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Using Evidence

Disease Management

Presenter:

Alfred B. Lewis, J.D., Executive Director, Disease Management Purchasing Consortium and Advisory Council, Newton, MA.


This session described the basic principles of disease management and outlined how policymakers can apply these principles. Disease management involves using evidence-based resources, such as published clinical guidelines, to monitor and improve the treatment of patients with chronic, ongoing, and treatable diseases. Disease management focuses on patient education and reducing practice variation among physicians and other healthcare professionals.

Dr. Lewis states that the overall goals of disease management are to improve the quality of care, improve health outcomes, and ultimately save money by catching chronic patients early and intervening before they experience medical complications that require serious interventions such as hospitalization.

Dr. Lewis identified what he calls "secrets to success" in selecting a population for disease management:

  • High prevalence (of the condition to be managed).
  • Low turnover among the enrollee population.
  • An ability to identify patients who are at risk for getting the disease.
  • A patient population that has a high illness severity (and consequently high use of medical resources).

He believes that policymakers can have the greatest impact by focusing disease management programs on high-prevalence diseases.

There are two approaches that public policymakers take to implement disease management programs: They can design and build their own program, or they can buy the services of a vendor who specializes in disease management. Both of these approaches have advantages and disadvantages.

For States or communities with the resources to build and implement their own programs, it may be less expensive than contracting with a disease management vendor. However, for low-frequency and highly complicated diseases, such as end stage renal disease, it may make more sense for a State to contract with a vendor that specializes in treating this type of patient.

Dr. Lewis suggested that, for States that wish to build disease management programs, it probably makes the most sense to focus on screening large numbers of at-risk patients and use low-intensity interventions such as self-management, lifestyle changes, or medications to control the disease.

For disease management programs that require intensive individual case management of a small number of patients with high levels of resource use, it will probably be more financially beneficial for a State to contract with a vendor, rather than spending time developing their own protocols. Mr. Lewis noted that, when contracting with disease management vendors, policymakers should be sure contracts contain guaranteed savings over current medical expenditures.


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