Disease Management Theories & Benefits
Over the decades disease management has instilled favorable standards and challenges for physicians and patients. The program for disease management must uphold exceptional standards and physicians must align themselves with patient treatment (DM) protocol. The clinical framework and theories surrounding disease management has rationales and benefits for MCO’s. It’s up to health systems and hospitals to have a business plan and structured (DM) program available for patient protocol. Disease management is vital for hospitals, health systems, and physicians to follow and be knowledgeable of the rules, safety standards, and communication practices for patient care. There’s an extensive history, framework, and rationale behind disease management that will be addressed in further detail.
First and foremost, it’s important to recognize the clinical framework for disease management and theory that is disease-specific approach to delivering health care for chronic illnesses managed medically spanning all encounter sites using non-physician practitioners, (Orji, PowerPoint slide 2, 2015). In addition to, emphasizing education of the patients for self-care and of the clinicians for standard and tested protocols, (Orji, PowerPoint slide 2, 2015). This approach is detailed and comprehensive for (DM) and is the proven approach to use for patients with disease-specific conditions. With every health care approach, a model there is a background historical origin surrounding it. Concepts of (DM) began in the early 80’s and spanned until present day. Disease management must understand population health management of how it impacts health of large numbers of people. Also, evidence-based medicine which impacts populations of affecting diseases from large based evidence. Then, there is managed care alignment which is common for pressure to exist for achieved cost efficiencies and improved quality. Practice variability is a fundamental tool for physicians and education, knowledge and training is crucial for practice variability. In theory, we must think should containment or reduce cost of care for delivery, and generates positive perceptions of value from the public, (Orji, PowerPoint slide 5, 2015). (DM) should always increase disease awareness and the negative aspect is (DM) doesn’t produce definitive evidence of a positive return–of-investment. Those are the theories, framework, an origins of (DM) which as some disadvantages and good qualities for physicians and patients.
Disease management provides the rationale and benefits for MCO’s in various ways. The general measure to use for measuring success of (DM) is reducing the medical loss ratio experienced by managed care companies, (Orji, PowerPoint slide 7, 2015). This is a cost-saving benefit and helps keep MCO’s maintained. Furthermore, when the application of disease management programs achieve reductions in the medical loss ratio for managed care organizations they can be financially adjusted, (Orji, PowerPoint slide 7, 2015). As a result, this simple measure tool for MCO’s to give a positive-return-on investment. Critical factors have to be considered for (DM) for instance, coordination, education, management, tracking, and assessment, not to mention business components of strategic planning and positive-return-of-investment. Lastly, MCO’s have to be aware of their applying quality will have a direct correlation to their ability to avoid lawsuits and to assure the freedoms of access. MCO’s work diligently and meticulously to avoid severe consequences and ensure quality of care is achieve when need be.
All in all, disease management has more advantages than disadvantages which consistently need to be in practice. Physicians have a pivotal role when it comes to (DM) and ensuring solid education is carried out to the patient and certain communication styles are relayed to patients. The framework and theories for (DM) are solid standards and challenges for (DM) and MCO’s have to work with physicians to achieve the measurable goal for patients. The return-on-investment is important for cost reduction and delivering better quality of care. As disease management as grown throughout the years with challenges but, it’s still beneficial for physician and patients delivering of quality care goals.

References
Orji, Godyson. (2015). Disease Management, Impact of ACA on Utilization. Module 5. [PowerPoint slides]. Saint Joseph’s University. Retrieved from: Lecture Notes.

Orji, Godyson. (2015). Module 5. Narration: Disease Management. Saint Joseph’s University. Retrieved from: Lecture Notes.