REDUCING HEALTHCARE COSTS THROUGH THE IMPLEMENTATION OF
HOSPITAL-GOVERNED DISEASE MANAGEMENT PROGRAMS
Healthcare costs in the United States are on a continual rise with no relief on the horizon. As the population ages and lifestyles differ from one individual to the next, healthcare third party payers such as commercial insurance plans, employee health benefit plans, the Medicare program and state Medicaid programs are searching for strategies to lower the costs associated with providing healthcare benefits to their beneficiaries. Disease management programs are emerging as a way to help decrease the high cost of health care typically associated with chronic illness by coordinating care between the patient and their healthcare provider. By researching how these programs currently being implemented by the third party payer population affect all aspects of a patient’s health, the healthcare industry can learn how to effectively reduce costs for both the patient and the care-providing entities of healthcare. There is a multitude of data; both in the current literature as well as within hospital-specific statistical reports that can be abstracted to prove these programs can be successful. While more research is needed on long-term effects of disease management programs over several years to determine if it does indeed reduce costs and improve the health of the patient, the current research being done is a definite start in the right direction.
TABLE OF CONTENTS
Page
CHAPTER 1 – INTRODUCTION--------------------------------------------------------- 1 Research Question------------------------------------------------------------------- 1 Basis for Study----------------------------------------------------------------------- 1 Background--------------------------------------------------------------------------- 2 Significance of the Study----------------------------------------------------------- 3
References: Bleil, L.D., Kalamas, J., & Mathoda, R.K. (2004). How to control health benefit costs. McKinsey Quarterly, 1, 104-114. Claiborne, N. & Vanderburgh, H. (2003). How can social workers improve outcomes and costs in disease management. Disease Management Health Outcomes, 11,7, 407-413. Gause, J.F. (2004) No silver bullet. Indiana Business, March, 20 & 44. Gillespie, J.L. & Rossiter, L.F. (2003). Medicaid disease management programs. Disease Management Health Outcomes, 11, 6, 345-361. Hoffman, J. (2001). Broad disease management interventions: Reducing healthcare costs for plan members with CHF. Disease Management Health Outcomes, 9, 11, 527-529. Kendall, D.B., Tremain, K., Lemieux, J., & Levine, S.R. (2003). Healthy aging v. chronic illness: Preparing Medicare for the new health care challenge. Maillet, P Mowll, C.A. (2003). Certification for disease-specific care programs. Disease Management Health Outcomes, 11, 9, 545-550. Norris, S.L., Glasgow, R.E., Engelgau, M.M., O’Conner, P.J., &McCulloch, D. (2003). Chronic disease management: A definition and systematic approach to component interventions. Disease Management Health Outcomes, 11, 8, 477-488. Stuart, M. & Weinrich, M. (2004). Integrated health system for chronic disease management: Lessons learned from France. The Cardiopulmonary and Critical Care Journal, 125, 2, 695-703. Terry, P.E. (2003). Creating a new vision for health promotion: Taking a profession to a new level of effectiveness in improving health. American Journal of Health Promotion, 18, 2, 143-145. Young, D. (2004). CMS disease management project underway in four states. American Journal of Health System Pharmacy, 61, 326-328. Meyer, J. (2004). Consumer-driven health plans: Design features to promote quality improvement. Benefits Quarterly, 2Q, 23-31. Muraoto, M., Campbell, J., & Salazar, Z. (2003). Provider training and education in disease management. Disease Management Health Outcomes, 11, 10, 633-345. Neuhauser, D. (2003). The coming third healthcare revolution: Personal empowerment. Quality Management in Healthcare, 12, 3, 171-184. Sidorov, J., Paulick, P., & Sobel, L. (2003). What is the return on investment associated with diabetes disease management? Disease Management Health Outcomes, 11, 9, 565-570. The disease management approach in Ontario: Current perspectives. (2002, February). The Change Foundation