Disease and Population Management

Example Project: Implement Disease Management Programs

We were involved in designing and implementing one of the first disease management programs in the country. The client was a multi-state, energy supply company. We worked closely with ERISA (Employee Retirement Income Security Act of 1974) attorneys to ensure appropriate patient confidentiality, patient contact, program implementation, and program quality monitoring. We helped establish fiduciary standards and responsibilities. The initial two disease management programs--diabetes and asthma--were developed in 1992-1993 and implemented in 1993-1994.

Experience

• Developed a patented system that integrates all inpatient, outpatient, ambulatory, and prescription drug claims data into episodes of care by medical condition (Cave et al, Patent Number 5,970,463). The system was designed to accurately and reliability determine patients with chronic medical conditions, patients at high-risk for a future flare-up of their condition, and patients with an undiagnosed medical condition (e.g., diabetes, hypothyroidism, depression, migraine headaches).

• Worked with health plans and physician-hospital organizations to support disease and patient management programs, including Allina Medica, Humana Health Plans, Harvard Pilgrim Health Plan, and Blue Cross/Blue Shield of Missouri.

• Worked with large self-insured employers to implement catastrophic case management programs and disease management programs--including diabetes, asthma, cancer, and rheumatoid arthritis.

• Developed patient outcome measures to evaluate the impact of disease management programs. These measures included reduced emergency use, reduced readmission rates, improved short-form 36 health status measures, increased compliance with prescription drug therapies, reduced cholesterol levels, reduced high blood pressure readings, and reduced lost work time.

• Performed speaking engagements for trade organizations on disease and patient management, and published many articles in peer-reviewed journals and trade journals on the topic.

• Obtained from the University of California, Los Angeles, a Ph.D. in Health Planning and Policy, and a Masters in Public Health in infectious disease epidemiology--providing a strong clinical, statistical, and methodological background.

Represented Industries and Organizations

Health plans
Pharmaceutical industry
Self-insured employers