History of Disease Management at National Jewish

Recognizing the dramatic changes that were occurring in healthcare delivery in the United States, National Jewish began the development of disease management programs in 1995 to emphasize education, good self-management technique and physician support programs. The goals for the new disease management programs were:

• Create programs that could be quickly implemented and operational with short-term and long-term improvements in quality of life for those suffering with chronic illness
• Provide a service for individuals focusing on education, adherence to a treatment plan and appropriate recognition and action in the case of an exacerbation
• Support our clients’ own quality initiatives and objectives for a disease management initiative
• Optimize loyalty between the National Jewish client and participants of the program

Asthma

Incredibly, less than 4% of the more than 10 million asthma sufferers account for more than 50% of the total costs associated with the disease. Every asthmatic, however, is a potential utilizer of services and will drive costs as they experience a decrease in their quality of life. That’s why National Jewish believes that in order for asthma or COPD management programs to be both clinically effective and cost-effective, we must focus on the needs of all sufferers: mild, moderate and severe.

Asthma severity is a constantly changing point on a continuum. Asthmatics who are stable with any degree of severity may experience an exacerbation of their disease at any time, resulting in service utilization. Our services vary with disease severity, allowing members to actively manage their disease and take the proper steps if it degenerates from a stable state. This approach to optimum asthma control provides high quality care, saves dollars and greatly improves the quality of life for the member.

The National Jewish Asthma program began as an intensive telephonic disease management program. This telephonic program continues to be the cornerstone of our business and has received national recognition as one of the top ten disease management programs in the country. Six-month and twelve-month utilization outcomes provide validity to our program. Our approach of providing individuals with clear direction and support for managing their condition on a daily basis and working with their doctor to optimize their treatment plan, results in a healthier and happier membership.

In addition to ensuring that members receive the right care, at the right time, and in the most appropriate setting, National Jewish ensures that we forge collaborative partnerships with physicians nationwide. Our board certified medical directors and nurse care managers speak with front-line health plan providers on a daily basis and discuss treatment options to ensure your members receive the optimal care for their asthma.

Physicians are kept informed of their patient’s progress after each telephonic encounter. Emergent calls are summarized in a report and faxed to the physician’s office within 24 hours. Physicians are also encouraged to consult with a National Jewish pulmonologist or allergist regarding difficult cases or specific patient issues.

COPD

Chronic Obstructive Pulmonary Disease (COPD) is a common, costly and often times, preventable disease. COPD is the 4th leading cause of death in the US. COPD affects up to 600,000,000 people worldwide. Over 15,000,000 people in the United States have COPD and more than 100,000 people die each year from complications of COPD. Total direct and indirect expenses account for up to $18.1 billion dollars annually.

National Jewish Medical and Research Center designed the Disease Management Program for COPD in 1996 in an effort to:

• Set an effective standard of care for treating and case managing individuals with COPD
• Coordinate and streamline the resources available to individuals with COPD
• Enhance access to educational, rehabilitation, and around-the-clock clinical support to proactively manage COPD episodes and symptoms
• Provide a cost-effective means for delivering disease management services to COPD members
• Measure clinical, utilization, and quality of life outcomes surrounding this chronic, debilitating pulmonary condition.

The COPD program offers organizations and members the experienced clinical and disease management expertise of the National Jewish COPD medical management team. Our experience in servicing COPD members has enabled us to develop cost-effective and high quality interventions for individuals with moderate or severe COPD.

National Jewish has collaborated with health plans, TPAs, academic centers and state and federal agencies since inception of our disease management programs.