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Disease management still up to the task


Disease management-or, what we have known as disease management-stands at a crossroads, as changing demands in the marketplace and a growing emphasis on wellness and prevention recast our thinking on chronic care. Can DM survive?

It can and will, because survival follows the ability to evolve. The past few years have seen a remarkable period in the evolution of chronic disease care and population health improvement. Disease management organizations, health plans, pharmaceutical companies, physicians and many other stakeholders are doing more today, in terms of conditions managed and services provided, with many emphasizing preventing disease as much as managing it.

DM's evolution has paralleled closely a growing national awareness that diabetes, obesity, heart disease and other conditions threaten not only the well-being of all Americans, but our country's fiscal health.

They are, if the innovative approaches we see now in Medicaid offer any lessons. These programs have succeeded because the disease management community and state officials have effectively responded to the unique and varied needs of Medicaid populations. The simple fact that chronic disease care and prevention has succeeded across states as diverse as Wyoming, Florida, Oregon, Washington and New Mexico offers convincing evidence that population-based interventions make for a good fit in public programs.

A recent six-month assessment of the Medicare Health Support (MHS) disease management pilot provided scarce data on the pilot's clinical or financial outcomes, and, acknowledging this gap, deferred conclusions about its long-term prospects. What it did note unequivocally was high beneficiary and physician satisfaction with disease management services.

Pilots, such as MHS and the Senior Risk Reduction and Coordinated Care demonstrations, and new products, such Special Needs Plans, offer essential tools for assessing best approaches to care for the chronically ill. We can no longer afford to delay our public response to chronic disease because the uninsured often forgo essential chronic care treatment until they reach Medicare age and generate higher costs as a result. We must have effective, population-based programs waiting for these new beneficiaries when they arrive.


We also must forge collaborative relationships among all stakeholders in chronic care-physicians and other caregivers, especially. DM, often portrayed as adjunct to the care team rather than a part of it, must successfully engage providers in a patient-centered approach.

Central to our definition of disease management is that it supports the practitioner-patient relationship and plan of care as well as appropriate compensation for services. DMAA: The Care Continuum Alliance members are working closely with physicians to understand how DM can support improved care and help providers make better use of time and resources. Coordinated, integrated chronic condition care, prevention and wellness offer our best hope for improving the health.

Tracey Moorhead is president and CEO of DMAA: The Care Continuum Alliance.

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