ANN ARBOR, MI - As health care costs continue to soar, a program for providing care, developed at the University of Michigan Health System, may become the model of the future for patients with chronic conditions as well as for businesses who foot the bill for medical insurance.

Five disease management programs at UMHS give patients with chronic illnesses such as asthma or diabetes intense education and strong clinical support by proven disease experts so they can learn to self-manage their condition.

"It's the next generation of managing care," says Chris Wise, Ph.D., administrative director of the Medical Management Center at UMHS. "It emphasizes finding those individuals who are in need of extra help, and getting them the help they need."

The five disease management programs received Disease-Care Certification recently from the Joint Commission on Accreditation of Healthcare Organizations, known as JCAHO. This is a new certification process from the same organization that issues accreditation to hospitals. It's particularly noteworthy that all five UMHS programs, each evaluated separately, received certification.

UMHS began to build its disease management programs five years ago as a natural extension of health care partnerships with Ford Motor Co. and General Motors Corp. The programs - in diabetes, asthma, depression, heart failure and coronary artery disease - involve collaborative efforts with doctors, nurses and other clinical specialists. The programs provide individualized education and regular contact from a disease-specific clinical expert so that patients can learn to self-manage their disease.

"It's nice to know that there's someone who is concerned about you from a professional point of view," says Brian Hickey, 49, of Chelsea, Mich. Hickey was referred to the coronary artery disease management program after having a heart attack in April 2002. Through classes, group sessions and one-on-one meetings, Hickey learned what risk factors he faced and what steps he could take to control his condition. He says the experience was much more in-depth than what his cardiologist could provide on his own. "It's a much more interpersonal dialogue," he says.

The disease management programs are designed for people like Hickey who, without lifestyle changes, could end up with serious complications from their chronic disease. The program is aimed primarily at patients who have not yet learned to manage their disease and are having recurring difficulties with self-management.

"The idea behind disease management is to find the person with, say, diabetes who is constantly visiting the emergency room because his or her diabetes is out of control," Wise says. "We help get those people connected with the resources they need to help manage their condition better. So next time they don't need to panic and run to the ER or require hospitalization."

Physicians can refer struggling patients to a UMHS disease management program, where the patient will receive aggressive attention from a team of expert clinicians. In addition, the U-M Emergency Department can refer patients to disease management when the staff there sees the same person coming in multiple times and believes the patient would benefit from the program.

This type of health care model has appealed to large corporations including Ford and GM, both of whom have partnered with UMHS to bring an improved health insurance option to their employees. By covering the up-front costs to begin this kind of program, businesses have the potential to see significant savings on health care in the future, Wise notes.

"Corporations need to be willing to invest in proactive care to offset their health care costs," Wise says. "Chronic disease accounts for a significant portion of health care expenses. Improved management of chronic disease will result in improved health outcomes and reduced costs."

Certification from a well-respected organization such as JCAHO gives extra merit to the UMHS programs. The process included nine months of documentation and preparation on the part of UMHS Disease Management physicians and clinicians, coordinated by Rosemary Schuett, M.S., manager of the UMHS Disease Management programs. JCAHO officials spent two days on site in March, reviewing the programs and talking to clinical and administrative staff, as well as patients enrolled in the programs. JCAHO told UMHS program leaders the patients' stories were especially moving.

"I'm very happy with the program," says Joseph Salame, 66, of Saline, Mich., who enrolled in the coronary artery disease management program in the fall. "I'll tell you, it's a wonderful thing to have and it goes a long way to help those with cardiac disease to really control their disease. It's second to none as far as I'm concerned."

Disease management certification is different from JCAHO accreditation for hospitals. "Hospital accreditation looks to see if you provide a treatment correctly in a given facility," Schuett explains. "In disease management, JCAHO examines the whole process. The certification of these programs was very focused - are you providing the right care at the right place, at the right time, in the right way; are you tracking your interventions, assessing and improving clinical outcomes for your patients, and so on."

Another important emphasis of JCAHO disease care certification is having physicians and nurses who are central to the program providing scientifically proven disease-specific care and following up with patients to track changes in their condition.

"The U-M Health System's Guidelines for Clinical Care are known and followed extensively," Wise says.

"You would be surprised how many patients think their artery or cardiology problem is solved after one surgical procedure," adds Schuett. "The UMHS disease management programs are provider-led and that makes them especially tuned into following the patient after initial diagnosis and through the course of treatment, possibly preventing rapid progression of the disease."

UMHS is not the only disease management program out there, although many programs that call themselves "disease management" rely more on Web- or phone-based patient education and do not have physicians or nurses involved.

"The University of Michigan Health System has always been recognized as a leader in the delivery of clinical care. JCAHO Disease-Care certification now also distinguishes UMHS as a leader in the management and prevention of chronic diseases," Wise says. "It's the way medicine should be - educating, helping and hopefully preventing."

Written by: Nicole Fawcett

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