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Policy Compendium

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MEC-010: Disease Management

 
Disease Management: The Wisconsin Medical Society supports disease management protocols that allow for appropriate flexibility and physician discretion when measuring adherence to and variations from practice guidelines as long as these protocols adhere to the goals outlined in the American Medical Association policy on a well-structured disease management (DM) program. These goals include:

  • Improves outcomes by the provision of timely and appropriate services.
  • Promotes cooperation between primary care and specialty care physician.
  • Emphasizes educating and empowering patients to successfully manage their own health and intelligently use care resources.
  • Develops clinical practice guidelines by physicians who are knowledgeable in dealing with chronic diseases.
  • Allows informed and voluntary patient participation in DM programs.
  • Allows physicians to deviate from DM practice guidelines when appropriate without incurring sanctions or jeopardizing coverage for services.
  • Emphasizes peer review assistance when a physician’s practice patterns warrant corrective action measures.
  • Promotes collaboration between providers of care and the patients primary care physician on an ongoing basis.
  • Allows the choice of pharmaceuticals to be based on clinical judgment and validated outcome studies rather than restricted to program formularies.
  • Employs certified or licensed physician assistants, nurse practitioners or individuals with a comparable level of training in care coordination.
  • Supports the primary care physician’s authority for decisions to use or not use specialized care and ancillary/support services or products for patients.
  • Requires DM company-employed physicians to be fully licensed to practice medicine in the jurisdiction of the program’s location and to be professionally and legally accountable for any adverse patient events resulting from their interventions. (HOD, 0415)