A Framework for Disease Management:

Plans and physician organizations working together to meet the needs of patients

Download the Population Management Task Force Charter here.

Overview

The Disease Management Project is aimed at improving coordination between plans and physician groups around disease management programs for patients they share. When the chronic care model and disease management are used to together in a coordinated way, there is opportunity to improve patient outcomes dramatically. When deployed independently, the results can be fragmented, uncoordinated care.

A large number of CA Physician Groups carry out one or more of the components of the chronic care model and in some of the more sophisticated groups, one or more components of disease management. Others have no programs in place.
California plans offer a variety of disease management programs, responding to NCQA accreditation and purchaser requirements.

CA Market trends are positive but fall short of best practice. A method for establishing coordinated division of tasks related to disease management between plans and groups to minimize duplication, maximize patient outcomes, and reduce costs is what is needed in California and nationwide.

In December of 2006, CQC established a multi-stakeholder Task Force, representatives from Plans and Groups, (click here for the task Force list) to identify an approach to get to coordinated efforts around disease management. As a first step, the Task Force recommended that CQC develop a Disease Management Programs Inventory to provide information on disease management programs to plans and physician groups to foster greater awareness. The Programs Inventory was tested successfully among a mix of health plans and Physician groups using diabetes as an example. (Click here to access the Programs Inventory)

Next steps will involve evaluating whether to expand the Programs Inventory to include group disease management programs; in addition to developing a collaborative approach that would involve some plans and groups to test and establish “best partnerships” to improve coordination of DM efforts.

Additional Information

Cathie Markow

cmarkow@pbgh.org

Additional

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Program Description

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