Overview of Disease Management

Disease management is an approach to health care that teaches patients how to manage a chronic disease. Patients learn to take responsibility for understanding how to take care of themselves. They learn to avoid potential problems and exacerbation, or worsening, of their health problem.

Example: One step in teaching disease management to a diabetes patient is to show her how to keep her blood sugar levels within a healthy range.

The concept of teaching patients disease management grew from a desire to improve the quality of a patient's care. In 2005, health insurance companies turned their focus on disease management in an effort to control healthcare costs. The theory was that if patients learned to take better care of their health problems, it would save the insurance company money.

The Health Policy Institute of Georgetown University noted that 44% of Americans who live at home have chronic conditions and they account for 78% of the healthcare expenditures in the United States. Better control of chronic diseases could lower healthcare costs.

Components of Disease Management

The Disease Management Association of America identifies these components:

• Identify the target populations: which diseases should be addressed and how can people with those conditions be enrolled in a disease management program?
• Establish evidence-based practice guidelines for the conditions that will be managed.
• Build collaborative practice models: In addition to physicians, disease management programs utilize nurses, dietitians, pharmacists, and other team members.
• Educate the Patient: Design a program to teach self-management to patients.
• Measure outcomes: establish procedures for tracking costs, utilization, health outcomes.
• Feedback and reporting.

Conditions Targeted for Disease Management

These conditions are often ones that are included in a disease management program:

• Heart diseases including congestive heart failure, coronary heart disease, and hypertension
• Lung diseases including chronic obstructive pulmonary disease (COPD)
• Liver diseases
• Diabetes
• Psychiatric disorders such as clinical depression.
• Alzheimer's disease or other dementia
• Cancer
• Arthritis
• Osteoporosis
• Sleep apnea
• Obesity
• Asthma

Effectiveness of Disease Management

In late 2007, the first reports on cost control through disease management showed that costs were not being controlled. This failure to achieve the primary goal of instituting these programs was alarming. But there were positive results for patient satisfaction and improvement of their quality of life with disease management programs.

The Medicare Health Support project focused on people with diabetes or heart failure. A report comparing 163,107 patients with a control group found that the disease management programs did not reduce hospital admissions or emergency room visits. There were no savings in Medicare expenditures for these patients.

However, a randomized trial of disease management for chronic obstructive pulmonary disease conducted by the Veterans Administration found a decrease in emergency room visits and hospitalizations and cost savings.

Systematic reviews of disease management programs have not shown consistent cost savings or improved patient health outcomes. This may point to the need to improve the disease management programs so they are more effective for both goals.