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disease management

dis_mgmt_ind
quality·Updated Jun 23, 2026

Definition

ISO-11179 Definition

A structured clinical program that supports individuals with chronic conditions such as diabetes, heart failure, COPD, asthma, and depression through evidence-based protocols, patient education, medication management, and regular monitoring to improve clinical outcomes, prevent complications, and reduce avoidable healthcare utilization. Disease management programs engage members between healthcare encounters through outreach calls, educational materials, remote monitoring, and pharmacy counseling to promote self-management skills and medication adherence. Effective disease management reduces hospitalizations, emergency department visits, and complications that generate high-cost utilization.

CMS HEDIS measures assess disease management program effectiveness through chronic condition quality measures including HbA1c control for diabetes, blood pressure control for hypertension, and medication adherence for cardiovascular disease. Healthcare data teams build disease management analytics that identify eligible members by condition using claims-based diagnosis algorithms, track program enrollment and engagement rates, measure clinical outcome improvements on condition-specific quality metrics, and calculate program return on investment through avoided hospitalization and emergency department costs.

Standard Abbreviation

dis_mgmt_ind

Category

quality

Production DDL — FACT_QUALITY_MEASURE

FACT_QUALITY_MEASURE.sql
CREATE OR REPLACE TABLE FACT_QUALITY_MEASURE (
    qlty_key        INTEGER        NOT NULL  -- surrogate key,
    mbr_key         INTEGER        NOT NULL  -- FK to DIM_MEMBER,
    plan_key        INTEGER        NOT NULL  -- FK to DIM_PLAN,
    meas_yr         SMALLINT                 -- measurement year,
    hedis_meas_cd   VARCHAR(20)              -- HEDIS measure code,
    denom_ind       CHAR(1)                  -- denominator eligible,
    numer_ind       CHAR(1)                  -- numerator met,
    excl_ind        CHAR(1)                  -- exclusion indicator,
    gap_open_ind    CHAR(1)                  -- care gap open,
    star_rtg_nbr    DECIMAL(3,1)             -- star rating,
    qlty_scr        DECIMAL(5,2)             -- quality score,
    perf_thrsh_pct  DECIMAL(5,2)             -- performance threshold,
    raf_scr         DECIMAL(10,3)            -- risk adjustment factor,
    outreach_cnt    SMALLINT                 -- outreach attempts,
    load_dt         TIMESTAMP_NTZ  NOT NULL  -- load timestamp
);

Standard Snowflake DDL for the canonical quality table. Convert to BigQuery or Databricks →

Why This Term Matters

Quality measure data determines how payers and providers are rated and reimbursed under CMS Stars, HEDIS, and value-based care contracts. Data engineers who understand quality terminology build measure calculation pipelines that correctly attribute patients, apply denominator exclusions, and flag documentation gaps before submission deadlines. Incorrect quality data directly affects star ratings, pay-for-performance bonuses, and Medicare Advantage plan bids.

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