and the public could improve the detection and treatment of COPD.
Disease Management for Depression, 2003
This monograph provides an introduction to disease management along with an analysis of penetration, trends and growth. Disease management strategies have great potential to improve therapeutic outcomes for patients with depression. Although there can be some challenges in managing depression through a disease management program, many programs have had success. While not every program included in the literature search represents a comprehensive disease management program, examples of specific educational interventions for depression are included and discussed.
Disease Management for Diabetes, 2004
This monograph presents 65 studies detailing the impact of educational interventions on diabetes treatment and management as well as information
on diabetes disease management programs in development. It is intended to serve as a guide for those interested in developing disease management programs for the treatment of diabetes. Fact sheet available.
Disease Management for Heart Failure, 2004
This bibliography presents 68 studies concerning the impact of educational interventions on heart failure treatment and management. It is intended to serve as a guide for those interested in developing disease management programs for the treatment of congestive heart failure. Fact sheet available.
Disease Management for Schizophrenia, 2004
Disease management efforts for schizophrenia are less well established than are efforts for other chronic illnesses such as asthma and diabetes. Managing schizophrenia poses more of a challenge than many other chronic diseases because it usually causes greater disability than other mental and physical illnesses. However, disease management strategies have the potential to improve therapeutic outcomes for patients with schizophrenia. This monograph provides an introduction to disease management as well as examples of interventions for schizophrenia.
DM LitFinder™ Database
The Disease Management Association of America offers a query tool to search the peer-reviewed literature available on disease management for eight conditions (asthma, congestive heart failure, diabetes, COPD, coronary artery disease, end-stage renal disease, high risk pregnancy, and depression). Updated quarterly, this tool helps users identify programs that have reported medical cost savings and demonstrated improvements in clinical processes and outcomes of care such as drug compliance, reduced absenteeism and better quality of life, and what patient and physician interventions were used to achieve these outcomes.
The Impact of Disease Management on Outcomes and Cost of Care: A Study of Low-Income Asthma Patients, by Louis F. Rossiter, et al.,
Inquiry, Vol. 37, No. 2, Summer 2000
This article chronicles how concerns about the health outcomes and costs of care for Medicaid recipients with chronic diseases has led to development of a model program to enhance the quality of care and reduce overall cost of care for Medicaid patients enrolled in Virginia's primary care case management program. Fact
sheet available.
Improving and Measuring Osteoporosis Management, 2008
In the United States, an estimated 10 million people are living with osteoporosis, also called brittle bone disease. Although osteoporosis is responsible for the majority of hip fractures, and accounts for more than eighteen billion dollars in health care expenditures annually, on average only 20% of patients are ever screened or treated for the disease. A new monograph developed by The Joint Commission through an unrestricted educational grant by NPC, is now available. The monograph contains 10 voluntary measures of care, designed for a variety of healthcare settings. "Improving and Measuring Osteoporosis Management" is intended for a professional audience and contains clinical information and practical tips for implementing an osteoporosis improvement initiative, whether clinical care is given in a hospital, emergency department, rehabilitation facility, home health agency, or doctor's office.
Medicaid 101 - Overview of Policies, Expenditures, Current Trends, and Initiatives
Medicaid 101 for State Legislators is designed to help legislators and their staffs:
- Understand the history and mission of Medicaid
- The drivers behind Medicaid budget growth (e.g., aged, blind, disabled eligibility expansions)
- The part that drugs play in the budget.
The presentation explains how barriers to care that delay effective treatment can add to long-term costs and reduce quality; examines a range of alternatives (along with their pros and cons) for managing drug expenditures; highlights extensive state-specific data on the Medicaid population.
Medicaid Disease Management Programs: Findings from Three Leading U.S. State Programs, by Jeann L. Gillespie and Louis F. Rossiter, Disease Management & Health Outcomes, Vol. 11, No. 6, June 2003
A growing number of states are beginning legislative and administrative studies, piloting disease management programs, and expanding existing programs. There is no single, correct way to implement programs across patient populations. Results will depend upon the way the program is implemented, the model used, the diseases selected, and the ability to implement purely voluntary efforts or programs with strong incentives and outcome-driven approaches.
State Medicaid Resource Kit: Maintaining Quality and Patient Access to Innovative Pharmaceuticals in Challenging Economic Times, 2006
This resource kit, modeled on NCSL's "Managing Medicaid Costs: A Legislator's Toolkit," is designed to help states better identify the needs of their populations and to develop patient-focused cost management interventions while maintaining quality care. Sixteen specific strategies are addressed, providing the pros and cons, states' experiences, design and policy issues, and Federal and State involvement/constraints.
The Value of Disease Management: Balancing Cost and Quality in the Treatment of Asthma, by Jeann Lee Gillespie, PharmD, MS, Disease Management, Vol. 5, No. 4, 2002
Asthma is often selected for disease management programs because of its high prevalence and large economic impact and the frequent failure to provide appropriate patient care and achieve optimal outcomes. The article examines the value of disease management in both improving the quality of care received and managing costs associated with the treatment of asthma. Case studies from state Medicaid initiatives and private sector HMO programs are provided.
The Value of Disease Management: Balancing Cost and Quality in the Treatment of Congestive Heart Failure, by Jeann Gillespie, PharmD, MS, Disease Management, Vol. 4, No. 2, 2001
This article reviews the literature to identify reports concerning the impact of educational interventions on heart failure treatment and management. It also
discusses why heart failure is often selected for disease management, outlines the management and treatment of heart failure, and provides a review of heart failure disease management literature.
The Value of Disease Management: Balancing Cost and Quality in the Treatment of Diabetes Mellitus, by Jeann Lee Gillespie, PharmD, MS, Disease Management, Vol. 5, No. 1, 2002
The article examines the value of disease management in both improving the quality of care received and managing costs associated with the treatment of diabetes. Case studies from state Medicaid initiatives and private sector HMO programs are provided, as well as a bibliography of 56 studies citing disease management interventions and outcomes for further reference.
The Virginia Health Outcomes Partnership: A Demonstration Project, 1997
Learn how to select diseases for Medicaid disease management from this 18-page NPC booklet written by Judith Jones, the Degge Group. See what Virginia considered before selecting asthma as its first targeted intervention. Fact sheet available.
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