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disease management program was a comprehensive, telephonic, nurse-staffed program. This is a fairly typical telephonic disease management program, except for its broad scope-covering thirty-two clinical conditions-and its linkage to a system of "clinical alerts, " in which medical, drug, and lab claims; lab results; and a large electronic database of clinical recommendations from the medical literature are used to identify opportunities to improve clinical care. When the clinical data provided indication for the use of a specific test or medication or a contraindication against a specific medication, the physician and patient were notified. This "clinical alerting" program was run against the employer's entire insured population several times a month
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The disease management program was a comprehensive, telephonic, nurse-staffed program. This is a fairly typical telephonic disease management program, except for its broad scope-covering thirty-two clinical conditions-and its linkage to a system of "clinical alerts, " in which medical, drug, and lab claims; lab results; and a large electronic database of clinical recommendations from the medical literature are used to identify opportunities to improve clinical care. When the clinical data provided indication for the use of a specific test or medication (or a contraindication against a specific medication), the physician and patient were notified. This "clinical alerting" program was run against the employer's entire insured population several times a month. Physicians were notified of potential clinical improvement opportunities via telephone, fax, or mail, as appropriate to the urgency of the clinical alert; and members were notified by telephone and mail if enrolled in the disease management program or by mail alone if not enrolled. To permit physicians to respond first to any clinical alerts, member notification was lagged by two to three weeks.
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ratio of adherer to non-adherer costs adherence effectiveness that would allow the firm to break even can be computed by simultaneously solving the equations for the following: 1 pre-VBID cost, 2 post-VBID cost, 3 the percentage who adhere post-VBID, 4 an effectiveness impact equation that produces dollars spent on adherers, and 5 increased drug cost. Complete equations are available in an Online Appendix; to access this appendix, click the Online Appendix link in the box to the right of the article online
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