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.

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