HSM420_Week 7_CollaborationGroup2_Final Presentation -APPROACHES TO DISEASE MANAGEMENT IN MANAGED CARE. GOOD FOR REVISION.

INTRODUCTION Disease Management. We will show routes on how to help you better yourself and be aware of programs that are out there to help. Disease management programs (DMP) are great programs there to try to keep y ...

INTRODUCTION Disease Management. We will show routes on how to help you better yourself and be aware of programs that are out there to help. Disease management programs (DMP) are great programs there to try to keep you in the best health possible. These slides will show the outlines challenges and solutions for Disease Management. BACKGROUND • Disease Management: “a system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant.” • Created to focus on chronic conditions with high costs. • Help with low-cost medications and decreases in hospital readmissions. BACKGROUND • There are six characteristics of disease management • Population Identification Processes • Evidence-Based Practice Guidelines • Collaborative Practice Models • Patient Self-Management Education • Process and Outcomes Measurement, Evaluation and Management • Routine Reporting and Feedback REVIEW OF LITERATURE Prevention is a cost-effective solution in disease management There are 3 levels of prevention to help manage healthcare costs in disease management: • Primary prevention – where you address the problem before it is an issue • Secondary prevention – where the disease is discovered during check-ups or screenings • Tertiary prevention – where the disease has been diagnosed and preventative measures are being taken CDCP states diseases such as heart disease, cancer, and diabetes make up 75% of the nation’s health spending and are responsible for 7 out of 10 deaths each year (Gateway, 2018). Affordable Care Act • Eliminated coinsurances, encouraged and funds worksite wellness programs, DHHS spends $2 billion per year to support these state and local programs, requires calorie counts at chain restaurants, and created 28 provisions that help prevent major chronic diseases. AREAS THAT COULD POSE CHALLENGES TO THE PROGRAM Program size - Large DMPs are more likely to be successful than small programs The simplicity of design - successful DMPs tend to be very simple Focus on patients’ needs - take patients’ needs sufficiently into account Ability to collect data easily and analyze results - collect data regularly and analyze it promptly Incentives that encourage all stakeholders to comply with the program - Both nonfinancial and financial incentives can be used to align the interests of all stakeholders with the DMP’s protocols Self-management –motivate patients to become proactive participants in care delivery or to self-manage well-being. DISEASE MANAGEMENT CHALLENGES, SOLUTIONS, AND IMPLEMENTATION Challenges -Patient commitment and compliance to programs -Hard time keeping up with appointments and treatments in the clinic -Communication and Cultural differences Solutions -Patient self-management treatments -Customizing care through Disease Management Programs for patients with multiple chronic diseases -Collaboration throughout the entire clinical team Implementation -Monetary incentives to prescribers -No overly restrictive enrollment criteria -Clear cut goals, w/ understanding that 100% compliance is not realized at all times -Constant Evaluation and monitoring of how the patient is adhering to plan -EHR THE LEGISLATURE REDUCED MEDICAID APPROPRIATIONS BASED ON ANTICIPATED SAVINGS THAT WAS TO BE ACHIEVED THROUGH THIS INITIATIVE. THE PROGRAM ACCOUNTABILITY AND EFFECTIVENESS OF FRAUD ABUSE ACTIVITIES; AND COST CONTROL POLICIES FOR MEDICAID’S PRESCRIPTION DRUG PROGRAM. THROUGH THESE FOLLOWING REPORTS *ASSESSES HOW SUCCESSFUL THE DISEASE MANAGEMENT INITIATIVE HAS BEEN IN MEETING LEGISLATIVE EXPECTATIONS FOR ANTICIPATED COST SAVINGS AND OTHER PROGRAM OUTCOMES *IDENTIFIES CIRCUMSTANCES OR FACTORS IMPEDING INITIATIVE SUCCESS *RECOMMENDS WAYS TO IMPROVE THE DESIGN OF THE INITIATIVE JUSTIFICATION THE FUTURE OF DISEASE MANAGEMENT IN MANAGED CARE I) Technology Solutions to Chronic Disease management. II) Innovative Approaches to Health Care Delivery