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Disease Management

How can managers utilize structured treatment plans to help individuals better manage their chronic disease, maintain and improve quality of life, and reduce hospital costs?

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Policy Examples

  • The Chronic Disease Management Act of 2018 (H.R. 4978) would have allowed high-deductible health plans with health savings accounts to cover chronic disease prevention programs on a pre-deductible basis. source
  • In the Medicare Modernization Act of 2003, Congress required the Centers for Medicare and Medicaid Services (CMS) to test the commercial disease-management model in the Medicare fee-for-service program, observing only 14 out of 40 significant improvements in process-of-care measures and did not reduce hospital or emergency department admissions. source
  • Beginning January 1, 2015, CMS, under the Medicare Physician Fee Schedule, began to separately identify and value clinical staff time and other resources used in providing chronic care management (CCM). source

Outcome Evidence

  • A 2002 study found Medicare beneficiaries in a diabetes management program improved many of their self-monitoring practices and used fewer inpatient services, along with use and expenditures decreases for about 7,000 participants. source
  • A 2001 study found children (under age 21) enrolled in a pediatric asthma management program implemented by North Carolina’s Medicaid program were less likely to be admitted to the hospital or emergency department. source
  • A 2003 study found two years after enrolling in a disease management program for congestive heart failure, Florida Medicaid beneficiaries were monitoring their condition more closely and spending fewer days in the hospital. source
  • Published in a 2018 report by America’s Health Insurance Plans (AHIP),  the University of Pennsylvania Medical Center (UPMC) health plan has worked with outside vendor, Vivify to improve disease management through remote monitoring and other telehealth solutions. After 18 months of the program, UPMC found results like fewer congestive heart failure observation visits and a 76% decrease in Medicare beneficiary readmissions to the hospital. source
  • Blue Cross Blue Shield of Massachusetts began a telehealth program in 2016. In 2018, they expanded the program to include outside applications like Livongo and Omada to provide patients with chronic disease necessary resources on easily accessible devices such as cell phones and computers. They are currently marketing these solutions to self-insured employers. source
  • A study by Rand published in 2014 evaluated the impact on Pepsico’s disease management program, which provided services to employees who had one of 10 chronic illnesses. The study found that the participants in the disease management program had a total health care savings of $136 per member per month and a 29 percent reduction in hospital admissions. source

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