Conquering Chronic Diseases: Disease Management Programs Help Patients with Chronic Illnesses While Saving Money
Goodwin, Kristine, State Legislatures
From a call center at National Jewish Medical Center in Denver, Colo., Sue Sinda helps patients understand their illnesses and treat them before they turn into emergencies.
"A lot of people deal with the immediate emergency and don't follow up with education," says the disease management nurse. Patients often end up back in the emergency room or hospitalized for conditions, like asthma, that could have been treated with medication or lifestyle changes.
Sinda worked with a mother in the asthma program for Medicaid enrollees who didn't understand the symptoms leading up to a serious asthma attack. Instead she would wait too long and then rush her 7-year-old to the emergency room when things got critical. "She had a fear of being over-alarmed" about her child's symptoms, Sinda says.
After working with Sinda and other nurses, the mother learned to act faster--to treat symptoms right away, see a primary care doctor and use the right medication to control the child's asthma. After several months, Sinda says, she "felt more independent and comfortable dealing with her child and knowing what to do to avoid emergencies."
Disease management programs target the most costly chronic conditions, like asthma, heart disease, cancer and diabetes. Given that these alone account for the lion's share of Medicaid expenditures--some estimates go as high as 80 percent--efforts to rein in the costs make sense.
"So often," says Dr. Sandeep Wadhwa, vice president of Government Services at McKesson Health Solutions, a disease management contractor for five states, "states enact measures to save money or improve health, so it comes as a surprise that there is an approach that is good for the population's health and good for the budget."
The costs associated with chronic diseases are "overwhelming" state Medicaid budgets, says Kansas Representative Bob Bethell. "We can't continue the spending we've had the past several years. We've got to start managing the diseases."
Depending on the severity of the condition, disease management programs provide varying levels of support--from written educational materials to home visits or frequent phone calls from a registered nurse. By giving patients the tools and knowledge to manage their care, they are less likely to need emergency room and hospital treatment.
FROM CURIOSITY TO COMMONPLACE
Disease management is not a new concept. It is used heavily by private health insurance companies and managed care plans. Ninety-seven percent of health plans have one or more disease management programs, according to the American Association of Health Plans.
Aetna, for example, has 885,000 members in management programs with asthma, congestive heart failure, coronary artery disease, diabetes, low back pain and end-stage renal disease. With disease management, providers monitor patients with chronic diseases; they don't wait for patients to seek care.
"We believe that you must get the members actively involved," says Dr. William C. Popik, Aetna's chief medical officer. "Then they will be in a position to help physicians provide better care and, as we've seen, lower costs."
What is commonplace in the commercial market is now being widely considered in public programs. "Disease management has gone from a curiosity to commonplace to critical in a few short years," says Al Lewis, executive director of the Disease Management Purchasing Consortium. He says the industry has grown 30 percent a year since 1997. Between 2000 and 2004, revenue estimates for disease management vendors jumped from $339 million to $819 million-more than 140 percent.
Virginia and Florida were first to try disease management for Medicaid enrollees in the 1990s. Today, as many as two dozen states have management programs for some Medicaid patients. Many have guaranteed savings (written into contracts with vendors) of 5 percent or more to their Medicaid budgets. …