The backlash against managed care has pressured health plans to reexamine their approaches to controlling utilization and managing their members' health care needs, but how much has really changed? Interviews with health plans and others in twelve nationally representative markets suggest that the changes are significant. New and refined disease management programs are improving the care experi...

Results Since the national implementation of DMPs in Germany, the most dramatic growth in patient enrollment occurred during the first year with a doubling every three months until the 1 million mark was reached in July 2004. Since then the enrollment has shown a slower but steady growth rate, with 1.76 million patients with type 2 diabetes currently enrolled. About 75 percent of primary care p...

Between 2000 and 2003, Medicaid spending (federal and state) increased by about one-third—from $205.7 billion to $275.5 billion—largely as a result of enrollment growth fueled by the economic downturn, job loss, the erosion of employer-sponsored health insurance coverage, and rising health care costs (Holahan and Ghosh, January 2005).1 This explosive growth caused fiscal problems for state gove...

OBJECTIVE To systematically evaluate and synthesize published evidence regarding the effect of disease management programs for patients with diabetes mellitus on processes and outcomes of care. STUDY DESIGN Systematic literature review and meta-analysis. PATIENTS AND METHODS Computerized databases were searched for English-language controlled studies assessing the effect of diabetes disease...

Despite pharmacological advances, both mortality and the incidence of hospital admissions are high for heart failure. As with many other chronic diseases, the findings of clinical trials are difficult to implement due to lack of adherence to treatment, frequent comorbidities not considered in clinical trials, and health systems’ typical focus on acute diseases. Public health systems usually pay...

The management of COPD is complex and patient adherence to treatment recommendations is known to be poor. In this paper the methods used for evaluating adherence in COPD are compared. Self-reporting has satisfactory reliability and offers a cheap, simple and easy method for assessing adherent behaviors. Unlike the objective measures of adherence such as electronic monitoring, self-reporting hel...

The introduction in 1996 of free choice among sickness funds in Germany was accompanied by a "risk structure compensation" (RSC) mechanism based on average spending by age and sex. Because chronically ill people were not adequately taken into account, competition for newly insured consumers concentrated on the healthy. The introduction in 2002 of disease management programs addresses this probl...

report issued by the Congressional Budget Office (CBO) on October 13, 2004 set in motion a national debate on the economic value of disease management (DM) programs and sent shock waves through the industry with the statement that “there was insufficient evidence to conclude that disease management programs can generally reduce overall health spending.”1 The Congressional Budget Office left lit...

Heart failure (HF) remains a major public health problem that affects 5 million patients in the United States.1 HF is the leading cause of hospitalization for people 65 years of age and older, and rates of hospital readmission within 6 months range from 25% to 50%.1,2 The personal burden of HF includes debilitating symptoms, frequent rehospitalizations, and high rates of mortality.2 HF also pos...