Tuesday, November 30, 2010

The Definition of "Disease Management" (with other definitions)

Thanks to prior postings in the Disease Management Care Blog, readers have had access to handy and literature-based definitions of "patient centered care," "care management" and "value based insurance design." Not only can regular readers quote them with confidence, insert them in company-wide memos, amaze colleagues with deep subject matter expertise, bore the DMCB spouse and use them against know-it-all consultants, the definitions make for perfect verbal swordsmanship at that next staff meeting. For example:

"Er, exsqueeze me Bob, but everyone at this meeting except you knows that care management should also be postured to reduce the duplication of medical services!"

Then it occurred to the DMCB that it had not blogged about the definition of disease management. Now that is an embarrassing lapse. The term may have lost much of its brand luster among the vendors and is no longer de rigueur among the policymaker elites, but the contrarian DMCB still predicts the catch-phrase will eventually make a comeback. In happy anticipation of its eventual resurrection, the DMCB proposes this formal definition:

A package of mutually supportive interventions to improve quality or mitigate the insurance risk of a population defined by the presence of a chronic condition.

This short and efficient definition is good because 1) it emphasizes disease management's multi-dimensional nature, resulting in a synergy that is greater than the sum of its parts, 2) it recognizes that in addition to quality, there is merit to controlling costs and doing so in the context of health insurance; in other words disease management and managed care are inextricably intertwined and 3) it transcends one-on-one care, akin to "applied" health services research that also studies defined cohorts. One other feature that favors this definition as eminently quotable is that it has also been published in the peer-reviewed literature (1).

The DMCB also looked up the old and more lengthy DMAA definition of disease management. For the sake of completion, it's reproduced below. Fortunately, it's also been memorialized in the medical literature (2) for your quoting pleasure:

"A system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant:

• Supports the physician or practitioner/patient relationship and plan of care,

• Emphasizes prevention of exacerbations and complications utilizing evidence-based practice guidelines and patient empowerment strategies, and

• Evaluates clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall health.

Disease management components include:

• Population identification processes

• Evidence-based practice guidelines

• Collaborative practice models to include physician and support-service providers

• Patient self-management education (may include primary prevention, behavior modification programs, and compliance/surveillance)

• Process and outcomes measurement, evaluation, and management

• Routine reporting/feedback loop (may include communication with patient, physician, health plan and ancillary providers, and practice profiling)

'Full-service disease management programs' must include all 6 of the above components. Programs consisting of fewer components are 'disease management support services.'"

Other definitions have been proposed. There is a list here and a table with other definitions was published here, courtesy of the American Heart Association (2).

As a further service to it's readers, the DMCB has reproduced the definitions of "patient centered care," "care management" and "value based insurance design" below along with the necessary citations. In addition, there is a paraphrased definition of "population health improvement," which has been put forward courtesy of the Care Continuum Alliance (CCA).

Patient centered care any care that is "respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions" (3).

Care management is a set of activities designed to assist patients and their support systems in managing medical conditions and related psychosocial problems more effectively, with the aims of improving patients’ functional health status, enhancing the coordination of care, eliminating the duplication of services, and reducing the need for expensive medical services (4).

Value based insurance designs are health insurance designs that reduce patient out-of-pocket expenses for covered services that provide important medical benefit relative to costs (5).

Population health improvement is paraphrased by the DMCB as a package of services that identifies a population, conducts a needs assessment of that population, provides health promotion programs that increase awareness of the health risks associated with certain personal behaviors and lifestyles, promotes health management goals and education as well as self-management interventions aimed at achieving behavioral changes. routine reporting and feedback loops which may include communications with patient, physicians, health plan and ancillary providers with ongoing evaluation of clinical, humanistic, and economic outcomes. the full definition can be found here.


1. Sidorov J, Schlosberg C: Disease management and the Medicare modernisation act: "It's the insurance, stupid." Disease Management December 2005;8(6): 331-338

2. Krumholz HM, Currie PM, Riegel B et al: A taxonomy for disease management. Circulation 2006;114:1432-1445

3. Epstein RM, Fiscella K, Lesser CS, Stange KC: Why the nation needs a policy push on patient centered health care. Health Affairs 2010;29(8):1489-1495

4. Bodenheimer T, Berry-Millett RL Follow the money - controlling expenditures by improving care for patients needing costly services. New Engl J Med 2009;1521-1523

5. Chernew ME, Juster IA, Shah M, Wegh A, Rosenberg S, Rosen AB, Sokol MC, Yu-Isenberg K, Fendrick AM: Evidence that value-based insurance can be effective. Health Affairs 29(3):530-536

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