Page 37 - Management Theory 2023-2024 Edition

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25. Disease Management Programs

Disease Management Program: It is considered to be a patient-focused, comprehensive approach to minimizing
the treatment variability of a specific disease to improve patient care outcomes and optimize the expenditure of
resources.

The main purpose to establish the disease management program is to:

1. Prevent illnesses
2. Avoid preventable exacerbations and complications
3. Reduce morbidity and mortality
4. Minimize the unnecessary use of resources
5. Reduce overall direct and indirect costs
6. Improve patient’s quality of life
7. Advance physicians’ knowledge of successful disease prevention and treatment

In the past, program sponsors (payers) have attempted to control the cost by focusing on individual components
of the healthcare delivery system (e.g. hospitalizations, prescription benefits, laboratory tests services,
outpatient visits), however no one ever thinks about controlling costs by preventing diseases at the first place.
This program is inspired by the statement: “Prevention is better than cure.”

The payers like the concept of the disease management program; however they are skeptical and unwilling to
accept an unproven program that is expensive to implement. Also, the cost cutting strategy used by these plan
sponsors made them unwilling to accept new changes in the delivery system. However, the problem arises when
patients start to complain about too much emphasis put on cost cutting strategy, and there has been the
constant decline in the quality of care. At this time, plan sponsors have started to think about other ways to cut
down costs as well as improve the quality of care.

The disease management program attempts to apply principles of population based management for specific
medical conditions to individual patients. Under this plan, physicians are encouraged to practice medicine using
literature-based evidence that the treatment is cost effective when applied to patients with the same medical
disorder or diagnosis.

There are certain criteria that must be met to include medical conditions or disorders in the disease
management program. They are:

1. Chronicity of the disease
2. Expensive and high prevalence rate of the disease
3. High rate of variability in physician-to-physician treatment patterns
4. Disease episodes can be easily identifiable
5. High rate of patient noncompliance with treatment

From the above criteria, the following medical conditions have been included in the disease management
programs. These are:

1. AIDS
2. Asthma
3. Chronic Obstructive Pulmonary Disease (COPD)

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