Philosophy and Benefits of Disease Management at National Jewish
Philosophy
The philosophy of disease management is simple. Individuals living with chronic illness, such as asthma or COPD require the tools and information necessary to make changes in their behavior in order to stay healthy and avoid further deterioration of the condition.
In the process medical care costs are reduced, often significantly. Reinforcement of appropriate medication use, discussion about lifestyle issues and ongoing education all contribute to a healthier, happier individual.
Most individuals offered enrollment in a disease management program are eager to participate and learn more about their condition. As of July 1, 2004, the average enrollment rate for a National Jewish asthma or COPD program is 41%, including all populations.
Benefits
The benefits of disease management are clear; some examples include:
Health Plan
- Reduction in medical care utilization for the managed condition
- Improved quality of care for members
- Access to data needed for NCQA or HEDIS
- Higher satisfaction rate with the insurance plan
- Can be used as a tool to strengthen relationships with the network physicians
Patient or Member
- Immediate access via telephone to a respiratory trained Care Manager to answer questions
- Guidance for active participation in the member’s own care
- Ongoing education materials and scheduled telephone calls with a nurse
- Reduced reliance on urgent care
- Improved quality of life
- Reduced out of pocket expenses due to the managed condition
Employer
- Reduction in claim costs for the population being managed
- More effective use of healthcare spending
- Reduced days missed from work
- Access to outcome data
- Seen as an employee benefit
- Increased satisfaction with the insurance plan
Physicians
- Ongoing information on each patient’s progress in the program, concerns for health, symptoms and acute episodes
- Patient education is provided to all participants
- Reinforcement of physician’s plan of care for the patient
- Fewer demands on physician’s office staff with phone calls and requests
- Patients are educated for good self-management of their condition
- National Jewish telephone consultation available to all physicians with enrolled patients
