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• « Behavioral Health

Public sector purchasers have begun to turn their attention toward the potential benefits of disease management programs for chronic mental health and substance use disorders.  As is characteristic of a developing field, definitions of disease management are in flux.  Nevertheless, a common understanding of some of the key characteristics and the distinctions between the newer approach of disease management and the more traditional approaches of case/care management is emerging.  In this evolving field, purchasers need to be extremely clear about the precise models of care that they want to purchase and to carefully and properly qualify prospective vendors.  Although the industry trade association and others have developed the capability to accredit disease management vendors, accreditation may not yet be reliable.

Disease management in the area of mental health and substance abuse shares many features with other evidence-based practices, such as Assertive Community Treatment and the Texas Medication Algorithm Project, as well as others included by Substance Abuse Mental Health Services Agency in its National Registry of Effective Prevention and Treatment Programs.

Three trends are converging to increase the interest in disease management programs today:

1. Health care costs per patient are especially high for individuals with chronic disease; the overall number of individuals with chronic disease in the population is increasing; and thus the proportion of health care costs attributable to individuals with chronic disease is high;
2. There is a significant gap between the existence of evidence-based practices in the treatment of individuals with mental health and substance abuse disorders and the actual deployment of these practices in the field; and
3. High quality care for these individuals with chronic disorders requires extensive coordination among a variety of entities, not all of them traditional medical care system participants.

Despite the promise and evident logic of disease management, its effectiveness in behavioral health has not yet been fully established. Nevertheless, several states have implemented disease management programs or pilots for behavioral health services. The experiences of the most significant of these programs are reviewed briefly in this Resource Paper to draw out implementation issues, lessons and implications.