Fact sheet: Structured treatment programs for people with chronic diseases (disease management programs)

Chronic diseases are usually lifelong conditions. This does not, however, necessarily mean that the disease dominate the entire life of the person who has it.

Disease management programs (DMPs) aim to help people get on top of their chronic disease and have a good quality of life. "Disease management" is the concept of systematically treating and managing a condition. It should improve the therapy of chronically ill people in the long term and help them to understand their disease better. This may mean dealing with the treatment and demands of their disease in a well-informed way and finding out how to live as good a life as possible with the disease.

What is a disease management program?

Disease management programs offer comprehensive health care services for people with chronic diseases. They aim to provide these people with a coordinated and systematic approach to treatment and care. In Germany, they were introduced following a recommendation of the Federal Joint Committee (G-BA) and are also called “structured treatment programs”. The G-BA is the highest decision-making body of the joint self-government of physicians, dentists, psychotherapists, hospitals and health insurance funds in Germany.

Since 2002 health insurance funds in Germany can offer disease management programs for people with certain chronic diseases. There are currently DMPs for type 1 and 2 diabetes, asthma, chronic obstructive pulmonary disease (COPD), breast cancer and coronary heart disease (with a chronic heart failure module). People who have several of these diseases can participate in the DMPs for each disease. There are plans to further develop the existing health care services for people who are extremely overweight (obese).

The programs offered by the German statutory health insurance funds include, among other things, regular doctor's appointments involving medical tests and consultations. Learning more is also a part of the program, in trainings, for example. Doctors who participate in the programs have to fulfill certain requirements and follow defined quality standards.

The main aim of the programs is to reduce the symptoms associated with the chronic disease and stop them from getting worse. This includes preventing complications or accompanying diseases from developing as much as is possible. In addition, this structured approach to treatment should enable people to play an active role in managing their disease themselves, and to integrate their treatment into everyday life in a way that suits them best. Together, these factors should improve the participants' overall quality of life.

Disease management programs also aim to improve cooperation between the various doctors and institutions that provide care for a patient, such as family and specialist doctors, hospitals and rehabilitation centers. This is meant to ensure that the individual treatment steps are well coordinated and, for example, help avoid the same exam being done twice.

Who offers disease management programs?

In Germany, disease management programs are offered by health insurance funds. Many health insurance funds encourage members who are chronically ill to participate in a DMP by giving them detailed information about their treatment programs. Some offer extra services, such as telephone hotlines for personal consultation or reimbursement for medical consultation co-payments.

In Germany, if you have one of the chronic diseases listed above and are interested in taking part in a DMP, it is best to contact your health insurance fund directly. They will be able to give you detailed information and tell you which doctors in your area are registered in the DMP for your disease. For example, if you have diabetes this may be your family doctor, and if you have breast cancer it may be a gynecologist. In any case, your coordinating medical practice is the one where all the different parts of your therapy come together. The doctors will document the progress of your treatment, refer you to (other) specialists or hospitals and are the main contact people in all matters related to your treatment.

What is meant by a "structured" program?

The treatment strategies in the DMPs offered by statutory health insurances are based on certain specifications. These were developed and defined on a national level by representatives of the health care system and a group of experts. They are meant to serve as guidelines for the treatment of individual patients. The participating health care providers – including doctors, hospitals, rehabilitation centers, nurses and trainers – commit themselves to fulfill certain quality requirements and follow the defined treatment plans. Patients who enroll in a DMP commit to actively cooperate in their treatment – for example, by keeping regular appointments with a doctor (every 3 or 6 months).

The exact treatment is determined by the doctor together with the patient. After in-depth consultations, medical tests and a clear diagnosis of the chronic disease, the doctor puts together a tailor-made treatment plan based on the specifications of the DMP. Among other things, this includes medications and other treatments, training courses and regular check-ups, some of which may be carried out by other doctors or hospitals. For example, the DMP for diabetes involves having regular eye tests in order to detect and treat possible eye damage early on.

The individual therapy steps, as well as the outcomes of tests and treatment, are also documented according to defined specifications. This aims to enable all those involved in the therapy to understand why certain decisions were made and certain measures taken, and to take this information into consideration when planning further treatment.

Some health insurance funds provide extensive brochures with information and some offer a telephone hotline for additional support, while others have text message or e-mail services to remind participants of their upcoming medical appointments.

How could I benefit from a DMP?

Chronic diseases are complex conditions and require long-term regular treatment which should be tailored to suit the individual wherever possible. If you have frequent symptoms, only going to your doctor whenever things get worse will probably not be enough for the long-term success of your treatment. Participating in a disease management program may be one option for improving the success of your treatment. As long as the program and the way it is carried out fulfill the quality requirements, it could have some advantages for you, for example:

• You work with doctors who have specialized in treating your disease. All of the therapists and nurses involved, both in inpatient and outpatient treatment, are to coordinate care with one another.
• Your doctor is well-informed informed about the course of your treatment and will be able to give you more personalized attention during the arranged appointments than would be possible in a normal consultation.
• Special training courses can make it easier for you to actively take part in making well-informed decisions about your treatment.

Some people also find a structured treatment plan helpful because it reduces some of the time and effort involved in managing their disease. For example, they no longer have to look for suitable specialists or hospitals themselves if they do not want to.

What are these programs based on, and are they evaluated?

The treatment of an illness should ideally be evidence-based. In other words, treatment decisions should be based on the best available medical knowledge. The treatment that a person receives should be well documented and coordinated as well as quality-assured. You can read more about evidence-based medicine here (URL: http://www.informedhealthonline.org/index.61.en.html) . The disease management programs offered in Germany are evaluated regularly. The German Federal (Social) Insurance Office (in German: Bundesversicherungsamt, BVA) defines the specifications of these evaluations.

Are there DMPs for people with other chronic diseases?

If the statutory health insurance funds do not offer a disease management program for your disease, it does not mean that you cannot have a structured treatment plan. A good doctor's practice that works in close cooperation with other doctors and institutions that might be important for your therapy can also make it possible to have disease management. If you and your doctor develop a personal treatment plan that suits you, and attend regular appointments, you will already have the fundamental elements of good disease management. Last, but not least, reliable, comprehensive information can help you understand your disease better and learn how best to live with it.


Author: Institute for Quality and Efficiency in Health Care (IQWiG)