Disease management is defined as "a system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant."
For people who can access health care practitioners or peer support it is the process whereby persons with long-term conditions (and often family/friend/carer) share knowledge, responsibility and care plans with healthcare practitioners and/or peers. To be effective it requires whole system implementation with community social support networks, a range of satisfying occupations and activities relevant to the context, clinical professionals willing to act as partners or coaches and on-line resources which are verified and relevant to the country and context. Knowledge sharing, knowledge building and a learning community are integral to the concept of disease management. It is a population health strategy as well as an approach to personal health. It may reduce healthcare costs and/or improve quality of life for individuals by preventing or minimizing the effects of disease, usually a chronic condition, through knowledge, skills, enabling a sense of control over life (despite symptoms of disease) and integrative care. On the other hand, it may increase health care costs by causing high implementation costs and promoting the use of costly health care interventions.
History
Disease management has evolved from managed care, specialty capitation, and health service demand management, and refers to the processes and people concerned with improving or maintaining health in large populations. It is concerned with common chronic illnesses, and the reduction of future complications associated with those diseases.
Illnesses that disease management would concern itself with would include: coronary heart disease, chronic obstructive pulmonary disease (COPD), kidney failure, hypertension, heart failure, obesity, diabetes mellitus, asthma, cancer, arthritis, clinical depression, sleep apnea, osteoporosis, and other common ailments.
Industry
In the United States, disease management is a large industry with many vendors. Major disease management organizations based on revenues and other criteria include Accordant (a subsidiary of Caremark), Alere (now including ParadigmHealth and Matria Healthcare), Caremark (excluding its Accordant subsidiary), Evercare, Health Dialog, Healthways, LifeMasters (now part of StayWell), LifeSynch (formerly Corphealth), Magellan, McKesson Health Solutions, and MedAssurant.
Disease management is of particular importance to health plans, agencies, trusts, associations and employers that offer health insurance. A 2002 survey found that 99.5% of enrollees of Health Maintenance Organization/Point Of Service (HMO/POS) plans are in plans that cover at least one disease management program. A Mercer Consulting study indicated that the percentage of employer-sponsored health plans offering disease management programs grew to 58% in 2003, up from 41% in 2002.
It was reported that $85 million was spent on disease management in the United States in 1997, and $600 million in 2002. Between 2000 and 2005, the compound annual growth rate of revenues for disease management organizations was 28%. In 2000, the Boston Consulting Group estimated that the U.S. market for outsourced disease management could be $20 billion by 2010; however, in 2008 the Disease Management Purchasing Consortium estimated that disease management organization revenues would be $2.8 billion by 2010. As of 2010, a study using National Ambulatory Medical Care Survey data estimated that 21.3% of patients in the U.S. with at least one chronic condition use disease management programs. Yet, management of chronic conditions is responsible for more than 75% of all health care spending.
During the 2000s, payers have then embraced disease management in many other world regions. In Europe, notable examples include Germany and France. In Germany, the first national disease management program for diabetes enrolled patients in 2003. They are funded and operated by individual sickness funds that in turn contract with regular health care providers. In France, the program Sophia for diabetic patients was introduced in 2008. It is financed and operated as a single national program by statutory health insurance, which has contracted with a private provider for support services. The introduction of these programs was in part facilitated by support from international organizations or firms and study trips or other forms of exchange with Anglo-Saxon countries.