Disease Management Model


A definition of disease management has been offered by the Disease Management Association of America - "Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant." Disease management is gaining momentum in nearly every health care arena. Failure of the health maintenance organization (HMO) business model to contain cost has the healthcare industry scrambling to develop alternative delivery methods.

The disease management model utilizes highly skilled teams of nurses who assess patients over the phone.  Unlike telephone triage, disease management regularly assesses known patient populations for subtle changes that could affect their overall state of health. It is believed that the nurse can identify subtle health changes long before the patient may realize the seriousness. Early identification of changes allows the nurse to guide self care interventions, avoiding the need for more extensive medical intervention.

The government is implementing disease management for Medicaid recipients who have a diagnosis of such chronic health care concerns as congestive heart failure, diabetes, or asthma.  Insurers are closely following these groups of patients as well as other high risk groups of patients including mental health patients and families with premature infants.  Independent call programs are often contracted to provide these services for patients, practices, and insurers.


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