Health plans have generally elected to build their own disease management programmes using their own resources. In addition to the widespread belief among health plans that their mission includes active management of chronically ill members despite their lack of background in that area, the `build' trend has been fuelled by a lack of high quality vendor-supplied (`outsource') programmes and by a failure to understand or believe the inherent value proposition of the better vendors. The better vendors guarantee improvements in cost, quality and member satisfaction - all at no budgeted expense to the health plan. This article explores outsource alternatives to the conventional `build' approach and identifies that a variety of factors make outsource programmes much more compelling choices for most health plans than internal programmes, particularly in the rarer and more serious disease categories. However, the clear lesson of Accordant Health Services (based in Greensboro, North Carolina, USA) and others is that for the more expensive, complex diseases requiring multiple interventions at the provider and patient level, the expertise available through outsourcing provides the better solution, as measured by cost savings, quality improvement and especially ease of implementation.
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