Condition Management

Resources and Information on Condition/Disease Management:

Introduction to Disease Managment Interventions:    In this paper, we have briefly surveyed common types of medical management directed at the member or patient. These programs or interventions have certain common features: all rely heavily on identification of at-risk members, all rely on clinical resources, and all rely (to some degree) on participation by the member or patient in the member’s own care.  

Introduction to Care Management: In this second paper in the series, we have discussed a number of the definitional, measurement and data issues that an actuary should be aware of when performing a program evaluation. Many of these issues will be familiar to actuaries in other contexts, for example anti-selection or underwriting risk factors. Actuarial familiarity with the issues will increase the potential value of actuaries to an organization interested in objectively evaluating a program.

Cost Savings from Disease Management: Our review of approximately 2,000 abstracts resulted in the identification of 85 articles that reported useable utilization or financial outcomes, or both. In most cases, the literature supports the hypothesis that interventions result in both clinical and financial improvement (there are some exceptions, such as asthma disease management, and some case management interventions).

Optimizing the Economics of Disease Management: Optimizing ROI and Total Savings can result in different program designs. Yet a different program design may also be required if the objective is to optimize clinical outcomes. Because there are many parties involved in implementing a DM program, it is possible that a single, compromise design will be decided on in a particular client situation that optimizes no single objective—for example, achieving adequate ROI without maximizing it—in favor of higher penetration and higher clinical scores.

Validating Disease Management Programs:  Because of the controversy over its results, many authors have discussed general methodological principles for ensuring validity in disease management ("DM") savings outcomes measurement. This paper will address the theory of measurement design and provide a practical evaluation of the most common designs for the practitioner.

Comparative Anaysis of Chronic & Non-Chronic Cost Trends: Estimating DM program financial outcomes based on the assumption that, absent the program, the chronic population would have had the same trend as the non-chronic population can lead to erroneous conclusions. Identification of a chronic member and the point at which that member is re-classified from one sub-population to another can significantly impact the observed trends in both sub-populations, implying that great care must be taken over classification and interpretation of the resulting trends and their use in DM savings calculations.