a continuous, coordinated health care process that seeks to manage and improve the health status of a carefully defined patient population over the entire course of a disease. The patient populations targeted are high-risk, high-cost patients with chronic conditions that depend on appropriate pharmaceutical care for proper maintenance. Disease management services include disease prevention efforts as well as patient management once the disease states have developed.
A philosophy toward the treatment of the patient with an illness (usually chronic in nature) that seeks to prevent recurrence of symptoms, maintain high quality of life, and prevent future need for medical resources by using an integrated, comprehensive approach to health care. Pharmaceutical care, continuous quality improvement, practice guidelines and case management all play key roles in this effort, which (in theory) will result in decreased health care costs as well.
The integrated monitoring of a patient, particularly with a chronic illness, to focus on prevention of recurrence, improved quality of life, and cost-effective care. Also refers to the systematic study of a diagnosis or intervention to focus on the outcomes for a population, rather then an individual patient.
An effort to improve patient outcomes and lower costs by organizing managed care initiative around patients with a particular disease or condition.
(also called Condition Management) - An educational program geared toward members with chronic disease or other medical conditions, to help members better understand and manage their condition. Condition Management Programs offered by Optima Health. back to the top
a systematic process of managing care of patients with specific diseases or conditions (particularly chronic conditions) across the spectrum of outpatient, inpatient, and ancillary services. The purposes of disease management may include: reduce acute episodes, reduce hospitalizations, reduce variations in care, improve health outcomes, and reduce costs. Disease management may involve continuous quality improvement or other management paradigms. It may involve a cyclical process of following practice protocols, measuring the resulting outcomes, feeding those results back to clinicians, and revising protocols as appropriate.
Patients with chronic (long-term) illness face daily challenges to stay healthy. Proper management of illness like diabetes, asthma and depression can help patients live a higher quality life, be more productive at work, and prevent small problems from becoming bigger. Illness can be properly managed by seeing a doctor regularly, taking prescribed medications as ordered, and getting laboratory tests ordered. Only Primary Care Providers (PCPs) who have 100 or more Priority Health patients are eligible to be measured in the disease management category. Providers are measured as a Practice Group (all participating doctors in one office receive the same rating), except for Depression, when they are measured as a Risk Group.
A coordinated system of identifying, educating and counseling patients who have or are at risk for a specific chronic illness or medical condition to promote condition management with an emphasis on self-care and positive lifestyle change.
A system of evidence-based health care interventions often used for high-volume, high cost conditions with a focus on self-management and clinical and cost outcomes measurement Fee for Service A payment system in which care providers are paid specific fees for each service provided. In this system, the more services that are provided, the higher the cost to the payer.
Comprehensive approach to treatment of chronic diseases that relies on integration of methods and early intervention.
Management system of introducing new tests to provide each patient with the most appropriate treatment.
The process of a physician managing a patient's disease (such as asthma or diabetes) on a long-term, continuing basis, rather than treating it as a single episode. Disease management is intended to improve patient care.
An agreed upon rate for service between the provider and payer that is usually less than the provider¹s full fee. This may be a fixed amount per service, or a percentage discount. Providers generally accept such contracts because they represent a means to increase their volume or reduce their chances of losing volume.
Programs designed to help members manage chronic conditions through a partnership between members, physicians and the health plan. Disease management programs focus on member education and self-management strategies in an effort to reduce costs and improve quality.
A cost control service within a group plan whereby individuals with specific chronic conditions are identified and provided additional services to help them manage their conditions.
A coordinated system of preventive, diagnostic and therapeutic measures intended to provide cost-effective, quality health care for a patient population who have or are at risk for a specific chronic illness or medical condition. Also known as disease state management.
A coordinated and proactive approach to managing care and support for patients with chronic illnesses such as diabetes, congestive heart failure, asthma, HIV/AIDS, and cancer. See also e-disease management.
Structured coordination of care over time and across healthcare settings
also Compliance Management. Identifying members with chronic health conditions and providing them with education and other support to comply with their prescribed treatments. The goal is to maximize members’ well-being and to reduce or delay the need for more advanced or costly medical interventions. Some conditions which benefit from disease management programs are arthritis, asthma, HIV-AIDS, lower back pain, and diabetes.
A type of product or service now being offered by many large pharmaceutical companies to get them into broader healthcare services. Bundles use of prescription drugs with physician and allied professionals, linked to large databases created by the pharmaceutical companies, to treat people with specific diseases. The claim is that this type of service provides higher quality of care at more reasonable price than alternative, presumably more fragmented, care. The development of such products by hugely-capitalized companies should be all the indicator necessary to convince a provider of how the healthcare market is changing. Competition is coming from every direction--other providers of all types, payers, employers (who are developing their own in-house service systems), the drug companies.
Disease management (DM) is the concept of reducing healthcare costs and/or improving quality of life for individuals with chronic disease conditions by preventing or minimizing the effects of a disease through integrative care. Also can be called care management, health management programs, or disease self-management.