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CHRONIC DISEASE MANAGEMENT PROGRAMS
Chronic Disease Management Programs
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Chronic Disease Management Programs
Introduction
The healthcare and public health departments of most countries around the globe have
resorted to various mechanisms of managing chronic diseases. Chronic diseases are maladies that
are long-term and show slow development over time, progressing to severe levels. The good
news with such diseases is that they can be controlled being that they are rarely curable (Nuovo,
2010). As a matter of fact, the number and level of chronic diseases overtake the infectious
diseases by far in the global scale (Nuovo, 2010). The cost of management of such diseases is
higher being that the patients have to get the best care that requires a lot of financial investments
(Nuovo, 2010). Amidst the increased healthcare costs, reduced budgetary allocations to the
healthcare sector and associated uncertainty of the economy chronic disease management
programs present an alternative that is used by governments to utilize the little funds available
while at the same time ensuring quality (Nuovo, 2010). A chronic disease management program
is just a cost effective approach that involves the use of coordinated healthcare communications
and interventions for chronic diseases that require self-care efforts within a population (Nuovo,
2010). Through these programs optimize the relationship between the patients and practitioners
ensuring that the management of chronic diseases is aligned to the evidence-based principles as
well as empowerment strategies for the patients. Most importantly, chronic illness management
programs improve the healthcare and institute the health reform for the benefit of a country.
Chronic Disease Management Programs and Improved Healthcare
The programs are meant to help in the provision of coordinated communication of the
self-care management programs for the patients thus improved the psychological, economic,
emotional and physical wellbeing of those ailing from chronic conditions (Nuovo, 2010). The
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program also offers a variety of services for these patients taking into account all the evidencebased practices that are effective in the self-management of the chronic illnesses such as
congestive heart failure, ischemic heart disease, epilepsy, Chronic Obstructive Pulmonary
Disease, Congestive Heart Failure, and Diabetes among others (Nuovo, 2010). Currently, 75%
of the healthcare expenditure is on chronic illness patients a rate that is five times higher than
other infectious diseases. Furthermore, the death rate of the chronic disease patients is stable at 7
in every ten people in the population. The management of the healthcare system being so
fragmented has failed to offer efficient management of chronic disease (Nuovo, 2010). The
current practices in the healthcare system have prompted most policy makers to review the
positions and make healthcare reforms that see the operability of chronic disease management
programs (Nuovo, 2010). The rationale behind this is to improve the healthcare outcomes, curtail
the high death rates, and reduce the costs of operation within the healthcare system.
The components of a complete chronic management program are distinct and
interdependent (Nuovo, 2010). First there us the first element is population identification
processes, that allows for the proactive determination of the population that completely need to
benefit from the program (Perk, 2007). These systems aid in identifying and classifying the
target population as either high, moderate or average risk populations and offer the best care
strategies or allocate the best experts. Secondly, there are evidence-based practical guidelines
that guide the procedures and protocols of the program (Perk, 2007). Through evidence-based
approach, the clinicians and physicians follow the appropriate rules that are consistent when
providing healthcare to the target population.
Thirdly, the program also entails collaborative practice models that include the doctors,
partnerships and support service providers such as social workers (Perk, 2007). Within the
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collaborative model, the experts communicate through the use of various information technology
tools to coordinate patient care. Furthermore, the other providers that are not mentioned are also
included in this element so as to cover the gap that exists in the current fragmented healthcare
system.
Fourthly, the program also has patient self-management education plan and schedules
that involve sessions where the patients are taken through the important methods they can
effectively use in the management of the disease (Perk, 2007). The methods here include primary
prevention methods, lifestyle management procedures, behavior modification programs, and
surveillance as well as adherence programs (Perk, 2007). The next component is the outcome
measurement systems where the impacts of the program on a given population are evaluated and
correspondingly managed (Perk, 2007). Last but not least, the chronic care model involves the
conventional feedback system or loop that enables the interchange of information among the
healthcare providers, physicians, patients, and also aids in practice profiling for future
management of the chronic disease (Perk, 2007).
There lie a plethora of benefits that accrue from the implementation of Chronic Disease
Management Programs in the healthcare environment. First off, the implementation of chronic
disease programs has increased the satisfaction of customers who are placed under such
programs. Over 90% of those who use the program admit having encountered excellent health
care outcomes compared to the early health care they received before the implement the program
(Ahn et al., 2013). The coordinated healthcare ensures that the information about the patient’s
condition is exchanged between healthcare practitioners where they are visiting for checkups.
