Disease Management Programs: The Second Generation

Disease management programs in the US were originally developed for the small minority of patients who consumed a large portion of healthcare resources, were complex cases to manage, or had specific chronic conditions. Although they vary in structure and are hard to describe with a single definition they usually contain one or more core components which may include the use of evidence-based practice guidelines, integrated information systems, and continuous quality improvement activities and processes. The literature describing disease management program outcomes and cost savings has been lacking, and published results tend to lack rigorous scientific discipline. The future and success of disease management will be measured by the efficacy of programs that impact the needs of individuals who have multiple chronic conditions. New second-generation programs will be designed around population-based methods to identify individuals with chronic illnesses, a primary care team that provides individualized medical management, documentation of outcomes beyond traditional utilization and cost measures, and quality improvement processes that identify areas for improvement through integrated information technology systems. In 2002, the Center for Medicare and Medicaid Services will begin operation of the Medicare Coordinated Care Demonstration project, a 4-year study to test whether combined disease and case management programs can improve clinical outcomes, satisfaction, quality of life, and cost outcomes for beneficiaries with multiple chronic conditions. If the demonstration is successful it has the possibility of placing second-generation disease management programs at the forefront of chronic illness management.