Journal of Health & Medical Economics

Description

A system of coordinated healthcare interventions and communications for populations with conditions where patient self-care efforts are significant," is the definition of disease management. The process by which individuals with long-term conditions frequently share knowledge, responsibility, and care plans with healthcare practitioners or peers is known as peer support for those who are able to access it. It needs to be implemented as a whole with community social support networks, a variety of fulfilling occupations and activities that are relevant to the context, clinical professionals who are willing to serve as partners or coaches, and online resources that are verified and relevant to the country and context in order to be effective. A learning community, knowledge sharing, and knowledge building are all essential components of disease management. It is a personal health strategy as well as a population health strategy. By preventing or minimizing the effects of disease, typically a chronic condition, through knowledge, skills, enabling a sense of control over life despite disease symptoms, and integrative care, it may reduce healthcare costs and/or improve quality of life for individuals.

Disease Management

On the other hand, it could cause high implementation costs and encourage the use of costly health care interventions, both of which could raise healthcare costs. From managed care, specialty capitation, and health service demand management, disease management is the process and people involved in improving or maintaining large populations' health. It focuses on preventing future complications from prevalent chronic diseases and their treatment. The following diseases would be the focus of disease management: chronic obstructive pulmonary disease, coronary heart disease, kidney failure, hypertension, heart failure, obesity, diabetes mellitus, asthma, cancer, arthritis, clinical depression, sleep apnea, and osteoporosis are just a few of the common conditions that can affect an individual. Disease management is a big business with many vendors in the United States.

Return on Investment

Accordant, a Caremark subsidiary, Alere, which now includes Paradigm Health and Maria Healthcare, Caremark, which does not include its Accordant subsidiary, Evercare, Health Dialog, Health ways, and Life Masters, which is now part of StayWell), LifeSynch, formerly Corphealth, Magellan, McKesson Health Solutions, and MedAssurant are the major disease management organizations based on revenues and other criteria. Health insurance plans, organizations, trusts, associations, and employers all place a special emphasis on disease management of people who enroll in Health plans have plans that cover at least one disease management program, according to a survey conducted in 2002.According to a study conducted by Mercer Consulting, the percentage of employer-sponsored health plans that offer disease management programs increased from 41% in 2002 to 58% in 2003. In 1997, $85 million and $600 million were reportedly spent on disease management in the United States. Disease management organizations saw a 28% compound annual growth rate in revenue between 2000 and 2005. The Disease Management Purchasing Consortium predicted in 2008 that disease management organization revenues would reach $2.8 billion by 2010, despite the Boston Consulting Group's estimate in 2000 that the U.S. market for outsourced disease management could reach $20 billion by 2010. Disease management programs were used by 21.3 percent of patients in the United States with at least one chronic condition in 2010, according to data from the National Ambulatory Medical Care Survey. However, chronic condition management accounts for more than 75% of all health care expenditures. In many other parts of the world, payers began to embrace disease management in the 2000s. Germany and France are notable examples in Europe. In 2003, patients were accepted into the first national diabetes disease management program in Germany. Individual sickness funds, which in turn sign contracts with regular health care providers, provide funding and manage them. In 2008, the program Sophia for diabetics was launched in France. Statutory health insurance, which has a contract with a private provider for support services, finances and runs it as a single national program. Support from international businesses and study trips or other forms of exchange with Anglo-Saxon nations contributed to the launch of these programs. Disease management is based on the idea that resources can be provided more effectively or that labor costs, particularly absenteeism, presenters, and direct insurance costs, can be reduced in the near future when the right tools, experts, and equipment are applied to a population. The goal is to slow the progression of the disease rather than treating it. Priority should be given to improving quality and activities of daily living. In some programs, lowering costs is also a necessary component. However, some disease management systems are of the opinion that although reductions in problems that last for a longer period of time may not be measurable right now, they may be sufficient justification for continuing disease management programs until better data are available in 10 to 20 years.

Although there are dozens of ways to measure Return on Investment (ROI) over time, the majority of disease management vendors offer ROI for their programs. The Care Continuum Alliance, an industry trade association, convened industry leaders to create consensus guidelines for measuring clinical and financial outcomes in disease management, wellness, and other population-based programs in response to this inconsistency. The federal Agency for Healthcare Research and Quality, the National Committee for Quality Assurance, URAC, and the Joint Commission were among the public and private health and quality organizations that contributed to the work. The project resulted in the first volume of the Outcomes Guidelines Report, which is the first of four volumes that describe industry-consensus approaches to measuring outcomes. Tools include web-based assessment tools, clinical guidelines, health risk assessments, outbound and inbound call-centre-based triage, best practices, formularies, and numerous other devices, systems and protocols. When disease management programs are voluntary, studies of their effectiveness may be affected by a self-selection bias; that is, a program may "attract enrolees who were already highly motivated to succeed". At least two studies have found that people who enrol in disease management programs differ significantly from those who do not on baseline clinical, demographic, and cost, utilization and quality parameters. To minimize any bias in estimates of the effectiveness of disease management due to differences in baseline characteristics, randomized controlled trials are better than observational studies.