Furthermore, most of the patients have also modified their lifestyles successfully through the
support services and educational programs that prove effective (Ahn et al., 2013). Secondly, the
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chronic disease management programs fill the gap between normal hospital care and chronic
health care that demanded some quick and proper response (Ahn et al., 2013). Thirdly, the CDM
program has also led to adherence to medical prescriptions. In the non-coordinated healthcare
setting almost 70% of the patients are nonadherent to medications most of whom are suffering
from chronic diseases (Ahn et al., 2013). However, the CMD program ensures a combined
monitoring and feedback system that ensures that the patients are educated about the importance
of sticking to a given prescription medication (Ahn et al., 2013). Consequently, the therapeutic
effects and results of most medications used in the management of chronic illnesses even among
those who have severe illnesses have been good (Ahn et al., 2013). Moreover, based on the
adherence, there has been a reduction in the number of hospitalizations, readmissions, and
emergency room visits.
Fourth, most of the patients have been introduced to self-care management model where
they can coordinate the strategies taught themselves through such things as behavior and lifestyle
management and modification (Geyman, 2007). As a result, most of the patients have gone for
injections and medication, show reduced levels of depression and utilize the prescribed drugs.
These programs also ensure that the screening processes and secondary prevention strategies
work for the sake of the patients (Geyman, 2007). Through the two strategies, the CDM
programs can make a forecast on the prevalence of the disease that is expected based on the
current statistics. In a way, this helps in policy development and in planning intervention
strategies for combating, preventing, and managing chronic illnesses (Nuovo, 2010). These
programs also aid in the prevention of fatigue, stress, and disability that result from diverse
chronic diseases. Furthermore, the programs also make it possible to take care of the aged
patients who form most of the population that is affected by chronic diseases.
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The CDM programs have also optimized the healthcare provision processes because the
patients and doctors alike can plan their time thus reducing inconveniences. Moreover, the
patients are also treated and given medications according to evidence-based practices that guide
consistency and effectiveness in a given target population (Geyman, 2007). Consequently,
complete utilization of the hospital resources is possible through such programs that ensure
quality improvement in healthcare. The CDM programs also increase the engagement between
the practitioners and the patients through such things as telephonic care management models
(Geyman, 2007). These models allow the patients who want the urgent help of the physicians or
nurses, as well as attention, are well attended to in a timely and orderly manner (Geyman, 2007).
The benefits of such an approach are that it counts in reducing the risks of the patients and thus
reduction of hospitalizations, emergency department visits and reduced readmissions due to
complications that are otherwise preventable (Ahn et al., 2013). All the above tenets just show
how the CDM program is a framework that helps in quality improvement in health care
provision (Nuovo, 2010).
The other eminent benefit of CDM programs is the cost effective in the long run despite
the implementation costs incurred in the early stages (Nuovo, 2010). The economic impact of
CDM programs in the healthcare systems cannot be underscored (Ahn et al., 2013). The
approach has reduced the healthcare expenditure because of reduced hospitalizations,
readmissions, and emergency department visits. The program has instead increased the rate at
which patients with chronic illnesses utilize other medical services that were initially
underutilized (Nolte, Knai & McKee, 2008). Moreover, the rollout of the program yields a better
cost saving on the part of the patients as well as on the part of the government. Therefore, the
government is left with the mandate of allocating budget to the health care reforms that need
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attention (Nuovo, 2010). The average estimated savings per individual in emergency room visits
and the utilization of the healthcare facilities is about $714 (Nolte, Knai & McKee, 2008).
However, for the total savings of the population suffering from chronic diseases both mild and
severe, the cost saving clocks around $6.6 billion with a wider positive impact on the community
(Nolte, Knai & McKee, 2008). The aim of a health reform is to save on costs, maximize the use
of resources and improve the outcome of the healthcare system (Nolte, Knai & McKee, 2008).
Authentically, the chronic disease management program offers an avenue through which
healthcare reforms such as Medicaid and Medicare, can save costs and meet their wider
objectives.
Chronic Disease Management Programs and Healthcare Reform
Approximately 90% of the care accorded to the chronic disease patients has to be
coordinated outside the health care settings and organizations (Nolte, Knai & McKee, 2008).
