Disease Management Program Audits

Employers are increasingly asking HDM to evaluate the effectiveness of disease management (DM) programs. Our Disease Management Audit evaluates two basic principles — comparability and equivalence — to determine the accuracy and effectiveness of the program, including its impact on improvements in care, prevention of medical errors, the reduction of unnecessary hospitalizations, and the lowering of medical costs for enrollees with a targeted disease state. Targeted disease states often include: Asthma, Congestive Heart Failure (CHF), Coronary Artery Disease (CAD), and Diabetes..

Our Disease Management Program audits address a dozen or more areas of specific concern:

• How are members identified as a DM candidate?
• What screening criteria are in place? How are they handled in the claims system? How is it integrated with the PBM?
• Once participating, do members stay involved? How is the communication handled with members and their family/dependents?
• What are the processes, and how effective are they, for involving caregivers?
• Are evidence-based practice guidelines being used in the administration of DM?
• What are the protocols for patient self-management education (including primary, prevention, behavior modification programs, and compliance/surveillance)?
• What is the process for outcomes measurement, evaluation, and management?
• Is there a routine reporting/feedback loop, which may include communication with patient, physical health plan and other caregivers?
• What is the process for integrating cases of co-morbidities? Are members managed in one, or in two or more programs?
• Should predictive-modeling be addressed?
• Is patient satisfaction measured? If so, how? How frequently? How effectively?
• How is patient safety and quality coordination handled?

HDM performs a comprehensive evaluation of the accuracy and effectiveness of DM programs. HDM audits the DM program to measure performance and effectiveness as well as to evaluate operational controls and identify improvement opportunities.

To discuss how HDM’s cost containment solutions for self-insured employers can benefit your organization, contact HDM today at 800.859.5119 ext. 1 or e-mail your inquiry to: info@HDMinc.com.