Caveats in Implementing a Disease Management Program

Abstract

Before an organization implements a disease management program, its decision makers need to assess their group's strengths and weaknesses and know which questions to ask of prospective vendors. The process then moves on to deciding whether the organization has the capability to build from within or contract with a vendor. The experience of the Michigan's Blue Cross/Blue Shield, which covers 3.2 million individuals, provides a prelude to the process by outlining the types of disease management programs and by giving valuable advice on taking a critical look at the motives and incentives of vendors proposing to implement the program. By covering 55% of the state's patient population, as well as contracting with 80% of its providers, BC/BS of Michigan gives a perspective relevant to both the HMO world and the PPO world.