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Health Care Quality Special Reports |
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Issue Date: Spring 2001 One of Health Care’s Best Kept Secrets While managed care has been effective at containing costs, many experts complain that it has failed to improve quality and patients have protested widely. Against this backdrop of widespread dissatisfaction comes evidence of one of health care’s best kept secrets: Disease management has been effective at doing the things managed care cannot. Disease Managers Align Financial Risk and Guarantee Results Disease management (DM) companies are so confident in their ability to control costs, that many are willing to offer guaranteed contracts. In these contracts, the companies promise to provide care to a certain population for a price that is lower than what the health plan or employer paid previously. Treating Chronic Pain Cuts Costs Pain experts agree that appropriate management of chronic pain not only improves clinical outcomes, it also reduces costs. Now, pain management companies are forming to try to achieve these twin goals. The Goal Is Total Population Health Disease Management Association of America (DMAA) was formed to represent a growing, new industry that has a lot of new stakeholders. Members include pharmacy benefit management (PBM) companies, drug companies, disease management companies, carve-out companies, enabling companies, HMOs, PPOs, benefit consultants, and large employers. Because of the growth of the industry, and expectations for continued growth because of the prevalence of chronic illness, there is a need to have a common voice for educating government regulators and legislators in Washington, D.C., and in the states. Technology Plays a Leading Role Information technology is having a profound effect on disease management, saving money for health plans and improving the quality of care, say executives with disease management companies. DM Program Cuts Employer’s Costs Most disease management programs are maintained by health plans, many of which purchase such programs from disease management vendors. Southern Co. in Atlanta is one of only about 50 companies that run disease management programs, experts say. Like other self-insured companies, Southern found that maintaining its own internally managed disease management program is an effective way to provide quality care to employees.
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