The Disease Management Care Blog Interviews a Full-Risk Physician Group Medical Director: Does Disease Management Work?

The Disease Management Care Blog had the opportunity to chat with the medical director of a >300 doc California-based physician group that, aside from some high cost conditions like transplants, accepts full capitation from most of the state’s insurers.

It was an interesting conversation.

• Much of his day is spent in technology assessment, dealing with an insatiable appetite among his specialist staff for the purchase of new medical devices so they can perform gee-whiz procedures. He frequently has to say no.
  

• About 10% of his primary care physicians’ compensation is based on “pay for performance.” He has no doubt that it leads to physician behavior change. The P4P measures are all driven by the insurers and the extra revenue is in turn shared with the docs. He is aware of other groups that make 30% of the provider compensation ‘variable.’
  

• The DMCB asked about that thingy called ‘disease management.’ This physician group has it and the medical director is convinced it works. They’ve hired the nurses that deploy remote telephonic coaching to help them manage their capitation risk.
  

To put this into perspective, check out this article from more than 10 years ago in the Annals of Internal Medicine. What was true then is still true today: when physician groups take responsibility for the cost of health care, they often adopt the hard-nosed approaches ascribed to managed care. Disease management is a late arriving but powerful equal-opportunity intervention agnostic to the insurer-physician divide. In the population-based health care business, whoever provides the service with the best outcomes for the lowest cost to the consumer should win.

Let the games continue.