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

Select Topic Public Speaking

Association of Health Services Research and the Foundation for Health Services Research, Implications for Policy, Management, and Clinical Practice. June/July 1991. Controlling the Costs of Ill Health: Employer Strategies and Their Effectiveness.

Boots Pharmaceuticals, Thyroid Disease-Management Programs, Lincolnshire, Illinois. January 1995. Developing Global Patterns of Treatment Using the Diagnostic Cluster Approach.

Pharmaceutical Management Science Association (PMSA), Managed Care and Outcomes Research, San Antonio, Texas. May 1995. Disease Management and Pharmaceutical Capitation Contracts.

Bristol-Myers Squibb/Emron, National Congress: Depression in the 21st Century--A Window to the Future, Washington, D.C. May 1995. Employers' Involvement in Depression and Other Mental Health Management.

IMS America, Navigating the Future Together, Palm Beach, Florida. May 1995. Disease-State Management: Risk Sharing and Capitation.

Self-Insurance Institute of America, SIIA Annual National Educational Conference and Exposition, Dallas, Texas. November 1996. Higher Quality Care Through Patient Management: Baseline Measures and Performance Monitoring.

American Association of Health Plans, Information Management Conference Exposition, San Diego, California. November 1996. Quality and Information Management Through Claims Data Analysis.

Glaxo Wellcome, Inc., COPD Managed Care Consultant Advisory Meeting, Dallas, Texas. May 1998. Chronic Obstructive Pulmonary Disease Practice Patterns.

Parke-Davis, Healthcare Management 1999 Horizons National Customer Forum, Phoenix, Arizona. October 1999. Outcomes as a Business Strategy.

Select Topic Articles

Cave, Douglas G. and Larry J. Tucker. 1990. Optimizing the Effectiveness of Your Case Management Program. Employee Benefits Journal September, pp. 4-9.

Cave, Douglas G. and Larry J. Tucker. 1991. Preventing Hospital Readmissions: A New Direction for Case Management Programs. Compensation and Benefits Management 7(2), pp. 21-27.

Cave, Douglas G. 1992. Employees Are Paying for Poor Health Habits. HRMagazine April, pp. 52-58.

Cave, Douglas G. 1993. Identifying and Eliminating Lifestyle-Related Medical Costs. Compensation and Benefits Management 9(3), pp. 30-39.

Cave, Douglas G. 1994. Managing Chronic Disease Patients. Compensation and Benefits Management 10(3), pp. 74-79.

Cave, Douglas G. 1995. Disease Management Takes Shape as a Viable Tool for Controlling Costly Chronic Conditions. Journal of Prescription Drug Benefits 3(1), pp. 17-20.

Cave, Douglas G. 1996. Developing Capitation Rates for Disease-Management Programs. Compensation and Benefits Management 12(1), pp. 67-73.

Cave, Douglas G., Susan Anderson, and Kyu Sung Cho. 1997. The Rationale for Disease Management. Managing Employee Health Benefits 5(2), pp. 23-29.

Baker, Trish, Alan Ertle, and Douglas G. Cave. 1997. Challenges to Identifying Actual Diabetes Case-Mix Complexity and Total Treatment Charges. Medical Interface 10(4), 91-96.

Arrandale, Kristin E., Paul R. Wilson, and Douglas G. Cave. 1997. Medical Trends Report: Low Back Pain. Medical Interface 10(8), pp. 60-62.

Ertle, Alan, Robert Navarro, and Douglas G. Cave. 1997. Medical Trends Report: Asthma. Managed Care Interface 10(9), pp. 80-82.

Wilson, Paul R., Thomas Barrett, and Douglas G. Cave. 1997. Medical Trends Report: Nonmigraine Headaches. Managed Care Interface 10(10), pp. 61-63.

Arrandale, Kristin E., Douglas G. Cave, and Michael Rowles. 1997. Patient Care Management Programs: Maximizing Efficiency Through the Use of Prevalence Rates. Managed Care Interface 10(11), pp. 75-78.

Arrandale, Kristin E., Robert P. Navarro, and Douglas G. Cave. 1998. Hypertension. Managed Care Interface 11(1), pp. 50-52.

Arrandale, Kristin E., Robert P. Navarro, and Douglas G. Cave. 1998. Medical Trend Report: Hypertension. Managed Care Interface 11(1), pp. 50-52.

Terry, Christine M., Stephen Thomas and Douglas G. Cave. 1998. Medical Trends Report: "Major Depression." Managed Care Interface 11(11), pp. 58-60.

Cave, Douglas G., Susan Anderson, and Thomas Barrett. 1998. Using Claims-Based Data to Develop a Practical Diabetes Patient Care Program. Compensation and Benefits Management 14(1), pp. 59-62.

Cave, Douglas G. 1999. The PPS/GreenBook: Prevalence Rates and Practice Patterns. St. Louis, Missouri. Practice Patterns Science.

Cave, Douglas G. 2000. Today's Managed Care Market: Benchmark Results for Medical Care Guidelines: Part I. Compensation and Benefits Management 16(1), pp. 57--62.

Cave, Douglas G. 2001. Today's Managed Care Market: Benchmark Results for Medical Care Guidelines: Part III. Compensation and Benefits Management 16(5), pp. 53-57.