|
|
 |
|
Viewing report
|
|
|
|
Disease Management in the 21st Century
Decision Resources, Inc., Nov 2005, Pages: 25
Disease management (DM) programs were pioneered by the pharmaceutical industry in the early 1990s, but beginning in 1996, manufacturer-sponsored DM programs began to lose ground as employer-sponsored health plans, recognizing the value of DM--improved patient outcomes and reduced costs--sought to develop their own DM programs. However, many employer plans discovered that design and implementation of effective DM programs called for skills and experience they lacked. Independent DM vendors and third-party administrators soon emerged to meet health plans' needs, which have become ever more exacting as they expand their programs to encompass the full spectrum of employee health conditions.
We begin this report by examining recent trends in the private sector, the cradle of DM. We then consider the growing impetus for DM programs in the Medicaid program and other state initiatives to promote this approach to patient care. We also review Medicare DM demonstration projects currently in progress.
Business Implications
- A recent survey found that 56% of covered workers are enrolled in health plans that offer disease management (DM) programs. Employers are becoming more exacting in their DM requirements— requesting programs for conditions that have not traditionally been covered in DM initiatives and demanding more complex strategies, such as case management. The growing use of predictive modeling based on health care claims data enables health plans to identify high-risk (and high-cost) patients early and to enroll them in case management programs. At the opposite end of the health risk spectrum, health plans are developing wellness programs designed to promote good health and prevent serious illness. One survey found that 85% of companies offered a formal wellness program in 2004, intended to do so at some point in the future, or provided certain wellness features but not a formal program.
- Many states now require the provision of DM initiatives within their Medicaid programs; some are also increasing pressure on managed care organizations to offer DM in the private sector. Laws passed in some states (e.g., California, Texas) make provision for manufacturer- sponsored DM programs to be considered as a (partial) alternative to supplemental rebates to Medicaid programs. It is common practice to offer enrollees incentives to sign up for DM initiatives, but South Dakota has been more aggressive, penalizing beneficiaries of the state's high-risk health insurance pool who refuse to participate in these programs. It will be interesting to see if this punitive approach to stimulating enrollment in DM programs spreads to other states and to the private sector.
- Medicare beneficiaries with five or more chronic conditions account for approximately 20% of the total Medicare population, but 66% of the program's total expenditures. In the course of a year, these severely ill beneficiaries make an average of 37 physician office visits, consult 14 different providers, spend 7 days in the hospital, and fill 49 prescriptions. This population could benefit enormously from effective DM. However, the Congressional Budget Office has suggested that DM programs might increase Medicare's total expenditures if, as a result, beneficiaries lived longer and ultimately developed more costly diseases.
- The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) has provided the greatest boost for DM in the history of Medicare. Since January 1, 2005, Medicare covers an initial preventive physical for new beneficiaries, cardiovascular screening tests, and free diabetes screening tests for at-risk patients. Several major demonstration projects will also assess the potential clinical effectiveness and cost-effectiveness of DM initiatives in the Medicare population. In particular, the Medicare Health Support Program will measure the impact of chronic care improvement programs in a population of 180,000 Medicare beneficiaries who have one or more specified chronic conditions.
Customers who bought this item also bought
Beyond Disease Management: Strategies for Improving Patient Care and Cutting Costs
Health & Wellness Promotion Benchmarking Series
Medicare Disease Management: Tactics to Improve Health, Education and Independence in an Aging Population
Medicare Disease Management: Identifying and Engaging the Elderly Population To Improve Chronic Health Status
New Directions in Disease Management: Medicare-Medicaid, Strategies, Outcomes, ROI, Live Audio-Conference on CD-ROM
Serving the Needs of the Medicaid Population in Disease Management Programs, Live Audio Conference on CD-ROM
Executive Update: CMS Health Demonstration Projects and Policies
Winning Ideas in Health Plan Wellness and Health Improvement Programs:Whats Working Today To Achieve Member , Live Audio-Conference on CD-ROM
Wellness Management: How to Select the Best Health Risk Appraisal for Your Organization Audio Conference on CD-ROM
Employers' Role in the U.S. Health Care System: Part 2--The Medicare Population
From Disease Management to Coaching Change, Growth and Health Improvement - Audio Webcast on CD
Experience in Workplace Wellness: Successes and Shortcomings of Health Promotion Programs
|
|
|
|
