Disease Management & Medicaid Health Outcomes Management

Cost containment of pharmaceutical expenditures usually involves various efforts to control drug utilization.

These efforts typically are aimed at physicians, pharmacists, or the pharmaceutical industry. They have included the establishment of drug formularies and prior authorization programs. Federal legislation has had an important role in shaping these efforts.

One approach to cost containment is disease management. Disease management refers to a system of coordinated health care interventions for populations with conditions in which patient self-care efforts are significant. The goal of disease management programs is to optimize therapy. Optimizing therapy should improve outcomes and decrease overall expenditures associated with a disease.

As more states implement strategies to better identify the needs of their populations to provide optimal health care, disease management programs have increasingly become an integral part of legislative, HMO and employer agendas. Through several studies conducted in the 2000s, the National Pharmaceutical Council examined some of these initiatives centered on evidence-based care for patients with chronic conditions, cost interventions at the state Medicaid level, and promoting the adoption of healthy lifestyles, thus helping chronic disease patients achieve optimal health.