Disease management (health)

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Disease management is defined as "a coordinated health care and communication intervention system for populations where conditions of patient self-care are significant."

For people who can access health care practitioners or peer support, it is a process whereby people with long-term conditions (and often family/friends/caregivers) share knowledge, responsibilities and care plans with health practitioners and/or peers. To be effective, it is necessary to apply the entire system with a community social support network, satisfactory work and activities relevant to the context, clinical professionals willing to act as partners or trainers and on-line resources that are verified and relevant to the country and its context.. Sharing knowledge, building knowledge and learning communities is an integral part of the concept of disease management. It is a population health strategy as well as an approach to personal health. This can reduce the cost of health care and/or improve the quality of life of individuals by preventing or minimizing the effects of disease, usually chronic conditions, through knowledge, skills, allowing a sense of control over life (despite symptoms of illness) and integrative care.

Video Disease management (health)

History

Disease management has evolved from managed care, special capitation, and demand management to health services, and refers to processes and people concerned with improving or maintaining health in large populations. It deals with common chronic diseases, and reduces future complications associated with the disease.

Diseases to be addressed by disease management will include: coronary heart disease, chronic obstructive pulmonary disease (COPD), renal failure, hypertension, heart failure, obesity, diabetes mellitus, asthma, cancer, arthritis, clinical depression, sleep apnea, osteoporosis, and other common ailments.

Maps Disease management (health)

Industry

In the United States, disease management is a large industry with many vendors. Major disease management organizations based on income and other criteria include Accordant (Caremark subsidiary), Alere (now including ParadigmHealth and Matria Healthcare), Caremark (excluding subsidiaries Accordant), Evercare, Health Dialog, Healthways, LifeMasters (now part of StayWell) , LifeSynch (formerly Corphealth), Magellan, McKesson Health Solutions, and MedAssurant.

Disease management is very important for health plans, agents, trusts, associations and employers who offer health insurance. A 2002 survey found that 99.5% of the Organizational Health Care/Service Point (HMO/POS) health plan is in a plan that includes at least one disease management program. A Mercer Consulting study shows that the percentage of a company-sponsored health plan offering disease management programs increased to 58% in 2003, up from 41% in 2002.

It was reported that $ 85 million was spent on disease management in the United States in 1997, and $ 600 million in 2002. Between 2000 and 2005, the combined annual income growth rate for the disease management organization was 28%. In 2000, the Boston Consulting Group estimated that the US market for the management of disabling diseases could be $ 20 billion by 2010; However, in 2008 the Consortium for Purchasing Disease Management estimated that the income of the disease management organization would be $ 2.8 billion in 2010. In 2010, a study using National Ambulatory Medical Care Survey data estimated that 21.3% of patients in the US with at least one chronic conditions. using a disease management program. However, management of chronic conditions is responsible for more than 75% of all health care expenditures.

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Process

The rationale for disease management is that when the right tools, experts... and equipment are applied to the population, labor costs (in particular: absenteeism, current costs, and direct insurance costs) can be minimized in the near future, or resources can be provided more efficient. The general idea is to alleviate the path of disease, not to cure illness. Improving quality and activities for everyday life is first and foremost. Increasing cost, in some programs, is also a necessary component. However, some disease management systems believe that reductions in long-term problems may not be measurable today, but can ensure continuation of disease management programs until better data are available in 10-20 years. Most disease management vendors offer return on investment (ROI) for their programs, although over the years there are many ways to measure ROI. In response to these inconsistencies, the industry trade association, the Care Continuum Alliance, gathers industry leaders to develop consensus guidelines for measuring clinical and financial outcomes in disease management, health and other population-based programs. Contributing to work are public and private health and quality organizations, including the Federal Agency for Research and Quality of Health, the National Committee for Quality Assurance, URAC, and the Joint Commission. The project produced the first volume of the four Results Report Volume Guidelines, detailing the industry consensus approach to measuring outcomes.

Tools include web-based assessment tools, clinical guidelines, health risk assessments, outbound and inbound call center trials, best practices, formularies, and various other devices, systems and protocols.

Experts include actuaries, doctors, pharmacists, medical economists, nurses, nutritionists, physical therapists, statisticians, epidemiologists, and professional human resources. Tools may include mail delivery systems, web-based applications (with or without interactive modes), monitoring devices, or telephony systems.

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Effectiveness

Possible bias

When disease management programs are voluntary, studies of their effectiveness may be affected by independent selection bias; that is, a program can "attract those registrants who are already motivated to succeed". At least two studies have found that people enrolling in disease management programs differ significantly from those who are not on the basis of clinical, demographic, cost, utilization and quality parameters. To minimize bias in estimates of effectiveness of disease management due to differences in basic characteristics, randomized controlled trials are better than observational studies.

Even if a particular study is a randomized trial, it may not provide strong evidence for effectiveness of disease management. A 2009 review paper tested a randomized trial and meta-analysis of disease management programs for heart failure and confirmed that many failed in the PICO process and the Integrated Reporting Reporting Standards: "interventions and comparisons are not adequately explained that complex programs are over-simplified and the potentially prominent differences in the program, population, and setting are not included in the analysis. "

Medicare

Section 721 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 authorizes the Centers for Medicare and Medicaid Services (CMS) to do what is a "Medicare Health Support" project to examine disease management. Phase I projects involving disease management companies (such as Aetna Health Management, CIGNA Health Support, Healthcare Dialogue Corp., Healthcare, and McKesson Health Solutions) are selected by a competitive process in eight states and the District of Columbia. The project focuses on people with diabetes or heart failure who have relatively high Medicare payments; in each location, about 20,000 such people were randomly assigned to the intervention group and 10,000 were randomly assigned to the control group. The CMS sets goals in the areas of clinical quality and beneficiary satisfaction, and negotiates with disease management programs for a 5% austerity target in Medicare costs. The program began between August 2005 and January 2006. What is now the Care Continuum Alliance praises this project as "the first national pilot to integrate advanced maintenance management techniques into the Medicare cost-for-service program".

