Case management programs generally enroll individual patients with complex combinations of medical problems--combinations that put them at high risk of adverse medical events and that require interventions tailored to the specific needs of each enrollee. Those interventions could even include such steps as coordinating transportation to medical appointments or teaching family caregivers to identify problems that require medical attention.

Disease management programs have been focused on treating a defined set of patients with specific diseases--particularly patients with prevalent and relatively well-defined chronic illnesses like coronary artery disease, congestive heart failure, diabetes, chronic obstructive pulmonary disease, asthma, and end-stage renal disease. Those programs often rely on the similar needs of their enrollees, which allows standardized approaches to be used.

BROAD DIFFERENCES BETWEEN CASE MANAGEMENT AND DISEASE MANAGEMENT
	Case Management		Disease Management
Characteristics of Patient Population	People at high risk for costly, adverse medical events and poor health outcomes		People diagnosed with a specific disease
Methods for Identifying Patient	Mailed questionnaires; data on use of hospitals and emergency rooms; referrals by physicians using criteria to identify "high-risk" patients		Data on presence of a particular diagnosis; prescription for certain drugs used to treat a disease; referrals by physicians who treat many patients with that disease
Patient Education	No standardization of curriculum or educational materials; highly individualized		Standardized curriculum and educational materials for a specific disease
Reliance on Evidence-Based Treatment Guidelines	Low		High
Reliance on Protocols and Standardization	Low		High
Importance of Using Social Support Services	High		Low
Importance of Engaging Family and Caregivers	High		Low
Reliance on Care Coordinator	High		Medium
SOURCE: Congressional Budget Office based on A. Chen and others, Best Practices in Coordinated Care, report prepared for the Centers for Medicare and Medicaid Services (Princeton, N.J.: Mathematica Policy Research, March 22, 2000).

The distinctions between those two approaches appear to be blurring as disease management firms have begun to focus on patients with multiple diseases--partly in response to the demands of employers who desire a single point of contact for enrollees with multiple conditions. Indeed, the definition of its services developed by the Disease Management Association of America appears to encompass both types of care coordination.

Source of this information: http://www.cbo.gov/ftpdoc.cfm?index=3776&type=0