Abstract
Introduction
Disease management has become a common term in the U.S. health care system. Yet, the more widely the term has been adopted, the more diffuse the defi nition of this health care strategy has become. Whatever the actual defi nition, many employers regard cost-containment as a key objective of DM initiatives. DM activity is focused largely on several highly prevalent chronic disorders-diabetes, asthma, hypertension, and dyslipidemia. Manufacturers of therapies need to prepare for the impact of DM on these markets.
Get the Answers You Need to Shape Your Strategy
- A 2006 survey found that 76% of employers saw a connection between employees' health status and employees' productivity. How can pharmaceutical companies underscore the positive impact of good health on productivity?
- The most basic challenge in recruiting participants for any form of care management program is identifying suitable candidates for enrollment. How do health plans stratify patients into risk categories? How do they use this information to project health care costs for patients?
- Disease management programs will likely alter established prescribing patterns. What effects will these programs have on drug sales? Which classes will be most affected?
- For most employers, cost-containment is an essential objective of care management. How do companies rate the effectiveness of these plans as a cost-cutting measure?
Scope
- Disease management overview: defi nition and evolution of disease management and related strategies.
- Employers' views on disease management: fi ndings from an employer health benefi t survey.
- Challenges of patient enrollment: identifying candidates, persuading members to sign up for the program, whether to offer incentives to employees.
- Disease management in Medicare: how to apply the DM concept to Medicare benefi ciaries.
- State initiative: several state governments have begun to explore the potential of DM.
- Outlook: implications of disease management for the pharmaceutical industry.
Table of Contents
- Executive Summary
- Strategic Considerations
- Stakeholder Implications
- Introduction
- Evolution of Disease Management and Related Strategies
- Growing Demand for Disease Management and Related Strategies
- Challenges of Patient Enrollment
- Employers' Views on Disease Management
- Medicare Initiatives
- Medicaid and State Initiatives
- Support from CMS
- State Initiatives
- Outlook and Implications for the Pharmaceutical Industry
Sidebars
- What Is Disease Management?
- Florida Gives Manufacturer-Sponsored Disease Management Programs a Second Chance
Tables
- 1. U.S. Employers' Actual and Potential Use of Select Care Management Measures
- 2. Pharmaceutical Manufacturer-Sponsored Disease Management Programs Certified by the National Committee for Quality Assurance, November 2007
Figures
- 1. Percentage of U.S. Employers of Various Sizes That Offer Health Benefi ts and Disease Management Programs, 2006
- 2. Coverage of Key Indications in U.S. Employers' Disease Management Programs, 2006
- 3. Coverage of Select Indications in Disease Management Programs of Health Maintenance Organizations That Offer Disease Management, 2006
- 4. U.S. Employers' Perceptions of the Effectiveness of Disease Management as a Cost-Containment Measure, 2007
