Information on Some Trends in the Disease Management Industry

It was a slow news weekend, so the Disease Management Care Blog played catch-up with a past November-December issue of Health Affairs. In it, Mays et al (you need a subscription to get the complete article) shared the results of a survey on the topic of disease management among 16 Blues plans, 12 local plans, 12 local divisions of four national plans, 60 employers and three national DM vendors. While none of the following should be a big surprise, the DMCB thinks the article is an excellent confirmation of what many readers may already know. It’s a superb read because there are also some nuggets here that not everyone knows. Pooling data? Read on.....

• Growing employer demand is being driven by increasing health care costs as well as the vendors’ growing array of more programs for more conditions. The much ballyhooed ‘lack of evidence’ is considered an acceptable business risk, not a deal breaker – especially because there are limited alternatives. The market has come to realize that disease management is not a magic bullet. Rather, it’s complementary and/or compatible with other initiatives that are attempting to address cost and quality.

• At the same time, payors are exerting greater pressure for proof. It’s not just the return on investment that’s at stake, but employee productivity, absenteeism, turnover, disability and workmans’ compensation. As evidence of this, limited information on outcomes from some vendors has prompted some insurers to abandon outsourcing disease management and bring these programs in-house. Some have even launched collaborative initiatives to pool health care data from multiple employers and health plans so that they can be used to compare the effectiveness of competing disease management programs.

• There is growing interest in ‘single source’ vendors for wellness, prevention, disease management and case management. In contrast to core disease management, health care costs are less of a driver of the demand for wellness. Instead, it’s employee morale and retention. Disease management is also being integrated with more case management of patients with multiple and complex heath conditions.

• Growing consumer cost sharing may complement or complicate DM programs efforts. This may be mitigated by increasing member incentives, waiving co-pays, providing 1^st dollar coverage for certain benefits or offering cash incentives.

• The market is witnessing the advent of more sophisticated health risk appraisals, computer algorithms that apply clinical guidelines to claims data and behavioral change methodologies.

• The market is beginning to ask which interventions and incentives within disease management programs have the greatest pay-off.

• Disease management vendors are offering additional new programs to their larger clients. This means smaller customers don’t have access - yet.

While the DMCB was thinking about this, it did some channel surfing & came upon the HGTV show House Hunters. It not only thinks Suzanne Whang is quite the host, it thinks she should host a NEW program….. Disease Management Program Hunters!

Welcome to Program Hunters, the number one show on HG-DMTV. In this episode Hugh G. Blues and his wife Lotta have toured three disease management programs that are needed for the entire Midwest United States, Paraguay, the Ukraine, the northern part of southern Florida, the coastal region of Arizona and Highlowuse County, Mississippi. It’s time for Hugh and Lotta to make a decision!

The first option is a robust call-center program that empowers enrollees with a state-of-the-art predictive modeling, high physician notification rates and a proven return on investment of 2:1 that has been reported in the peer-reviewed literature!

Their second choice is a state of the art call-center program that engages enrollees with an it’s-so-good-it-must-be proprietary predictive modeling program, very very elevated physician notification rates and a confirmed return on investment of 2:1 that has been accepted in peer-reviewed publications!

The third offering is an award winning call-center program that enrolls candidates with a latest-generation predictive modeling program, unsurpassed physician notification rates and a validated return on investment of 2:1 that has published in the peer reviewed scientific literature!

Which one do the Blues choose……