Monday, December 31, 2007

Introduction, RAND and DMAA

Welcome to the Disease Management Care blog.

This is not only a chance to keep up with news and events in that growing segment of the health care industry called "disease management" aka care coordination aka population health, but a place for readers to share comments.

Speaking of which, the latest news of some note is another publication casting some doubt on the effectiveness of disease management. Drawing on a wellspring of 317 studies, Dr. Mattke and colleagues at RAND were only able to find evidence of reductions of hospitalizations in chronic heart failure and increases in outpatient care among persons with depression. While there was evidence that DM can improve processes of care, the long term impact on outcomes in other diseases (for example, diabetes mellitus) was unknown. Except for depression (ruh roh, costs increased), there was inconclusive or insufficient evidence of any impact. Not only did RAND post this on their web site, the news spilled over into the lay media.

Think DMAA will take that lying down? Not when their members have a $1.8 billion revenue stream at stake and the folks at Medicare are pondering just what they're going to do about this disease management thingy.

Among the DMAA responses: purchasers, unlike academics, are forced to make seasoned judgments without the benefit of conclusive evidence, that findings from peer review may not apply to their settings and what's more, other swaths of health care are also lacking in evidence. What do the very smart Medical Directors, Operations VPs, CEOs and CFOs in the commercial insurance industry know that the peer review literature doesn't?

If I may say so, waiting for conclusive proof before instituting a needed intervention also has its downsides (like unopposed gravity).

Let the games continue.

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