DEFINITION of 'Disease Management Program'

A program offered by a health insurance company to manage the costs of policyholders’ chronic health conditions. Disease management programs can help control health care expenses for insurance companies and employers who offer health insurance. These programs (1) identify individuals who have or may be at risk for developing a chronic condition, (2) use evidence-based practices to manage the condition and mitigate the risk of expensive treatments, and (3) coordinate care among the several health care providers the individual may see. They also teach the patient prevention and behavior modification methods to minimize the risk of developing the condition or to manage a condition that has already developed.

BREAKING DOWN 'Disease Management Program'

Disease management programs provide support for ongoing health problems such as diabetes, coronary artery disease, asthma, cancer, back pain, kidney disease and depression. These programs use strategies such as putting members in touch with nurses who can answer questions by phone and email without the need for a doctor visit; analyzing claims and other health information to look for possible treatment gaps; and educating patients about things they can do to prevent or mitigate the condition, e.g. exercising to prevent heart disease.

Through a disease management program, insurance companies and employers who provide health insurance can minimize costs and maintain a healthy workforce by proactively managing health-related risks. Wellness programs that offer incentives to exercise, eat well and take other basic steps toward good health can complement disease management programs. Disease management aims to reduce the need for expensive hospitalizations, procedures and surgeries for chronic problems, because these are often the most expensive problems to treat. The idea is to manage the patient’s care on an ongoing basis, not just to treat them when a crisis arises. Disease management is one way to mitigate the impact of continually increasing health care costs.

RELATED TERMS
  1. Accountable Care Organizations

    Healthcare providers that take a group approach to coordinating ...
  2. Medical Identity Theft

    Stealing another person’s health insurance information so that ...
  3. Medical Cost Ratio

    A comparison of a health insurance company's healthcare costs ...
  4. Wellness Program

    Wellness programs aim to improve employee health with company-sponsored ...
  5. Medical Underwriting

    Medical underwriting is the process of assessing the risk associated ...
  6. Incidence Rate

    A measure of the frequency with which a disease occurs in a population ...
Related Articles
  1. Insurance

    How To Manage Chronic Illness Expenses

    Chronic illnesses affect millions of Americans, but it is not only taxing their health. Its also hurts their wallets. But there are ways to reduce the burden.
  2. Investing

    Methods of Handling Risk: A Quick Guide

    Discover the five methods to manage pure risk, and learn how they can be implemented to mitigate risk with health and life insurance.
  3. Insurance

    Freebies From Your Health Insurance Company

    Whether your goal is to lose weight, quit smoking or just take overall better care of yourself you may have a surprising ally: your health insurance company.
  4. Insurance

    Why Health Insurance Premiums Will Rise in 2017

    To battle the costs and challenges of the Affordable Care Act, many health insurances are raising their premiums in 2017.
  5. Insurance

    The Debt Report: The Health Care Sector

    Discover how the health care industry's largest companies have greatly increased their debt exposure since the financial crisis, and why this trend matters.
  6. Insurance

    3 Reasons To Get High-Premium Health Insurance

    Health insurance is expensive, which is why many people opt for the lowest-premium plan. But that may not always be the cheapest.
  7. Retirement

    Is Your Health Insurance Enough For Retirement?

    Learn what to expect to pay for health insurance in retirement, what is covered through Medicare and what the Affordable Care Act means for retirees.
  8. Insurance

    5 Alternatives to Traditional Health Insurance

    Discover five of the most popular alternatives to traditional health insurance plans, alternatives that are increasingly popular as health insurance costs rise.
  9. Insurance

    Learn About the Health Insurance Marketplace

    2016 Open Enrollment is Nov. 1 to Jan. 31. Here are five things you should know about the Health Insurance Marketplace (AKA Health Insurance Exchange).
RELATED FAQS
  1. In what ways does government regulation impact the insurance sector?

    See how government regulation of the insurance sector leads to higher prices, more risk and a system where the consumer has ... Read Answer >>
  2. What does it mean to have orphan drug status?

    In 1982, The U.S. Food and Drug Administration (FDA) recognized the lack of incentive for pharmaceutical companies to develop ... Read Answer >>
  3. Can I get dental insurance with Obamacare?

    Discover how you can obtain dental insurance as part of a health plan or on a standalone basis through the Health Insurance ... Read Answer >>
Hot Definitions
  1. Ethereum

    Ethereum is a decentralized software platform that enables SmartContracts and Distributed Applications (ĐApps) to be built ...
  2. Cryptocurrency

    A digital or virtual currency that uses cryptography for security. A cryptocurrency is difficult to counterfeit because of ...
  3. Financial Industry Regulatory Authority - FINRA

    A regulatory body created after the merger of the National Association of Securities Dealers and the New York Stock Exchange's ...
  4. Initial Public Offering - IPO

    The first sale of stock by a private company to the public. IPOs are often issued by companies seeking the capital to expand ...
  5. Cost of Goods Sold - COGS

    Cost of goods sold (COGS) is the direct costs attributable to the production of the goods sold in a company.
  6. Profit and Loss Statement (P&L)

    A financial statement that summarizes the revenues, costs and expenses incurred during a specified period of time, usually ...
Trading Center