The initial Phase I project evaluation by RTI International emerged in June 2007 which has "three key participation and financial findings":

• Medicare spending for the intervention group was higher than the comparison group at the time the pilot started.
• In the intervention group, participants have lower Medicare payments (ie, tend to be healthier) than non-participants.
• "The fees paid so far exceed the savings generated."

The DMAA focuses on other findings from the initial evaluation, "a high degree of satisfaction with chronic disease management services among heirs and physicians". One comment noted that the project "can only be observational" because "equality is not achieved at the beginning". Another comment stated that the project was "in big trouble". A six-month evaluation paper, published in the fall of 2008, concludes that "Results to date show limited success in achieving Medicare cost savings or reducing the use of acute care".

In December 2007, the CMS changed the financial threshold of a 5% austerity budget neutrality, a change to which DMAA "praised". In January 2008, however, the CMS decided to end Phase I because it claimed that the legal authority had been exhausted. Four US senators wrote a letter to the CMS to reverse its decision. The DMAA denounces the termination of Phase I and is called CMS to start Phase II as soon as possible. Among other critics of the project, the management of the disease company claimed that Medicare "lists patients much more sick than they expected," failed to transmit information on patient prescriptions and laboratory results to them in a timely manner, and disallowed the company from choosing the most patient may benefit from disease management.

Until April 2008, CMS has spent $ 360 million for the project. Individual programs ended between December 2006 and August 2008.

Results from this program were published in The New England Journal of Medicine in November 2011. Comparing 163,107 patients who were randomized to the intervention group with 79,310 patients who were randomized to the control group, the investigators found that "disease - management programs were not reducing hospital admissions or emergency room visits, compared with regular care. "In addition, there is" no provable savings in Medicare spending, "with net costs for disease management ranging from 3.8% to 10.9% patients per month. The investigators suggest that the findings may be explained by the severity of chronic illness among the patients studied, the delay in receiving management of the patient's disease after hospitalization, and the lack of integration between the health trainer and the primary care provider of the patient.

More studies

Studies that have reviewed other research on the effectiveness of disease management include the following:

• The 2004 Budget Analysis of the Congress concluded that published research "does not provide a solid basis for concluding that disease management programs generally reduce total costs". The report causes the disease management industry to "scrambl [e] to build better business cases for their services".
• A 2005 review of 44 studies on disease management found a positive return on investment for congestive heart failure and various disease conditions, but an unconvincing, mixed or negative ROI for diabetes, asthma, and depression management programs. The lead author, from Cornell University and Thomson Medstat, was quoted as saying that the lack of research done on ROI disease management is "a concern because so many companies and government agencies have adopted disease management to manage maintenance costs for people." with chronic conditions. "
• A 2007 RAND summary of 26 reviews and a meta-analysis of small-scale disease management programs, and 3 evaluations of population-based disease management programs, concluded that "Payers and policymakers should remain skeptical about vendor claims [about disease management] and should demand supporting evidence based on sound and transparent scientific methods. "Specifically:
  • Disease management improves the "clinical care process" (eg, adherence to evidence-based guidelines) for congestive heart failure, coronary artery disease, diabetes, and depression.
  • There is inconclusive evidence, insufficient evidence, or evidence of no effect of disease management on health-related behavior.
  • Disease management leads to better disease control for congestive heart failure, coronary artery disease, diabetes, and depression.
  • There is inconclusive evidence, insufficient evidence, or evidence of no effect of disease management on clinical outcomes (eg, "mortality and functional status").
  • Disease management reduces hospital admission rates for congestive heart failure, but increases the use of health care for depression, with inconclusive or insufficient evidence for other underlying diseases.
  • In the field of financial results, there is inconclusive evidence, insufficient evidence, no evidence of effect, or evidence of increased costs.
  • Disease management improves patient satisfaction and health-related quality of life in congestive heart failure and depression, but insufficient evidence for other underlying diseases.

The next letter to the editor claims that disease management may still "satisfy buyers today, even if academics remain unsure".

• The systematic review and meta-analysis in 2008 concluded that disease management for COPD "enhances exercise capacity, health-related quality of life, and hospital admission, but not all causes of death".
• A 2009 review of 27 studies "can not take definite conclusions about the effectiveness or cost-effectiveness of asthma management programs" for adults.
• A systematic review of Canadians published in 2009 found that home telehealth in chronic disease management might save costs but "research quality is generally low."
• Researchers from the Netherlands systematically reviewed 31 papers published 2007-09 and determined that evidence that disease management programs for four diseases reduced health care spending was "unconvincing."
• A meta-analysis of randomized trials published during 2009 estimates that disease management for diabetes has "clinically moderate but significant impact on hemoglobin A _1C levels," with average differences absolute 0,51% between experiment and control group.
A "meta-review" 2011 (systematic review of meta-analysis) of a heart failure disease management program found them to "mixed quality" because they did not report the important characteristics of the study under review.

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