Innovations in Chronic Care Management: San Antonio Disease Management Demonstration

Health Care Issue
Large segments of the population in South Texas suffer from chronic illnesses such as diabetes and congestive heart failure.  These patients traditionally receive care that is sporadic, costly, and does little to improve their health status.  Without regular and appropriate care, they experience exacerbations of their illnesses requiring frequent, expensive emergency room visits and/or costly hospitalizations.  Working with a company pioneering a new care model for these patients based on better patient management and the prevention of acute care episodes—the disease management model—HPG convinced public program stakeholders of a novel approach to understand if care could be improved for these very sick and costly patients.   

HPG Approach
HPG developed a three-year collaborative disease management demonstration project in South Texas.  The project was one of the earliest broad Federal efforts to study the value of disease management.  This pilot program inspired numerous additional Federal studies in the care of the chronically ill and helped establish what are now recognized as key elements of disease management—patient self-management, evidence-based medicine, collaboration among health care providers, and an emphasis on preventative care.

HPG successfully designed the demonstration concept and policy rationale, and helped assemble the demonstration’s collaborative team.  An academic health center, the U.S. veterans’ health care system, and the Department of Defense military health care system all joined in the project.  This collaboration was a first-of-its-kind.  Altogether, with additional funding by congressional appropriators, HPG helped secure a landmark pilot Federal health care program, relying on discretionary appropriations rather than traditional Medicare or Medicaid entitlement dollars to fund the demonstration project.