Operational Issues Multiple programs While, for some years, care management programs have been aimed at discretely identifiable populations (e.g., DM, catastrophic case management, end-stage renal disease), the current trend is toward more patient-centric integrated programs (i.e., in which a care manager may direct a number of different interventions to the target population). At the same time, traditional chronic DM is being deconstructed into segments that may be managed by different vendors or a combination of vendor and internal staff. These new models pose significant challenges for measurement. The typical DM measurement methodology (i.e., historical population control) works well at the population level; it is difficult to apply in situations where multiple programs or vendors may manage a defined group at different times. We are likely to see the application of alternative methodologies to accommodate increasingly complex measurement needs.
Use in Medical Management a. Identification of disease states that would benefit from DM b. Identification of treatments that eliminate the need for DM c. Program structure issues (what they are and how to control for them)
Disease Management Practice Note
19
December 2007