NAMI Policy Research Institute Study Describes State Medicaid Disease Management Approaches
Disease management (DM) is becoming the new trend in health care service and delivery as public and private sector health care purchasers grapple and respond to rising health care costs and health insurance premiums. It is an intervention intended to reduce health care spending and improve health outcomes through better management of one or more chronic conditions. DM programs focus on patient education, patient self management and physician feedback.
State DM programs target the most costly chronic diseases in their Medicaid population and those that offer the greatest potential for cost savings from improved provider practices and patient self-management. DM programs most often focus on asthma, diabetes, hypertension and mental disorders. Medicaid managed care companies have used DM programs and their associated tools for several years in the Medicaid program.
More than 20 states are engaged in developing and implementing Medicaid DM programs. To date, limited quantitative research has been conducted to evaluate the impact of state programs. Early reports from programs that have conducted assessments indicate that DM programs have contributed to quality improvements in Medicaid and to some cost savings.
The state of Texas is strongly committed to a disease management approach for treating people with severe mental illnesses. In May 2003, the legislature passed a measure requiring that local mental health authorities in the state (DM will be piloted in four communities) ensure the provision of assessment services, crisis services, and intensive and comprehensive services using DM practices for adults with bipolar disorder, schizophrenia, or clinically severe depression and for children with serious emotional disorders.
As DM programs are implemented, it will be critically important to identify how savings in DM initiatives translate into additional funds for mental health programs. This issue was at the forefront of discussions in Texas. Cost savings should be earmarked so that they are translated into increased funding for mental health programs.