Disease Management: Overview

What Is Disease Management?
Disease management (DM) programs provide an effective way to man...
How DM Works
Below is the typical structure of a DM program:

    – Identify patient       – Follow-up visits          ...
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Improving Patient Safety with Disease Management – McKesson


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Effective Disease Management (DM) can improve the health of many Americans suffering from chronic illness while reducing costs to patients, health care providers, employers and more. Discover how use of DM from McKesson is helping to improve patient safety and medication safety.

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Improving Patient Safety with Disease Management – McKesson

  1. 1. Disease Management: Overview What Is Disease Management? Disease management (DM) programs provide an effective way to manage and prevent the further health deterioration of millions of Americans with chronic illnesses—resulting in cost savings for individuals, employers, payors and healthcare providers, according to the Disease Management Association of America (DMAA). DM helps patients understand important self management skills in treating their chronic illnesses to avoid crises in their conditions, which can result in costly emergency department visits or long-term hospital stays. The six components of Disease Management • Population identification • Patient self-management • Routine reporting/feedback loop processes education (may include primary (may include communication prevention, behavior with patient, physician, health • Evidence-based practice modification programs, and plan and ancillary providers, and guidelines compliance/surveillance) practice profiling) • Collaborative practice models to • Process and outcomes include physician and support- measurement, evaluation, and service providers management Although DM today accounts for only .1 percent of overall U.S. healthcare spending (a total of $3 trillion in 2005), widespread adoption of DM programs is expected to significantly increase due to: 1 3 An aging population Nationwide healthcare cost crises a. Americans 65 years and older will jump to a. Hospitalizations – many of which are nearly 63 million by 2024 (versus roughly 35 avoidable – are the single most expensive million in 2004) – Centers for Disease Control component of healthcare, consuming 33 percent of every dollar spent on healthcare – 2 Increases of chronic diseases Agency of Healthcare Research & Quality a. 54 million Americans are at risk for diabetes Diabetes and its complications is the 6th most b. – American Diabetes Association costly disease, accounting for estimated $132 billion in direct and indirect healthcare costs b. 5 million Americans are living with heart in the United States in 2003 – ADA failure and 550,000 new cases are diagnosed each year – American Heart Association c. In 2004, heart failure was responsible for an estimated $25.8 billion in direct and indirect c. From 1982 to 1995, cases of asthma in the costs – AHA U.S. have jumped by over 61 percent. Today, 17 million Americans suffer from the lung d. A 2003 study revealed the annual cost to disease – American Lung Association treat asthma was $4,900 per person – The Journal of Allergy and Clinical Immunology DM Benefits Individuals Payors (Insurers) Employers Healthcare providers - Longer, healthier lives - Prolonged life and - Fewer employee sick - Complementary - Improved knowledge improvements in quality days treatment for patients about chronic illnesses of life for program - Increased productivity - Support in managing - Helpful tools and participants due to better health of complex patients resources to better - Greatly reduced costs employees - Decreased no-show manage chronic illnesses of providing healthcare - Reduced healthcare rates for appointments - Reduced costs of care as a result of fewer budgets - Improved adherence to -Improved Medication avoidable emergency treatment plan department visits and - Consistency of care hospital admissions Page 1
  2. 2. How DM Works Below is the typical structure of a DM program: – Identify patient – Follow-up visits – Patient and provider – End service – Patient agreement to – Follow-up phone calls – Inform payor and/or satisfaction – Quality assurance – Assess self-monitoring and participate provider – Initial health – Process evaluation symptoms – Patient education – Optimize program assessment – Develop care – Communicate with outcomes management plan providers – Identify and engage providers – Patient education Source: South Carolina Heart Center, Piper Jaffray & Co How McKesson Helps As the largest DM contractor for state McKesson has helped states and healthcare providers save Medicaid Fee-for-Service plans and the money and improve the quality of health of millions of patients recipient of multiple awards from DMAA, in the United States. McKesson Corporation has a proven track record of improving the overall health of • A 2004 study published in the peer-reviewed Journal of the people with chronic diseases, reducing costs American Geriatrics Society showed that MediCare+Choice by decreasing avoidable hospitalizations, members with heart failure who participated in McKesson’s and improving clinical outcomes. Through a CareEnhance Disease Management Heart Failure Program combination of technology and services, experienced a significant decrease in hospitalizations (23 McKesson provides industry-leading DM percent less); 22 percent fewer emergency department programs to the top 25 managed care visits; 45 percent reduction in 30-day readmission rates; and organizations, 90 percent of Blue Cross 45 percent less skilled nursing facility bed days. Blue Shield plans, 15 state Medicaid • Research published in Disease Management in 2005 revealed agencies and more than 160 million that participants in McKesson’s CareEnhance Asthma disease Americans. management program had fewer hospitalizations, bed days and emergency department visits compared to a matched McKesson’s approach to DM complements group of non-participants. the care provided by physicians. McKesson believes that DM is most effective with • In 2005, the Oregon Department of Human Services reported integrated communication between a that McKesson DM services saved the program $6 million patient, doctor and the care-givers involved year-over-year. in the DM programs. In fact, if a patient • A recent McKesson study of people who participated in the does not have a primary care physician, McKesson will work with the patient to company’s asthma DM program found: 162 percent increase identify one. Also unique to McKesson are in patients with action plans; 29 percent increase in patients the company’s triage and care coordination with preventive medication prescriptions; 17 percent increase services. Most DM programs focus on in the use of inhaled corticosteroid daily controllers; 100 proactive care and communication, but percent increase in annual flu shots received; and 70 percent McKesson’s triage services offer reactive owned a peak flow meter. support for clients as well. By offering DM program participants an additional means of healthcare advice—whether the symptom, ailment or psychosocial need is related to the person’s chronic illness or not— McKesson’s qualified nurses can help patients determine the severity of their conditions. For more information on McKesson’s disease management programs, please visit: www.mckesson.com 2