Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. Executive Summary


Disease management (DM) is a system of coordinated health care interventions and communications to help patients self-manage their chronic diseases and prevent complications from these health conditions. Key components of DM include population identification processes; evidence-based practice guidelines; collaborative practice models to include physician and support-service providers; patient self-management education (may include primary prevention, behavior modification programs, and compliance/surveillance); process and outcomes measurement, evaluation, and management; and routine reporting/feedback loop (may include communication with patient, physician, health plan and ancillary providers).

Demographic trends, rising numbers of Americans with multiple chronic illnesses, and unsustainable cost growth in the health care sector need to be addressed. Disease management has been marketed as a way to improve health outcomes and reduce health care costs. However, questions remain about disease management and its ability to improve cost effectiveness of care and outcomes for certain populations. The growing trend of using DM in Medicaid may yield information about how such approaches can benefit vulnerable populations with chronic conditions and possibly make the case for expanding DM as an intervention within other programs for population health improvement. A major challenge in measuring DM outcomes is the wide variation in program designs and the populations enrolled in the programs. Existing DM research examines different interventions for different diseases among different populations. Based on the current state of DM outcomes measurement, increased standardization in evaluation methodologies is needed to more accurately estimate DM programs’ impact.

There is no broad evidence base to support the assumption that DM significantly improves health outcomes and reduces the cost of care for populations with multiple chronic illnesses. One costly, complex chronic illness that merits more attention is HIV disease. People with HIV are living longer and experiencing chronic conditions that commonly occur with aging. Because of the growing prevalence of HIV/AIDS in the U.S., studying HIV DM programs may provide a better understanding of the impact DM can have on health outcomes, treatment compliance, cost effectiveness and overall quality of care for people living with HIV/AIDS.

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