Case Management and Disease Management Programs

Disease Management Programs effectively reduce healthcare costs by helping patients (beneficiaries) manage and control their health conditions and prevent excessive utilization. In particular, the development of a disease or case management approach aims at providing better care while minimizing the costs of care for chronically ill individuals (Huston, Nov-Dec 2020). Disease and care management programs are mostly structured to improve the health of individuals suffering from chronic conditions and reduce health care requirements and costs related to avoidable health complications, such as hospitalizations and emergency room visits. All case management and disease management have various characteristics: population identification process; use of collaborative practice models; evidence-based practice guidelines; education on patient self-management; process and results measuring; and routine feedback and reporting between care providers, patients, and health plans (Huston, Nov-Dec 2020).

Medical Associates Health Plans is an example of a Disease Management and Case Management program whose key objective is making continuous efforts to improve their quality of case management programs services, into which members enroll for free (Besler & Reinert, 2021). The organization offers comprehensive Disease and Care Management programs to benefit members suffering from diabetes and hypertension as well as providing Complex Case Management services to members who face complicated or multiple health conditions.

These programs are synchronized and executed by competent, registered nurses who customize and modify services to fit and cater to each member individually. Their disease and care management programs reduce the cost of health for its members by improving their health and reducing the frequency of healthcare service needs. According to their website, over 90% of enrolled members in a 6-month diabetes management program reported reduced healthcare use. These expenditures measured patients’ and physicians’ satisfaction with the program (Besler & Reinert, 2021).

References

Besler, J., & Reinert, C. (2021, March 9th). Medical Associates. Retrieved from Disease Management/Complex Case Management: https://www.mahealthcare.com/insurance/products-and-services/managed-care/health-care-services/disease-management-complex-case-management

Huston, C. (Nov-Dec 2020). The role of the case manager in a disease management program. Lippincotts Case Management, Vol 7(6), 221-227.

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