Manage care is a term that encompasses a variety of restrictions and guidelines for healthcare professionals in order to promote efficient and cost effective outcomes throughout the healthcare environment. The ultimate goal of a managed care system is to produce quality healthcare at a cost that is sufficient to both the system and to the healthcare consumer. In practice Managed Care Organizations take a variety of shapes and thus there is no one fit all model that works ideally for each type of healthcare organization. In terms of the disease management of chronic long-term conditions, MCOs can offer services at cheaper cost than the fee-for-service model. A key function of a manage care system with a disease management inclusion is the integration between all of the providers providing care. This paper will primarily act to define disease management and give a brief overview of its clinical framework. …show more content…
In relation to MCOs, DM programs act to prevent, or lessen, the effects of chronic diseases through the use of integrated care and self-involvement. Unlike many health care plans, disease management programs have greater inclusion of the individual, their environment and their support systems outside of the care network. As defined by Kongstvedt (2013), disease management is the process of intensively managing a particular disease far beyond the hospital setting (p. 647). Essentially this type of care management occurs over the span of the disease and includes all settings of care with its primary focus being care maintenance and prevention. DM programs supports the care plan formulated by the physician-patient relationship and has a goal of overall health improvement through greater patient