Saturday, February 9, 2008

Disease Management, Wellness, Benefit Design, Innvovation & Coalitions - The Path to Real Shareholder Value

In addition to being notified by email of having won the "UK NATIONAL LOTTERY," the disease management weekend blog received this interesting tidbit from the Google Alerts: AstraZeneca grants $1.5M to NCDOT.

The disease management blog's clickclickclicking revealed that the ERISA-exempted North Carolina State Health Plan covers over 600,000 state employees, teachers, retirees, current and former lawmakers, state university and community college personnel, state hospital staff and their dependents. The Plan also includes disease management programs. The provider those programs? Health Dialog.

Thanks to AstraZeneca (AZ for short), a segment of the state employees, i.e. those in the North Carolina Department of Transportation (NCDOT) are being given an additional benefit: "wellness programs" that are targeting tobacco use, stress, physical activity and nutrition habits. It appears to this blog that the grant from AZ is really going NC Prevention Partners, a statewide coalition that includes the North Carolina hospitals, Blues, State Department of Insurance and State Medical Society. I suspect that Health Dialog will not only have a role in evaluating the "impact" of this initiative but actually delivering some of the services: hint: and 800 number and the use of the word "coaches."


Once again, it's the ERISA-exempted plans outside the DC beltwayosphere that are taking the leadership in piloting novel benefit designs that include population care.

The disease management industry is morphing. Wellness embedded in a multi-dimensional care management program is just one example. It ain't your mother's call center for diabetes anymore.

The disease management industry, despite what its detractors say, is not all about grabbing a piece of the insurance premium and returning value to its shareholders. It can be about coalitions that lead to something being greater than the sum of its parts. THAT is shareholder value.

The press release heralds the coming achievement of "cost savings through reduced health care claims and improved employee outcomes." If the North Carolina State Health Plan was so confident of that, why did it take outside money to make that happen? If they truly believe in the value of wellness in the preservation of human capital leading to reduced claims expense down the road, the taxpayers shouldn't mind the investment.

What happens when the money runs out in three years? Suppose there aren't any hard savings but NCDOT employees are abusing less tobacco, exercising more and eating their veggies? How will past savings translate into future administrative expense?

The answer to that may lie in the evaluation of outcomes. I can only hope our friends in Health Dialog do a transparent and complete job of evaluating the impact of this initiative. Given the degree of skepticism out there about disease management outcomes, it may take a neutral independent third party and an upfront commitment to share the results in a peer reviewed public forum.

As an aside, I looked at the North Carolina State Health Plan formulary and did not discern favorable placement of AZ's products for the state employees. Maybe the grant truly is motivated by a desire to do good. And good thing they're not relying on the UK NATIONAL LOTTERY for financial support - I'm keeping all that money and have no intention of sharing it.

Here's to Health Dialog's and the NCDOT's and the NC Prevention Partners' success. Cheers!

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