Disease Management is:

  • The use of evidence-based interventions that have a demonstrated positive impact on member health behaviors
  • The use of clinical practice guidelines to provide tailored interventions based on health risk assessments and stratification (health risk categorization)
  • Clinical education of members to enable them to make intelligent health care decisions that focus on prevention, not exacerbation

As healthcare costs continue to increase, chronic illnesses consume the largest portion of the health care dollar and payers struggle to find solutions. Physician education of patients on how to best live and manage their conditions to minimize their impact is all too sparse and infrequent. Payers need to identify members with chronic illnesses and educate them in the management of their condition to assist them in staying healthy. The developement of disease management program support services is a necessity for payers for the following reasons:

  • Healthcare costs for patients with chronic illnesses are five times higher
  • Patients have shortcomings in managing their conditions
  • Time is limited for patient education by the physician
  • Identification helps bring utilization costs under control
Members with unhealthy lifestyle habits also need to be identified and educated so they do not become chronically ill, and high service utilizers of the future.

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