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Disease management practices of health plans.
Am J Manag Care. 2002 Apr; 8(4):353-61.AJ

Abstract

OBJECTIVE

To investigate how health plans manage chronic diseases.

STUDY DESIGN

Health plan medical directors were surveyed regarding the disease management (DM) practices of their plans.

METHODS

We took a stratified random sample of 65 plans, all members of the American Association of Health Plans. Forty-five plans responded. Results were weighted to be representative of the industry (including nonmember plans). Medical directors were asked to consider that they had a DM program only if 2 things were true: (1) A majority of a plan's enrollees could not be ineligible for a DM program for non-clinical reasons (eg, geographic location); and (2) a DM program had to have at least 6 of the 8 components of a DM program as defined by the Disease Management Association of America.

RESULTS

The 3 diseases most likely to be the focus of DM programs were diabetes, asthma, and congestive heart failure. For each of these diseases, at least one quarter of Americans were enrolled in plans offering a DM program. Medical directors perceived their DM programs to be highly effective in reducing mortality and morbidity and in improving the functional status of patients, and perceived them to be effective in lowering cost. The greatest challenge in implementing DM programs involves information technology. These results yield insights into the future of treatment of chronic disease in the United States.

CONCLUSION

Health plans have made a significant investment in programs to improve care for chronic illness. The almost universality of DM programs highlight the need for scholarly evaluations of their effectiveness and cost effectiveness.

Authors+Show Affiliations

Mid Atlantic Medical Services, Inc, Rockville, MD 20850, USA. pwelch@mamsi.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11950130

Citation

Welch, W Pete, et al. "Disease Management Practices of Health Plans." The American Journal of Managed Care, vol. 8, no. 4, 2002, pp. 353-61.
Welch WP, Bergsten C, Cutler C, et al. Disease management practices of health plans. Am J Manag Care. 2002;8(4):353-61.
Welch, W. P., Bergsten, C., Cutler, C., Bocchino, C., & Smith, R. I. (2002). Disease management practices of health plans. The American Journal of Managed Care, 8(4), 353-61.
Welch WP, et al. Disease Management Practices of Health Plans. Am J Manag Care. 2002;8(4):353-61. PubMed PMID: 11950130.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Disease management practices of health plans. AU - Welch,W Pete, AU - Bergsten,Christopher, AU - Cutler,Charles, AU - Bocchino,Carmella, AU - Smith,Richard I, PY - 2002/4/13/pubmed PY - 2002/5/4/medline PY - 2002/4/13/entrez SP - 353 EP - 61 JF - The American journal of managed care JO - Am J Manag Care VL - 8 IS - 4 N2 - OBJECTIVE: To investigate how health plans manage chronic diseases. STUDY DESIGN: Health plan medical directors were surveyed regarding the disease management (DM) practices of their plans. METHODS: We took a stratified random sample of 65 plans, all members of the American Association of Health Plans. Forty-five plans responded. Results were weighted to be representative of the industry (including nonmember plans). Medical directors were asked to consider that they had a DM program only if 2 things were true: (1) A majority of a plan's enrollees could not be ineligible for a DM program for non-clinical reasons (eg, geographic location); and (2) a DM program had to have at least 6 of the 8 components of a DM program as defined by the Disease Management Association of America. RESULTS: The 3 diseases most likely to be the focus of DM programs were diabetes, asthma, and congestive heart failure. For each of these diseases, at least one quarter of Americans were enrolled in plans offering a DM program. Medical directors perceived their DM programs to be highly effective in reducing mortality and morbidity and in improving the functional status of patients, and perceived them to be effective in lowering cost. The greatest challenge in implementing DM programs involves information technology. These results yield insights into the future of treatment of chronic disease in the United States. CONCLUSION: Health plans have made a significant investment in programs to improve care for chronic illness. The almost universality of DM programs highlight the need for scholarly evaluations of their effectiveness and cost effectiveness. SN - 1088-0224 UR - https://www.unboundmedicine.com/medline/citation/11950130/Disease_management_practices_of_health_plans_ L2 - https://www.ajmc.com/pubMed.php?pii=303 DB - PRIME DP - Unbound Medicine ER -