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  1. 1. Disease Management Program GLENDA S. DAVIS MHA 628 MANAGED AND CONTRACTUAL SERVICES DR. ONA JOHNSON N O V E M B E R 2 6 TH, 2 0 1 1
  2. 2. Role of Preventing Disease  Encourage early detection.  Advertisements on TV, websites, magazines, and word of mouth testimonials.  CDC, WHO, PCP, health plans  Government regulations, no smoking facilities  Family histories  State regulations—child has to have vaccines for school entrance.  Public demand  Secondary prevention takes the form of the early detection of asymptomatic diseases through screening•  Tertiary prevention services intervene when a disease or injury has already occurred.  Source: The Economic Impact of Prevention
  3. 3. Patient Incentives  Self managed health care, control  Lower cost in health insurance.  Self esteem.  Healthier living style.  Less risk of early death.  Support groups-talk with others with same diagnosis  People of all ages want to look better and feel better and have a different view of growing older—gracefully  EMR’s so don’t have to keep telling the same history over and over again. Its all in one place with quick retrieval.  Interact with healthcare provider .  Monitor their own physical and emotional status.  Manage the impact of their illness.  Source: Essentials of Managed Health Care
  4. 4. Physician Incentives  Income affected by performance.  Reduce overall costs  Quality versus incentives.  Should physicians receive incentives for what they trained and took an oath to uphold?  Financial risk as with Medicare and Medicaid.  Source: Essentials of Managed Health Care
  5. 5. Facilities  Disease managed programs can be held in:  1. Hospitals  2. Doctors offices  3. Community centers  4. Schools—cafeteria or auditorium  5. Attention to physical environment to facility  6. Easy accessibility.  7. Extended hours to allow people who work odd shifts to be able to attend.
  6. 6. Quality of Care  “Disease management is a way to personalize health care more than ever. The old system was looking at disease only. It was event-centered. Now we look at care management as being patient-centered.“  Surveys, a source of measurement.  Monitor infection rates in hospitals for better quality.  Measure length of hospital stay, and re-assess if patient returns for same medical problem, certain time frame.  Measure how many visits a patient makes to his PCP for the same medical problem. Re-assess treatment plan.  EMR’s will ensure privacy and increase quick retrieval of information to aide in better quality of care.  Source: Disease Management Gains a Degree of Responsibility
  7. 7. Prescription Benefits  Use generic brands when possible.  Don’t over medicate patients.  Discuss with one pharmaceutical company about supplying all the meds needed for this program, which will help with patient expenses and good PR for the pharmaceutical company.  Rebates. 
  8. 8. Case Management  Interventions occur at appropriate times.  Support groups for patients to receive re-inforcements.  Patient is scheduled for yearly visit to PCP.  Patient is scheduled for yearly visit with all other ancillary medical staff such as nutritionist, physical therapists, and other patient care givers in the prevention of disease.  Ensure recent updates in medicine and treatments to patients for review for their particular disease.  Advertisement as to prevention being less costly and a healthier life style for everyone.  Use medias that will cross all barriers, radio, TV, internet, billboards, newspaper, and magazines.  Encourage patient to engage in activities offered.  Source: Building a Computerized Disease Registry for Chronic Illness Management of Diabetes
  9. 9. Future of Data Use and Informatics  EMR’s in all medical facility and doctors offices.  The health plan consumer analytic record including behavioral data.  Closed-loop promotion, direct relationship between sales and marketing.  Second sale excellence, annual open enrollment.  Sales and marketing outsourcing.  Demonstrated value, fact based results.  Quantitative MROI, health plan investment.  Internet marketing, internet users to specific web sites provide marketing messages.  Putting gathered data together in graphs or charts to view the area of positive treatment over a treatment that is not producing active results, for the good of all patients.  Doctors can view the big picture and gain new knowledge.
  10. 10. Conclusion  Discussion on what role of prevention you are introducing.  How do you want to present the information to the patient?  Where will these programs meet and for how long?  The person that will be leading this program will have what qualifications?  Finance and management.
  11. 11. Conclusion  For patient incentives it will come from within each of them.  Their success or failure will result in behavioral changes.  Unlike doctor incentives that involves money, lives will be changed with patients.  Case management has to make sure that patients are informed, engaged, supported, and encouraged to be their own self managers.  Information and meetings places are accessible.  Staff is devoted to the means.  Monitor quality of care.
  12. 12. Conclusion  Facilities are available in all areas of a city.  Hours of operation are flexible.  Schedules of appointments.  Monitor patient adherence to their specific health problem.  Classes on their disease and the mode of action to take.  Make information available and where to access it.  Discuss prevention versus having a chronic disease that has been ignored, early intervention, healthier and less costly.
  13. 13. Conclusion  Quality of care.  Measurements of quality.  Surveys.  Ratings.  Word of mouth.  What acne of care are we desiring?  What is quality of care? Do we even know?  Are there other options, such as universal health care?
  14. 14. Conclusion  Prescription benefits is the big one that should take precedence over anything else.  Medicine is wasted and very expensive.  Patient teaching on going to different doctors and taking lots of different medicine without informing the other provider can spell trouble.  Patients must realize they can have interactions and may die from taking meds they don’t really need and affect one adversely.
  15. 15. Conclusion from CDC  “ Evidence-based preventive services are effective in reducing death and disability, and are cost-effective or even cost-saving. Preventive services consist of screening tests, counseling, immunizations or medications used to prevent disease, detect health problems early, or provide people with the information they need to make good decisions about their health. While preventive services are traditionally delivered in clinical settings, some can be delivered within communities, work sites, schools, residential treatment centers, or homes. Clinical preventive services can be supported and reinforced by community-based prevention, policies, and programs. Community programs can also play a role in promoting the use of clinical preventive service and assisting patients in overcoming barriers (e.g., transportation, child care, patient navigation issues).”   Source: CDC Strategic Directions. Clinical and Community Preventive Services. 
  16. 16. References  Hummel, Jeffrey. (2002). Building a Computerized Disease Registry for Chronic Illness. Management of Diabetes.  http://journal.diabetes.org/clinicaldiabetes/V18N32000/pg107.htm  Kongstvedt, Peter, R. (2007). Essentials of Managed Health Care. (5th ed). McLean, Va: Jones and Bartlett Publishers.  The Economic Impact of Prevention. Retrieved November 27th, 2011.  http:publichealth.uconn.edu/images/reports/UCONN EconomicImpactPrevention.pdf  Wehrivein, Peter. (1997). Disease Management Gains a Degree of Responsibilty. Retrieved November 27th, 2011.  http://www.managedcaremag.com/archives/9708/9708.mainstream.htm

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