However, most of the health care systems do not acknowledge this in their plans (Nolte, Knai &
McKee, 2008). Instead, the healthcare system is mounted on the patient-centric line of thought,
failing to factor in those with severe chronic illnesses who are in dire need of self-management
education (Ahn et al., 2013). The prevalence and incidences of chronic illnesses are as a result of
the original health care orientation leading to deaths of thousands of patients most deaths that are
preventable (Nolte, Knai & McKee, 2008). The community-based support systems that attend to
the chronically ill patients were initially strained being that the numbers of the patients are
increased. The reorientation of the US healthcare system has been sufficient enough in
combating the disease (Ahn et al., 2013). Specifically the beneficiaries of Medicaid and
Medicare programs who are enrolled in the CDM programs have indicated improvement
regarding their conditions, access to medication and reduction of the costs (Nolte, Knai &
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McKee, 2008). The programs that were initially meant to cover all other diseases have expanded
their scope and are now covering patients who have chronic illnesses (Nolte, Knai & McKee,
2008). As a backup to the healthcare reforms the chronic disease management programs also
ensure that the elderly who are among the senior citizens such that Medicare covers them
without any deductions or co-payments (Ahn et al., 2013). Furthermore, the elderly population is
likely to access annual checkups and have personal prevention plans despite having other
medical covers (Nolte, Knai & McKee, 2008). Also, this system also makes it possible to reduce
the prevalence and incidence of the chronic illnesses among the people before they reach the age
where they are eligible for Medicare (Nuovo, 2010). As a plus, the pre-planning process stated
above will aid in reducing Medicare costs that are higher without the programs (Ahn et al.,
2013). These programs also reduce the gaps in information interchange through the use of
Electronic Health Records in the United States (Nolte, Knai & McKee, 2008). Primarily, the use
of the program saves costs of healthcare systems and reduces the rate of hospitalizations that are
the key focus of Medicare and Medicaid (Ahn et al., 2013). Furthermore, the chronic disease
management program offers an avenue for the determination of the payment methods that are
used by the patients as well as the incentives given to the practitioners for the services they
provide to the patients (Nuovo, 2010).
The CDM program also assures the inclusion of other health care professionals such as
community health workers and caregivers in giving a team-based care to the chronic disease
patient population (Nuovo, 2010). The provision of care at lower rates meets the cost-reduction
objectives of the healthcare system reforms. The framework of chronic disease management
programs is easy to implement meaning that the benefits it comes with in the elimination of
barriers are far much greater than the costs of its implementation (Nuovo, 2010). The chronic
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disease management program offers an opportunity to reach national prevention through the use
of methods that involves the inclusion of the affected individuals (Nolte, Knai & McKee, 2008).
The healthcare reforms also look at the inclusion of the private sector in the healthcare systems
(Nuovo, 2010). With the CDMPs, the private sector gets an edge to engage in service delivery to
the patients suffering from chronic illnesses (Nolte, Knai & McKee, 2008).
Conclusion
The chronic disease burden has far-reaching effects all over the world. The chronic
diseases are preventable. Even so, their management and treatment require much attention and
financial investment. Most of the healthcare policies that were recently faced out never took into
consideration the management of chronic diseases when in the planning, design and
implementation stages. However, in the recent past, disease management with much emphasis on
chronic disease management programs has been the center stage of most policy formulation
meetings. Moreover, the advancement of IT and a corresponding increase in its use in the
healthcare systems proves useful in the implementation of such programs. The two major
advantages that accrue from the CDMPs are quality improvement within the healthcare system
and cost reduction of the expenditure or budget on the healthcare system. The good thing with
the CDMPs is that they are patient-centered and fill the gap that exists due to the fragmented
healthcare environment. The program also ensures coordinated care between healthcare
specialists. Most importantly, the rollout of such systems has seen the reduction of health care
visits and the rates of hospitalization. Furthermore, the program has also ensured that reforms
through initiatives such as Medicaid and Medicare tackle the problem of chronic diseases
effectively. As noted in this paper, there is the rising edge that comes along with the
implementation of chronic disease management programs within the healthcare system. With its
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full implementation, the prevalence and incidences of chronic diseases among different
populations are likely to reduce.
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References
Ahn, S., Basu, R., Smith, M., Jiang, L., Lorig, K., Whitelaw, N., & Ory, M. (2013). The impact
of chronic disease self-management programs: healthcare savings through a communitybased intervention. BMC Public Health, 13(1), 1141. http://dx.doi.org/10.1186/1471-245813-1141
Geyman, J. (2007). Disease Management: Panacea, another False Hope, or Something in
Between? The Annals of Family Medicine, 5(3), 257-260. http://dx.doi.org/10.1370/afm.649
Nolte, E., Knai, C., & McKee, M. (2008). Managing chronic conditions. Copenhagen: World
Health Organization on behalf of the European Observatory on Health Systems and Policies.
Nuovo, J. (2010). Chronic disease management. New York, NY: Springer.
Perk, J. (2007). Cardiovascular prevention and rehabilitation. London: Springer.