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Financial and risk considerations for successful disease management programs.

A L Baldwin1

  • 1Milliman & Robertson, Seattle, Wash., USA.

Managed Care (Langhorne, Pa.)
|September 8, 2000
PubMed
Summary

Disease management programs face financial volatility due to clinical and administrative issues. Actuarial tools can improve financial projections and risk analysis for better revenue and capital targets.

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Area of Science:

  • Health Economics
  • Healthcare Management
  • Risk Management

Background:

  • Disease management (DM) programs often yield suboptimal results due to clinical, financial, and administrative challenges.
  • Existing financial projections may inaccurately estimate revenue and costs by underestimating complicating factors in DM programs.

Purpose of the Study:

  • To evaluate the utility of actuarial tools for enhancing financial projections and risk analysis in disease management programs.
  • To assist DM companies and health plans in setting appropriate financial targets and identifying suitable diseases for DM initiatives.

Main Methods:

  • Utilizing actuarial tools, including risk analysis and risk projection models, to analyze DM contracts.
  • Quantifying the impact of cost-driving factors and contract volatility through model-based analysis.

Main Results:

  • Actuarial models provide a more robust understanding of DM contract finances compared to experience-based projections.
  • These models enable quantification of cost drivers and financial volatility, aiding in setting realistic revenue and capital targets.
  • Analysis supports health plans in identifying optimal candidates for DM programs and establishing performance benchmarks.

Conclusions:

  • Actuarial tools are crucial for improving the financial predictability and success of disease management programs.
  • Accurate financial modeling and risk assessment are essential for sustainable DM program development and investment.
  • Implementing these analytical approaches can lead to better resource allocation and performance outcomes in healthcare management.

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