IV. DISEASE Management MODEL
A disease management plan is necessary for the congestive heart failure patient because so many other illnesses are associated with this disease. The plan is designed to improve the patient's health, while at the same time reducing medical costs.
Disease Management Model
Purpose
To manage as well as reduce congestive heart failure and the illnesses generally associated with it.
Target Population
Patients who already have congestive heart failure or those who are at risk.
Goals
To reduce the chances of developing other illnesses and diseases associated with congestive heart failure.
To cut down on hospital admissions by ensuring patients follow instructions for at home care as well as regular follow up visits.
To cut down on medical costs by monitoring patients at home self-care programs and encouraging them to stick with it.
In addition to closely monitoring and recording each patient's progress, patients will be given a short survey to fill out at each office visit to gauge how they feel about their management plan and other criteria.
Measures
Develop a plan for patients who are at risk for congestive heart failure which stresses proper diet, no smoking, plenty of exercise and stress reduction. This plan would include twice yearly routine check ups.
Develop a maintenance plan for patients already diagnosed with congestive heart failure. The plan will be similar to the patients who are at risk, but have not been diagnosed. But, these patients will be required to have routine exams on a quarterly basis to closely monitor whether or not they are or have developed any of the other closely related illnesses to congestive heart failure.
Funding
Funding will come from each patient's individual healthcare plan.
Methods
Statistical information was collected and analyzed from various hospitals in the region. The congestive...
We stress to our patients that no plan is fool proof and will only work if the patient is willing to work with the healthcare provider and follow the plan laid out for him.
Patients
Expected Outcomes
At risk patients will drastically reduce or eliminate the chance of developing congestive heart failure.
Diagnosed patients will drastically reduce or eliminate the chances of acquiring the associated illnesses of congestive heart failure while continuing to improve their current condition.
Healthcare costs are reduced by very little or no hospital admissions.
Barriers to Success
The number one barrier is if the patient does not follow the plan that the healthcare provider has developed.
Another barrier could be with the patient's insurance, especially in the case of HMO's and determining which services they will and will not cover.
V. HEDIS REQUIREMENTS
HEDIS stands for Healthcare Effectiveness Data and Information Set and it health plans use it to measure certain performance aspects of healthcare and service. The disease management plan addresses the eight domains of HEDIS. It must be made clear that although the healthcare professional or case manager may stay on top of the patients by monitoring their situations, the patient plays a large role in improving the quality of his life by following the guidelines developed for him.
Bibliography
Jones, M., Edwards, I., and L. Gifford. (2002). Conceptual models for implementing biopsychosocial theory in clinical practice. Manual Therapy, 7(1), 2-9.
