MANAGEMENT OF MEMBER COSTS

MHS DISEASE MANAGEMENT

DEFINITION
Disease Management Programmes focus on the active management of patients with certain chronic conditions. They represent a shift away from looking at health care costs per episode, to a more comprehensive view - that of the entire pattern of health care provision and the total management and coordination of care for a particular condition.

• An off-line, regularly updated database identifies members who are being treated for a chronic illness or who are at risk of developing a chronic illness.

• Patients are identified for education and management and stratified according to the severity of their condition.

• Care pathways are guideline-driven with input from recognised clinical experts.

• Patients are counselled telephonically by specially trained nurse counselors, on a regular basis.

• Care is coordinated with the patient's doctor.

• Patients also receive printed educational material.

• Health outcomes are measured.

• Reports include member uptake, clinical outcomes, financial outcomes and humanistic outcomes.

• Disease management is conducted proactively, which reduces the risks of any disease deterioration and facilitates significant improvement, thus eliminating avoidable costs.

• Admissions to hospital and emergency room are reduced.

• Patients are encouraged to take responsibility for their own health.

• There is a shift in emphasis from 'disease' towards 'health' to lifestyle modification.

• Health outcomes are improved.

• High level of member acceptance and appreciation.

Disease management programmes offered include those for cardiovascular disease (CVD), diabetes and asthma, with programmes for other conditions, such as HIV/AIDS, in development.

All the programmes have proved themselves in terms of health results for patients and cost-savings for medical schemes.