are organizations do not have the structure or the trained staff to support self-management programming, and even with the needed personnel do exist, they are generally not seen as central to the mission of the organization.    In order for self-management education to be integrated, “buy-in” would need to exist among the important decision-makers, and there would also need to be a significant commitment to training the needed staff to sustain such programming.6


Preparing the Patients

            In the 20th century, public expectations for medical care shifted from individuals, families, and communities to healthcare systems and institutions.  With this shift in expectation, patients are now accustomed to looking to those healthcare providers and institutions for disease prevention, treatment, and cure.  This means that personal responsibility for the management of disease is not usually on the individual or his/her family and community.  If self-management education is to be presented as an acceptable option to today’s patients, social marketing campaigns will be needed, physicians will need to actively refer patients (and express to their patients why self-management is important), and options for access to self-management education will need to be offered (such as through group sessions, telephone counseling, and Internet-delivered programs).6


Securing a Financial Commitment from the Insurance Industry

            Even with the needed “buy-in” from both healthcare professionals and patients, self-management education cannot be integrated without adequate financing.  Currently, little funding exists from government insurance providers, such as the Centers for Medicare and Medicaid Services, the U.S. Department of Veteran Affairs, or state Medicaid programs.  This lack of coverage is generally due to the difficult time that providers and payers have in identifying effective programs that are applicable to large populations of people.  However, programs such as the CDSMP, once shown to meet the standards of effectiveness, should be fully funded just as any other treatment or medication would.  If the program truly is effective in increasing health-related quality of life and decreasing healthcare utilization, this would most likely mean that the insurance companies would not be billed for as many doctor’s visits or healthcare services.

Effectiveness should not be the only reason for insurance companies to provide coverage for this program, as there are other financial incentives built into the very structure of the program.  First of all, the program is offered in a group setting, which costs less than individual or one-on-one care, and it is also offered by lay individuals and not necessarily health professionals, which means that the insurance companies would not be billed for any extra doctor time.  In other words, patients can receive the same important message that could technically be provided by the physician in the context of a healthcare visit, but in a more cost-efficient setting.  The other major benefit to this program is that long-term results have been shown.  It would seem extremely beneficial for insurance companies to offer this service, which has clear boundaries (6 sessions total) and can offer long-term benefit well beyond those boundaries. 

It is also worth noting that Health Savings Accounts (HSA’s) (fed by tax-deferred money from an individual’s paycheck) could also provide another avenue for coverage for these types of patient programs, if the patients themselves deem it a worthwhile expenditure. 



            The CDSMP and other types of self-management education may have an important place in the U.S. healthcare system.  Current models of successful use of the program, such as Kaiser Permanente (who awarded the CDSMP the James A. Vohs Award for Quality in 2001),25 should be evaluated to better understand how self-management education can be integrated and sustained to improve the health outcomes of chronic disease patients.  It is with these efforts to empower patients that the U.S. healthcare system may be able to better the lives of its citizens and reduce the healthcare costs that will only rise as our population ages.


Other Sources of Information

For readers who wish to explore the topic further, visit the Stanford Patient Education Research Center’s website at or explore the listed references for more details on the topics discussed in this chapter.



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