Tuesday, July 15, 2008

Return on Investment, Disease Management and Wellness

The Disease Management Care Blog is coming to you from Washington DC, where it is attending (and speaking at) a World Research Group conference focused on wellness. It intends to share the highlights of the other speakers from other settings who are embarking on new programs in future posts, so stay tuned.

One of the major themes of this confab is the perennially difficult topic of ‘return on investment.’

Some of the DMCB’s planned – and simplistic - comments for tomorrow:

If we must use the term ‘return on investment,’ its measure is generally done one of five ways. These are:

1. Compare the claims expense of either the population or a representative part of the population to a matched control. Using the population at baseline and comparing it to itself (pre-post) after the intervention is a variation on this theme. It’s better to use a parallel control. This has the advantage of being conceptually easy to understand. This may partially explain why this approach still appears, in the experience of the DMCB, to dominate the market place.

2. Examine the trend (change over time or the slope) in claims expense for the population and compare it to a control or what the expected trend should be. Trend can be more difficult to understand but it has the advantage of also being used in other health insurance calculations. As such, it is probably destined to be the ‘coin of the realm.’

3. Use ‘Other Weird Calculations’ such as measuring the relative impact of the program on the observed trend. In other words, as the claims expense goes down (or up), is there any correlation with the amount of the intervention, and if so, how much? For example, do more coaching calls translate to correspondingly fewer admissions?

4. Use anecdotes. Don’t underestimate the impact of positive or negative personal testimonials shared at an all-employee meeting or given to the head of Human Resources.

5. Rely on Quality Adjusted Life Years (QALYs), which captures the possibility that there isn’t a reduction in claims expense. If there aren’t, what gains in quality are there, and for each ‘unit’ of quality what is the cost?

The DMCB will be looking forward to hearing how others at the Conference tackle this. More to follow.

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