Analytic and Informational Requirements in Disease Management Proposals: A Managed Care Perspective

Abstract

Objective:

To outline informational and analytic requirements that one healthcare management system has implemented to ensure that disease management submissions meet common standards for evaluation and review.

Context:

The need for guidelines to support the scope and quality of submissions for disease management negotiation and contracting.

Design:

A series of task definitions are proposed to support three stages in the submission, negotiation, and implementation process: A preliminary submission, establishment of a disease state management agreement, and implementation of the disease state management agreement.

Discussion:

These guidelines are designed to assist companies in meeting minimum standards in their disease state management submissions. The minimum standards relate to their appreciation of the analytic complexities involved, the need to access the appropriate data sources, and the need to meet minimum contracting requirements for program delivery. Not only does application of these guidelines place all potential partners on an equal basis and allow a systematic assessment of competing proposals, but also the degree of uncertainty associated with such agreements, notably in the process of negotiation, is reduced substantially.

Conclusions:

Unless guidelines are implemented by managed care organizations, the prospects for entering into successful disease state management agreements may be uncertain.