Compare And Contrast The Theory And Clinical Framework Of Disease Management

The health care market is constant state of growth and reform. As primary care continues to become the focus of health care delivery, efficiency and quality has become an important issue for providers and payers. As many organizations continue to consolidate providers, resources and services, new models for health care delivery, which offer increased efficiency and health care information technology advances while improving the overall functionality of health care delivery systems, take form. The idea of disease management has been incorporated in many different areas of health care, such as pharmaceutical companies looking to pinpoint a certain market for their drug, and managed care organizations. The framework of disease management could be looked as patient management, because it is the patient that is being management and not necessarily the disease. As one of the major developments to evolve from the managed care industry, disease management can be described as a prospective disease-specific approach to delivering health care for chronic illnesses. This process is completed using non-physician practitioners who emphasize education of certain maintenance precautions and treatments. This paper will highlight the theory and clinical framework of disease management and how it benefits
managed care organizations. The traditional approach to care management has been the way the healthcare industry has delivered health care form many years.
In this approach to health care, the physician has been the center of care for the patient. It is also in this approach where patients could not see other specialist with out the referral of a primary doctor. The traditional care model required patients to be compliant, and relied on episodic care. The issue with this way of care management is that it may not be tied to proven protocols. Therefore, this model produces over treatments and costly care, which drives he price up for the patients and equals a hefty payday for the
providers. The introduction of disease management created a way to monitor care and cost. Disease management uses a cross-disciplinary care team approach. This approach is fewer physicians focused and more team oriented. Many physicians have a team role, and not a central role, which allows for non-physicians deliver most of the care. Another characteristic of disease management is patient education. Patients have to be advocates for their care in order for this process to be successful. Therefore, patients have to educate themselves so that they can recognize signs of complications, and so that they can perform some maintenance measures at home. If the process of patient education and care teams is executed properly, then the acute care facilities can be reserved for chronic illnesses and disease, and not for people with less acute needs. The functionality of disease management is directed by documented and tested protocols. In a nutshell, disease management is a solution tool used by managed care organizations. Disease management is the process that is responsible for prevention, diagnosis, and treatment of diseases. This management process also maintains standards while addressing personnel issues and cost that are related to providing care. Many times providers and patients give up choice in treatment to a disease management provider. This is often a subcontractor for a managed care organization whose interest is to standardize or streamline treatment, in order to reduce cost without losing quality standards. Therefore, the overall goal is to generate the best possible health care outcomes through improvements in the quality of care and efficient cost control.