An assessment of the total population approach for evaluating disease management program effectiveness.

A key challenge currently facing the disease management industry is accurately demonstrating program effectiveness at controlling utilization of services and medical costs of populations with chronic disease. The most common method used in the disease management industry to date for determining financial outcomes is referred to as the "total population approach." This model is a pretest-posttest design, which is a relatively weak research and evaluation technique. This paper describes the "total population approach," details many of the biases and confounding factors that may influence outcomes using this method, and illustrates the potential consequences of these factors.