Disease Management

Background

The rise in the prevalence of chronic diseases has put an enormous strain on the economy because of a reduction in worker productivity and the increase in healthcare expenditures. The rapid escalation in healthcare costs and the pressure to contain costs by the purchasers of healthcare was one of the primary forces that led the way toward disease management. Because of these growing expenditures, purchasers began to question what the relative value of healthcare was for their dollar and started to take a closer look at inappropriate use of services.

Managed-care initiatives were another factor that led the way for disease management initiatives in the late 1980s and early 1990s. Managed care, through its prepayment mechanism and risk sharing with providers, created financial incentives that encouraged the efficient and effective delivery of care as opposed to traditional fee-for-service, which rewarded providers for performing more tests and procedures. Furthermore, because of managed care's involvement in the continuum of patient care, disease management was more feasible under this model. Based on the concept of case management, managed-care organizations began to look into disease management as an approach to address chronic conditions at the population level. Beginning in the 1990s, disease management programs began to flourish primarily because of the goal of managed care plans to offer their members a product that was of high value.

The pharmaceutical industry was another major force that shaped disease management. Because of the growth in pharmaceutical benefit managers and managed care, the pharmaceutical industry underwent rapid consolidation and integration to increase its leverage in the healthcare market. As a result, the pharmaceutical industry transformed its image from a drug manufacturer to a healthcare company with direct marketing to consumers. Pharmaceutical companies began to offer disease management programs centered on prescription drug use in order to promote patient compliance with medications. These programs often included provider education, patient information, and counseling, and they were then sold to managed-care organizations and employers.

The increased development of clinical practice guidelines also helped facilitate the growth of disease [Page 315]management. Clinical practice guidelines are generally evidence based, and they represent a systematic approach to treating patients with similar conditions. Managed care's influence over the healthcare system promoted the use of clinical practice guidelines by providers to increase the probability of improved patient outcomes. Finally, research on patient outcomes and cost-effectiveness that cover a variety of conditions has allowed the development of effective disease management strategies.

...