Develop Effective Disease Management Program for Managed Care Organization Using SAS

Individuals with chronic illnesses account for over 70% of the total health care costs in the United States. Chronic illness is extremely costly for health insurance payers due to high readmission rates and the large volume of care. Therefore, health insurance payers and health care providers increasingly seek to identify strategies to manage this patient population in order to reduce cost and improve patient care. Health insurance payers have data from various sources; how to evaluate data to support disease management initiatives and strategies becomes very challenging. The paper focuses on four key processes to develop an effective disease management program. SAS solutions are implemented to build (1) Data Integration and Management; (2) High Risk Population Classification; (3) Intervention Automation; and (4) Outcome Evaluation and Management. Examples show how SAS solutions and Base SAS® data programming techniques are implemented for each process of the disease management program.