|
|
|
|
How did the concept emerge? Disease management approaches grew out of the increasingly unpopular methods of Managed Care. Managed Care began as a population- and risk-based movement to control the rapidly escalating costs of healthcare. It did succeed in controlling the emerging financial risk--in effect capping growth to nearly the rate of inflation. Some of its methods were draconian, doing the hard job nobody else wanted--essentially saying "no" to care that many felt necessary. Critics (particularly providers and patients denied care) felt that clinical decisions were based more on financial concerns rather than the health of the patient. But managed care also began to bring an unexpected benefit: it reinforced--well, forced--a fundamental search for treatments that worked--paying ONLY for treatments that worked as identified by scientific findings (rather than by "intuition" or "tradition"). The effort forced quality of care and improved clinical outcomes to the forefront of the discussion. This was an approach that was more comfortable for providers (particularly medical providers) and the patients who would benefit from better treatments. It moved healthcare back to the heart of the issue: healing people who are unwell and preventing others from getting sick. But it also had financial benefits: as treatment worked more effectively (particularly preventive strategies), the costs of healthcare grew more slowly--sometimes even dropping dramatically.
What Is Disease Management? Disease Management is an organized and consistent approach to the treatment of chronic illnesses using evidence-based practices. A key element is the training of patients to understand and self-manage their illnesses. Much of the work done in disease management stems from the research done by Kate Lorig, MD, Ed Wagner, MD, and J.O. Prochaska, PhD in testing and developing the concepts that were built into a Chronic Care Model that has been proven to work with a range of conditions. The research on the Chronic Care Model--which has been replicated multiple times--has been seen as indicating outcomes so successful that it has been adopted by the federal government in programs administered by the Center for Medicare and Medicaid Services (CMS) and the Administration on Aging (AOA). Follow-up studies by the Robert Woods Johnson Foundation (Chronic Care Evaluation) have led RWJ to support extended efforts to disseminate the model nationally with a range of conditions. The image below--developed by the Improving Chronic Ill Care Project--describes the central elements of this disease management method. Like many scientific solutions that work, the elements are simple, the effects profound.
Why not Disease Management for Serious Mental Illness? Which raises the obvious question: if Disease Management outcomes are so impressive that the federal government, commercial and public health plans, and national foundations are pushing for dissemination of DM practices, why NOT use DM with Serious Mental Illness? Would clients not benefit from treatments that are designed to work--and work reliably? Touchstone innovare has asked that question of itself--and answered with the development of Community Treatment and Rehabilitation (CT&R) for the conditions of persons with serious mental illness. (Please take a look at a short Briefing Paper that describes some of the thinking that went into creating the CT&R management approach, entitled What is Disease Management?) or go directly to the Community Treatment and Rehabilitation Page. Return to Top of Page Return to Interest Areas Home
|
Send Email to reginam@TI-GR.com with
questions or comments about this web site.
|
