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Disease management practices of health plans
W Pete Welch1, Christopher Bergsten, Charles Cutler
1Mid Atlantic Medical Services, Inc, Rockville, MD 20850, USA. pwelch@mamsi.com
Objective:
To investigate how health plans manage chronic diseases.
Study Design:
Health plan medical directors were surveyed regarding the disease management (DM) practices of their plans.
Methods:
We took a stratified random sample of 65 plans, all members of the American Association of Health Plans. Forty-five plans responded. Results were weighted to be representative of the industry (including nonmember plans). Medical directors were asked to consider that they had a DM program only if 2 things were true: (1) A majority of a plan's enrollees could not be ineligible for a DM program for non-clinical reasons (eg, geographic location); and (2) a DM program had to have at least 6 of the 8 components of a DM program as defined by the Disease Management Association of America.
Results:
The 3 diseases most likely to be the focus of DM programs were diabetes, asthma, and congestive heart failure. For each of these diseases, at least one quarter of Americans were enrolled in plans offering a DM program. Medical directors perceived their DM programs to be highly effective in reducing mortality and morbidity and in improving the functional status of patients, and perceived them to be effective in lowering cost. The greatest challenge in implementing DM programs involves information technology. These results yield insights into the future of treatment of chronic disease in the United States.
Conclusion:
Health plans have made a significant investment in programs to improve care for chronic illness. The almost universality of DM programs highlight the need for scholarly evaluations of their effectiveness and cost effectiveness.
Insights
Health plans invest in disease management (DM) programs for chronic conditions like diabetes. These DM programs are perceived as effective, but information technology poses implementation challenges.
Area of Science:
- Health Services Research
- Health Management
- Chronic Disease Management
Background:
- Health plans are increasingly involved in managing chronic diseases.
- Disease management (DM) programs are a key strategy employed by health plans.
- Understanding the scope and perceived effectiveness of these programs is crucial.
Purpose of the Study:
- To investigate the disease management practices of health plans in the United States.
- To identify the chronic diseases most commonly targeted by DM programs.
- To assess the perceived effectiveness and challenges of DM programs from the perspective of medical directors.
Main Methods:
- A stratified random sample of 65 health plans was surveyed.
- 45 plans responded and results were weighted for industry representation.
- A standardized definition of a DM program was used, requiring broad eligibility and specific components.
Main Results:
- Diabetes, asthma, and congestive heart failure were the most frequent DM program targets.
- Approximately one-quarter of Americans were enrolled in plans with DM programs for these conditions.
- Medical directors perceived DM programs as effective in reducing mortality, morbidity, and improving function, with perceived cost savings, though information technology was a major challenge.
Conclusions:
- Health plans have significantly invested in chronic disease management programs.
- The widespread adoption of DM programs necessitates rigorous scholarly evaluation of their effectiveness and cost-effectiveness.