How to Implement a Successful Disease Management Program

Health Enhancement Newsletter
By Thomas Morrow, M.D.
Matria Healthcare
Published June 2004

As healthcare costs continue to escalate each year, more employers are turning to disease management as a solution. Disease management has become a mainstream trend, with nearly 90 percent of large employers offering at least one program.

Are you one of the 90 percent? Or are you thinking about starting a program?

Either way, many employers are still in the dark about what's involved with a successful implementation. Here are a few pointers to keep in mind whether you are just getting started or need to solve a problem with an existing program:

1. Identify the most common diseases in your population.

Your current cost structure will determine what diseases are most common and most expensive in your population. Not all employers are in need of a disease management program for every possible disease. Older populations will typically benefit most from the cancer programs and cardiovascular programs, such as coronary artery disease and heart failure. Younger populations tend to benefit most from maternity programs and asthma management programs. All employers will benefit from diabetes programs, as incidence of diabetes is increasing. And do not neglect depression, a disorder that costs you many times the direct medical costs in lost productivity, accidents and ãpresentismä.

2. Maximize the effectiveness of your program.

Your employees should be fully aware of the benefits of a program and know that you support them in maintaining or improving their health. Reassure them that the program is a part of their benefits and that you, the employer, do not have access to their personal information. Privacy is a big concern to scare some employees away.

3. Continuously remind your employees about your disease management programs.

Begin with kick-off announcements. Then progress to paycheck stuffers, newsletters, email notices, posters and reminders at any work site health fairs or clinics. Also, adding the disease management logo on their benefit cards to promote ãname brandä recognition. Messages should stress the benefits of disease management and encourage immediate responses to phone calls and mailings.

4. Make sure your employee phone numbers and addresses are correct.

Surprisingly, many large company HR departments do a poor job maintaining their employee contact information. Inaccurate or inadequate telephone data costs you a considerable amount of money both in search fees as well as diminished enrollment in the programs designed to save you money! You need to set up a process whereby employees keep you informed of telephone number changes. Some of the more successful employers have online programs to collect and maintain phone numbers and addresses.

5. Make sure your senior management is on board.

Senior management commitment to a disease management program is crucial. Employees need to be aware that their managers totally support the program and see their managers enrolling, not only themselves, but their children in the programs. When senior managers with chronic conditions refuse to participate in their own company's disease management programs when they are identified and contacted, this sends a negative message to employees. Top management needs to demonstrate commitment on all fronts.

6. Make sure you have access to low-cost medical data.

A well run disease management program will require a lot of data, such as monthly medical and pharmacy claims and eligibility information. To avoid costly fees for this information, you need to insert a clause in your health plan contract guaranteeing access to cost-free or low-cost medical data.

7. Require your health insurer to cooperate with your disease management vendor.

While you are negotiating with health insurers, ask that they cooperate with your current or future disease management vendor in handling the case management needs of your employees. More and more employers are ãcarving outä case management clauses to ensure that their selected case manager is actually acting on behalf of the patient and not the health plan.

In summary, setting the stage for a successful disease management program requires foresight and planning. For more information about disease management, check out the Disease Management Association of America Web site at www.dmaa.org.