Thursday, January 24, 2008

The Tale of Two Simpsons

The relationship between resources used and the benefit obtained has been seen in many pockets of the healthcare industry. In general, the more money you put in, the more you get until you reach a point of diminishing returns. In fact, there is some evidence that overdoing it will cause the curve (way over on the right) to dip down thanks, in part, to patient harm. For example, lots of CAT scans means big doses of ionizing radiation, lots of biotech means flakey off-label use and lots of plastic surgeons means funny looking celebs.

The Disease Management Blog wonders if much of the same phenomenon is true in the disease management part of the industry. Consider the case of the two Simpsons.

Jessica, may not deserve it but let’s face it: she does not have a reputation for high intelligence. However, she is an earnest and well meaning person (Dallas fans may disagree). If Jessica were tasked with some remote patient behavior change, I suspect that, despite her low healthcare skill set, she’d have some success even if all she did was call, leave a message and remind the “client” to regularly check the blood glucose or remind the physician about this study. Jessica is on the lower part of the curve.

On the other hand, Lisa is remarkably talented and insightful and she would undoubtedly be able to adjust her interactions with patients and deploy just the right input of insight, coaching and good cheer necessary to convince even the most unmotivated person to comply with the most complex of Care Plans. Lisa is higher up on the curve.

While the value of disease management is more than a function of telephony, it’s still fun to think about. There may be a role for Jessica, depending on the needs and health status of the population - as well as the negotiated price. Lisa is important also, but having too much of her can lead to diminishing returns. I also think Jessica or Lisa can overdo it and prompt some patients to seek additional high-cost, low-value or unnecessary care. I suspect finding the right balance of “Jessica” and “Lisa” is what distinguishes the high performing disease management companies from the others.

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