Many commentators have described the American health care system as sick, but amid all the problems and deficiencies, at least one line of innovation is growing stronger: disease management (DM). So far, it’s the best thing the health care system has discovered to advance the quality of care and contain its cost.

DM helps patients be more responsible for their own care, thereby improving their quality of life while curtailing long-range costs for the health care insurer. It got its start in the 1980s when blood glucose monitoring (BGM) systems entered the scene. BGMs allowed diabetic patients, for the first time, to monitor their own blood sugar and take responsive action. By empowering patients, the use of BGMs reduced diabetic complications, the number of intense interventions and, ultimately, the cost of diabetic care. However, to play their role, patients needed training, ready access to monitors and medications and on-going support. DM was created to provide these support services.

Lifestyle Coaching

While patient advocacy and wellness counseling can be performed in a more limited fashion by non-medical personnel, they are best conducted by appropriately-trained nurses or physician assistants who can merge a variety of support services into a comprehensive program of lifestyle coaching.

  • Condition care coaching goes beyond traditional DM to help patients with chronic health problems improve their diet and exercise habits while addressing associated emotional stress.
  • Acute care coaching helps patients handle conditions such as surgery, high-risk pregnancy and accidental injuries by monitoring treatment and recovery to accelerate returns to work.
  • Wellness coaching aims to keep healthy people disease-free by guiding efforts to improve their lifestyles – better diets, incorporating exercise, abandoning tobacco and managing stress.


Since the ‘80s, as specialized care has expanded in many directions, patient self-care has become more and more critical, yet increasingly complex. Today, all but five of the nation’s 120 health insurers have DM programs in place.

While the advent and proliferation of DM programs have instilled a more comprehensive, patient-centric orientation in parts of the health care industry, it remains highly fragmented. Once outside the bounds of routine care, patients face an often bewildering set of medication and treatment options offered by a diverse array of providers, specialists, testers and facilities – many primarily concerned with their own revenue streams and often unaware of the patient’s overall situation and long-term needs. Unnecessary procedures are sometimes performed, follow-up care is inconsistent, costs escalate and no real change in the basic conditions of a patient’s life is achieved. Patient outcomes are compromised and frustration is high.

However, DM continues to evolve and may eventually overcome the industry’s fragmentation. As insurers, health plans and other payers (including the government) appreciate the power of DM to improve care and save costs, they are investing more in the expansion of these programs. Disease management is broadening into lifestyle coaching – wellness, condition care and acute care coaching (see sidebar).

In effect, the evolution of DM is re-organizing the provision of health care in the United States. It is forging a patient-centered orientation that fosters participation of patients in lifestyle changes and their own health care management.

[Steve Clark]