At a time when so many employers are trying to figure out what Healthcare Reform is going to mean for their employees and their company, services provided by healthcare vendors diligently move forward. One of these services is Disease Management.
So, what is Disease Management and should you be paying attention to this service?
Disease Management (DM) is defined as a system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant. It is the process of reducing healthcare costs and/or improving the quality of life for individuals by preventing or minimizing the effects of a disease. 1, 2, 3
DM is concerned with common chronic illnesses and the reduction of future complications associated with these diseases. This activity requires a multidisciplinary approach with regard to data sharing and patient assessment. The goal of Disease Management includes improvement in the following areas of a patient's care: clinical outcomes, quality of care, care management, utilization of proper services and financial performance.
Today, a great many Americans are living with chronic diseases, and a significant percentage of them are not paying enough attention to the management of their health condition, be it knowingly or unknowingly. Employers offering benefit packages will, in many cases, ultimately pay for the unhealthy lifestyle choices of their employees. DM offers a way for employers to protect their financial future, while also investing in their human resources. Employers can choose to make the programs mandatory, advising up front that they will not cover a certain percentage of an employee's claim amounts should the employee opt out of the program.
Disease Management Programs can assist an employee in significantly improving their overall health by helping them to manage their condition, be it diabetes, heart disease, stroke, arthritis, or multiple conditions, etc. Support and behavioral coaching from DM nurses assist employees in changing their lifestyle habits; furthermore, the process often causes an employee to begin to see his/her family doctor more regularly, and these two healthcare professionals reinforce each other.
So what does an employer need to focus on with Disease Management? It is critical that upper management be supportive and enthusiastic about a DM program. Resources need to be available to employees to help with their journey through the DM process. The program can also be a PR boost for the employer, since word may get around that the employer not only cares about the health of its employees but gives them the resources to be successful in the program.
What is the ROI on a Disease Management program for an employer? ... Priceless.
Mary S. Gogel, RN, MSN, MBA
Brown & Brown of Kentucky
1. Care Continuum Alliance (CCA) definition of disease management.
2. Congressional Budget Office. An analysis of the literature on disease management programs. 2004-10-13.
3. Coughlin JF, et al. Old age, new technology, and future innovations in disease management and home health care. Home Health Care Management & Practice 2006 Apr;18(3):196-207.