Disease Management

Acronym: DM

DM attempts to improve the quality of care for beneficiaries with chronic diseases, while slowing the growth of their health care costs.11 The aim of DM initiatives is to identify chronic conditions more quickly, treat them more effectively, and slow their progression. DM techniques combine the following: enhanced screening, monitoring, and education; coordination of care among providers and settings; and use of best medical practices. Though it is not a recognized reimbursable service under Medicaid, states have increasingly turned to DM to improve care for people with specific conditions, in recognition of the fact that a small share of Medicaid beneficiaries with high levels of need and health care costs accounts for a large share of Medicaid spending. Early DM programs tended to focus narrowly on management of a specific chronic condition (e.g., asthma, diabetes, congestive heart failure), but programs have evolved toward more comprehensive management of the individual’s total health care needs.12 DM can be carried out by risk-based Medicaid managed care organizations or integrated into states’ primary care case management programs. For the fee-for- service population, states can operate their own DM programs or contract with Disease Management Organizations.13 Relevant Federal Legislation or Regulation: CMS State Medicaid Director Letter regarding disease management for Medicaid beneficiaries with chronic conditions. February 25, 2004. [http://downloads.cms.gov/cmsgov/archived-](http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/smd022504.pdf) [downloads/SMDL/downloads/smd022504.pdf](http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/smd022504.pdf)