Here's Your Summary of the Latest Population Health Management Journal

It’s time once again for the Disease Management Care Blog to help you save time by summarizing your latest issue of the newly renamed Population Health Management Journal. Read on and then decide which articles deserve your additional attention. If you don't get the Journal, you're in luck because everything for this issue is available on-line gratis.

Norman G: Disease management outcomes: Are we asking the right questions yet? This is one of the better commentaries from one of the industry’s smartest apologists about the preponderance of evidence that favors disease management and how we should think about it. The DMCB recommends this as required reading for anyone interested in population-based care. Seriously.

Nash, DB, Lewis JD, Moorhead T, Woodburn J: Insights from the 2008 disease management colloquium. If you missed this May 2008 meeting, hearken to these experts’ impressions. Lewis believes the next generation of population-based care will hinge on higher generation data management that goes beyond claims and includes (for example) enrollee phone calls. Moorhead heard Chief Medical Officers worry, as they are wont to do, about everything: physician and patient trust, the role of incrementalism, fully leveraging the expertise of non-physicians, better use of evidence-based medicine, demonstrating value instead of cost savings, physician engagement, malpractice mitigation, promoting patient health and reducing health disparities. Woodburn wonders if retail medicine could be a threat to the medical home. Despite physician tensions, disease management may be able to glue it altogether by relying on retail clinics as data collection and patient counseling channels. He also believes there’s great potential in leveraging their pharmaceutical management stream and potential ability to provide wellness programs. The DMCB didn't go to the Colloquium, so this was interesting.

Drozda JP, Libby D, Keiserman W, Rundhaug P: Case management decision support tools: Predictive risk report or health risk assessment? Should you use an HRA or use claims-based predictive modeling? Maybe either. Or both. Wisconsin Medicaid made its claims available at the same time that the waiver process mandated the use of an HRA. Because both happened at the same time, the authors compared their impact. This is not an easy study to read because of the use of a ‘path analysis’ that sought correlations between the HRA, the predictive risk score, the likelihood of being placed in case management and the likelihood of an emergency room visit. The ‘risk report’ preformed better than the HRA at predicting ER visits. The risk report and the HRA both performed equally well in predicting acceptance into case management. Maybe either. Or both. Or neither if Wisconsin Medicaid isn’t generalizable, if the risk report and HRA used are significantly different than other predictive models and surveys, respectively.

Wilhid C, Hayes JR, Farah JR: The use and influence of employee incentives on participation and throughput in a telephonic disease management program. This study arrayed the disease management program ‘opt-in’ participation levels in 88 employer groups and then compared the pooled results of the high and low tertiles. Opt-in participation rates ranged from 3% to 13%. Program completion rates were inversely correlated with participation rates. Cash incentives helped boost participation once they exceeded $50 all the way up to a maximum of $800. Large companies and self insurance was also correlated with higher participation rates. A survey of account managers indicated that use of email, repeated communications and health fairs also helped increase participation rates. The DMCB asks how meaningful enrollee engagement can be increased in the more prevalent opt-out programs. Will cash incentives work there too?

Leas BF, Gagne JJ, Goldfarb NI, Rupnow MFT, Silberstein S: Assessing quality of care for migraineurs: a model health plan measurement set. Did you know that no population-based measure set exists for migraine? The authors used the literature, published guidelines, opinion leader interviews, health care purchaser interviews, managed care leader interviews and an Advisory Board. Twenty areas of measurement were developed. Unfortunately, these 'areas' (e.g.,‘diagnosis of migraine’) do not specific measures make. Much work remains until we can start extracting claims and performing chart reviews.

Picariello G, Hanson C, Futterman R, Hill J, Anselm E: Impact of a geriatric case management program on health plan costs. The authors assessed New York’s HIP’s geriatric case management program by comparing the change in costs for 101 participants versus 1585 otherwise eligible non-participants after controlling for age, sex and baseline health care costs. Savings amounted to $7720 per year with a cost of $2755 per member, netting $4965 per enrollee. The authors ascribed the results to a) including the patients’ physician in care coordination, b) focused interventions and goals, c) highly trained staff and d) giving the staff financial incentives. The DMCB knows how hard it is to demonstrate the value of case management and, short of a randomized clinical trial, this is a pretty good effort. Too bad we don't know more about the actual content of HIP's case management approach and how they intend to extend it to the other 1500 eligible patients.

Conwell LJ, Boult C: The effects of complications and comorbidities on the quality of preventive diabetes care: A literature review. The authors point out what primary care physicians have known for decades: the presence of co-morbidities have a big impact on how patients and physicians decide to participate in care processes. That in turn has implications for measurement. The authors review the literature on this topic and find it lacking.