Disease Management Programs
A disease management program is like an HMO-within-an-HMO. Certain diseases are targeted in which preventive care does save money and where the patient may need to cooperate with a very complicated regimen, and a program is developed to provide special services to those patients. Common examples are asthma, heart failure, diabetes and HIV.
As an example, suppose an asthmatic is requiring frequent emergency room visits. She may be assigned a case manager, her physician may be contacted to make an appointment with her, she may be contacted to attend an asthma specialty clinic, or may be provided with a home nebulizer machine and peak flow meter. These are not expenses the HMO would want to undertake with all its patients, but in this patient's case the HMO could save a considerable amount of money if the patient's asthma were better controlled.
Ironically, audiences of the film As Good As It Gets cheered as one of the lead characters lambasted her son's HMO for not letting him get any care, causing her to spend frequent nights in the emergency room every time her child had another asthma attack. In reality, this is one area where HMO's tend to come after the patient to provide special care. If you know an HMO that would allow a child to end up in an emergency room several times a month without so much as making sure he could get a visit with his pediatrician, sell your stock in that company now.
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©2000 Eileen K. Carpenter, MD