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Disease Management
What is Disease Management?
Disease Management is a program designed to manage the small percent (10%-30%) of covered members who generate the largest portion of the medical cost. Chronic health conditions such as heart disease, diabetes, hypertension, and asthma left unmanaged lead to major medical expenses later.

Monthly review of claims data through Episodic Risk Groups (ERGs) allows us to identify newly diagnosed patients with chronic disease, which expedites disease management intervention.

Doctors Direct Healthcare uses EBM Connect, a quality measurement tool that facilitates increased compliance with evidence-based care standards to enhance quality care and improve outcomes. These measures provide a quantifiable basis for actionable interventions by health plans, employers, and disease managers. It allows us to increase patient compliance with diet, exercise, medication usage and the physician treatment plan. Communication with both the physician and the participating member drives engagement and risk reduction by making the member aware of unhealthy lifestyle habits that are likely to worsen a given chronic condition.

By managing the disease, progression of the condition can be avoided, leading to lower healthcare cost.

 

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