Disease management practices of health plans

Am J Manag Care. 2002 Apr;8(4):353-61.


Objective: To investigate how health plans manage chronic diseases.

Study design: Health plan medical directors were surveyed regarding the disease management (DM) practices of their plans.

Methods: We took a stratified random sample of 65 plans, all members of the American Association of Health Plans. Forty-five plans responded. Results were weighted to be representative of the industry (including nonmember plans). Medical directors were asked to consider that they had a DM program only if 2 things were true: (1) A majority of a plan's enrollees could not be ineligible for a DM program for non-clinical reasons (eg, geographic location); and (2) a DM program had to have at least 6 of the 8 components of a DM program as defined by the Disease Management Association of America.

Results: The 3 diseases most likely to be the focus of DM programs were diabetes, asthma, and congestive heart failure. For each of these diseases, at least one quarter of Americans were enrolled in plans offering a DM program. Medical directors perceived their DM programs to be highly effective in reducing mortality and morbidity and in improving the functional status of patients, and perceived them to be effective in lowering cost. The greatest challenge in implementing DM programs involves information technology. These results yield insights into the future of treatment of chronic disease in the United States.

Conclusion: Health plans have made a significant investment in programs to improve care for chronic illness. The almost universality of DM programs highlight the need for scholarly evaluations of their effectiveness and cost effectiveness.

MeSH terms

  • Asthma / therapy
  • Chronic Disease / therapy*
  • Decision Making, Organizational
  • Diabetes Mellitus / therapy
  • Disease Management*
  • Health Care Surveys
  • Heart Failure / therapy
  • Humans
  • Insurance, Health*
  • Managed Care Programs / organization & administration*
  • Medical Informatics
  • United States