Disease management is defined as "a system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant.
Major disease management organizations based on revenues and other criteria[5][6] include Accordant (a subsidiary of Caremark), Alere (now including ParadigmHealth and Matria Healthcare),[7] Caremark (excluding its Accordant subsidiary), Evercare, Health Dialog, Healthways, LifeMasters (now part of StayWell), LifeSynch (formerly Corphealth),[8] Magellan, McKesson Health Solutions, and MedAssurant.
[9] A Mercer Consulting study indicated that the percentage of employer-sponsored health plans offering disease management programs grew to 58% in 2003, up from 41% in 2002.
[5] As of 2010, a study using National Ambulatory Medical Care Survey data estimated that 21.3% of patients in the U.S. with at least one chronic condition use disease management programs.
It is financed and operated as a single national program by statutory health insurance, which has contracted with a private provider for support services.
The introduction of these programs was in part facilitated by support from international organizations or firms and study trips or other forms of exchange with Anglo-Saxon countries.
[14] The underlying premise of disease management is that when the right tools, experts, and equipment are applied to a population, labor costs (specifically: absenteeism, presenteeism, and direct insurance expenses) can be minimized in the near term, or resources can be provided more efficiently.
Experts include actuaries, physicians, pharmacists, medical economists, nurses, nutritionists, physical therapists, statisticians, epidemiologists, and human resources professionals.
[15] At least two studies have found that people who enroll in disease management programs differ significantly from those who do not on baseline clinical, demographic, cost, utilization and quality parameters.
[16][17] To minimize any bias in estimates of the effectiveness of disease management due to differences in baseline characteristics, randomized controlled trials are better than observational studies.
[21] CMS set goals in the areas of clinical quality and beneficiary satisfaction, and negotiated with the disease management programs for a target of 5% savings in Medicare costs.
[26] A paper on the six-month evaluation, published in fall 2008, concluded that "Results to date indicate limited success in achieving Medicare cost savings or reducing acute care utilization".
"[34] Furthermore, there was "no demonstrable savings in Medicare expenditures," with the net fees for disease management ranging from 3.8% to 10.9% per patient per month.