Managing chronic conditions reduces health plan costs.Beginning in the late '90s, many large organizations and health plans began engaging employees with chronic illnesses to help them manage their conditions more effectively. These programs are now commonly referred to as disease management programs and have the win-win goal of offering patients support for a better quality of life and employers lower health-care and absenteeism/disability costs. Targeted conditions and their treatment are often not thoroughly communicated by physicians during a 20-minute office visit. In many cases, several physicians might treat patients without adequate coordination. A disease management program addresses these inadequacies of the health-care system. What is the impact of chronic conditions on health-care costs? Chronic disease is the leading cause of illness, disability, and death in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. , driving a significant portion of health-care costs for organizations. In 2000, approximately 125 million or 45 percent of Americans had one or more chronic diseases accounting for $510 billion in medical costs (see chart). How do disease management programs work? Ongoing medical and pharmacy pharmacy, art of compounding and dispensing drugs and medication. The term is also applied to an establishment used for such purposes. Until modern times medication was prepared and dispensed by the physician himself. In the 18th cent. claim data, along with other tools such as health risk appraisals, are used to identify members with chronic conditions. Members are typically stratified stratified /strat·i·fied/ (strat´i-fid) formed or arranged in layers. strat·i·fied adj. Arranged in the form of layers or strata. and engaged by the severity of the condition and their ability to manage their illness: * High-risk high-risk adjective Referring to an ↑ risk of suffering from a particular condition Infectious disease Referring to an ↑ risk for exposure to blood-borne pathogens, which occurs with blood bank technicians, dental professionals, dialysis unit members receive frequent phone contact, home visits and medical monitoring. * Medium-risk members receive frequent phone contact. * Low-risk members receive frequent mailings and occasional phone contact. * All may receive supplies to help in managing their conditions (such as glucometers, peak flow meters peak flow meter n. A portable instrument that detects minute decreases in air flow and that is used by people with asthma to monitor small changes in breathing capacity. , smoking cessation smoking cessation Public health Temporary or permanent halting of habitual cigarette smoking; withdrawal therapies–eg, hypnosis, psychotherapy, group counseling, exposing smokers to Pts with terminal lung CA and nicotine chewing gum are often ineffective. kits). Why should organizations care about disease management? In the dynamics of our current health-care system, there are no incentives for providers to offer programs that can't be billed to an insurer An individual or company who, through a contractual agreement, undertakes to compensate specified losses, liability, or damages incurred by another individual. An insurer is frequently an insurance company and is also known as an underwriter. , nor is there a financial incentive for them to curb services for their chronic patients. In addition, the health-care system is organized into silos, where different physicians treat different conditions for the same member. Disease management programs are able to look at all claims data received by the plan and their staff is trained to identify conditions, such as depression, that may have been missed by their providers. If an organization fully insures its health plan, there is a very good chance that their carrier utilizes these programs already. If an organization self funds its health plan, disease management programs should be available through its administrator or utilization management Utilization management is the evaluation of the appropriateness, medical need and efficiency of health care services procedures and facilities according to established criteria or guidelines and under the provisions of an applicable health benefits plan. vendor for a fee (usually $2-$9 per employee per month). Elaine Coffman Barbara Elaine Gunter Coffman (b. June 19, 1942 in San Diego, California) is an American writer of both historical romance and suspense as her married name Elaine Coffman. is an account director at McGraw Wentworth, a member of the Detroit Regional Chamber. [ILLUSTRATION OMITTED] |
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