What is a disease management program?
According to the AMCP, disease management programs are "designed to improve the health of persons with chronic conditions and reduce associated costs from avoidable complications by identifying and treating chronic conditions more quickly and more effectively, thus slowing the progression of those diseases." Simply put, disease management programs help patients with chronic diseases stay well and out of the hospital.
The keystones of disease management programs are coordination and communication:
- Coordination among patients and caregivers helps ensure that resources are focused on the patient's well-being—and wasteful and unnecessary care are avoided.
- Communication between patients and practitioners, and among caregivers, avoids "fragmentation of care," which occurs when more than one practitioner manages the same problem.
Types of disease management programs
According to the Cameron Institute, a public policy think tank that studies health and social issues, there are two types of disease management programs. The first is exemplified by managed care organizations. These organizations optimize care by incentivizing healthcare organizations to keep patients with chronic diseases healthy and out of the hospital. A cornerstone of these programs is protocols designed to ensure that patients with chronic illnesses discharged from the hospital are not soon readmitted for the same problem. Such readmissions are costly for hospitals, but more importantly, they signal that the patient's disease isn't being adequately treated.
In the second type of program, hospitals or health plans contract with third-party vendors, like Lincare, to manage these programs and tailor disease management to the particular needs of patients and their caregivers.
How big data helps patients
Both types of disease management programs rely on a relatively recent development: big data. This term refers to a computer's ability to help identify patients who are most likely to require extra resources to keep them healthy. Mining large data sets also allows practitioners to identify patients to avoid interventions that are not only costly, but that also may be more likely to harm than help. Computerized manipulation of large databases allows disease management programs to provide personalized care by sifting through reams of de-personalized data.
Benefits of disease management programs
The best disease management programs ensure that patients' needs and desires are the same as those of caregivers and hospitals. Most practitioners will tell you that they work for the patient and their best interests. Disease management programs help to ensure this is always the case.
Imagine an 80-year-old man with congestive heart failure who goes home after a short stay in the hospital. Using big data, the hospital's disease management program finds that the man is at high risk of needing to be hospitalized again within 30 days. The care coordinator connects the man with a visiting nurse and an electronic monitor that will help detect any signs that his condition is worsening. This is, of course, excellent for the patient. However, at the same time, the hospital avoids the risk of incurring a financial penalty from the health plan for failing to prevent early readmission for congestive heart failure.
Disease management programs reduce preventable hospital admissions by helping you adhere to prescribed treatments and health-related behaviors. The evidence shows that following these programs can result in substantial improvements to patient health-related quality of life and financial savings for the health system. The key to a successful disease management program is the full cooperation and enthusiasm that you bring as the patient. When deciding whether a disease management program is right for you, it's important to realize the potential upsides are enormous — a better health-related quality of life.