Challenges and Incentives for Disease Management Programs
Disease management (DM) programs are organized, coordinated, and integrated efforts to improve the health outcomes and reduce the costs of patients with chronic conditions. DM programs typically involve a multidisciplinary team of health care professionals who provide education, self-management support, care coordination, and monitoring to patients with diseases such as diabetes, asthma, heart failure, or chronic obstructive pulmonary disease (COPD).
However, DM programs face several challenges that limit their effectiveness and sustainability. Some of the major challenges are:
– Lack of standardized definitions and measures of DM program components, outcomes, and costs. This makes it difficult to compare and evaluate the performance and impact of different DM programs across settings and populations.
– Lack of evidence-based guidelines and best practices for DM program design, implementation, and evaluation. This leads to variability and inconsistency in the quality and delivery of DM services, as well as gaps and duplication in the care continuum.
– Lack of alignment and integration of DM programs with other health care delivery systems, such as primary care, specialty care, acute care, and long-term care. This results in fragmentation and discontinuity of care, as well as inefficiencies and redundancies in the use of resources.
– Lack of patient engagement and adherence to DM program interventions and recommendations. This is influenced by factors such as patient preferences, beliefs, attitudes, knowledge, skills, motivation, self-efficacy, social support, and barriers to access and utilization of DM services.
– Lack of provider engagement and support for DM program participation and collaboration. This is affected by factors such as provider incentives, attitudes, knowledge, skills, workload, time constraints, communication channels, and feedback mechanisms.
To overcome these challenges and enhance the effectiveness and sustainability of DM programs, there is a need for incentives that promote the adoption, implementation, and evaluation of DM programs. Some of the possible incentives are:
– Financial incentives that reward providers and patients for achieving desired outcomes and reducing costs associated with DM programs. These can include pay-for-performance schemes, shared savings models, bundled payments, capitation rates, or value-based purchasing arrangements.
– Regulatory incentives that mandate or encourage providers and patients to participate in or comply with DM programs. These can include accreditation standards, quality reporting requirements, performance benchmarks, or penalties for non-compliance.
– Educational incentives that increase the awareness, knowledge, skills, and competencies of providers and patients regarding DM programs. These can include training programs, certification programs, continuing education opportunities, or information dissemination campaigns.
– Technological incentives that facilitate the delivery, coordination, monitoring, and evaluation of DM services. These can include electronic health records (EHRs), telehealth platforms, mobile applications, remote sensors, or decision support tools.
By addressing the challenges and creating the incentives for DM programs, it is possible to improve the quality of life and reduce the burden of chronic diseases for millions of patients around the world.
Bodenheimer T., Wagner E.H., Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288(14):1775-1779.
Feltner C., Jones C.D., Cené C.W., et al. Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis. Ann Intern Med. 2014;160(11):774-784.
Krumholz H.M., Currie P.M., Riegel B., et al. A taxonomy for disease management: a scientific statement from the American Heart Association Disease Management Taxonomy Writing Group. Circulation. 2006;114(13):1432-1445.