Sunday, September 7, 2008

No Requiem for Disease Management

In the August 2008 issue of Managed Care, Blain Bos, Mercer’s ‘chief strategist for health reform,’ is interviewed about emerging trends in health plan benefit designs. Interesting article and worth a look, but there was one quote about the business community’s perception of disease management caught the attention of the Disease Management Care Blog:

Disease management has been embraced, and there is general agreement that it is having a positive impact on the healthy and well being of people who have chronic conditions. The questions now are: How can we measure that to be sure we are getting the best return on investment.’

The DMCB thinks this is one other indication that the ‘disease management’ phenomenon is not going to dissipate. Embraced means they’re not letting go. The name may evolve (‘population health improvement’) but the underlying concept has become a fixture in the medical landscape, along with managed care, the NCQA and physician networks. This upstart industry is maturing and is becoming part of the fabric of employer sponsored U.S. healthcare.

And what exactly is that ‘concept’ you ask? Well, even if you didn’t, and, without relying on the usual formula of a list of specific ingredients, the DMCB suggests the following definition (with explanatory notes) meets the marketplace definition of disease management:

‘Any health insurer (can be commercial or a self-insured employer) sponsored (i.e., paid for) package (there is no single silver bullet) of interlocking communication activities (depending on local market conditions, vary from setting to setting) relying on principles that include (and are not limited to) industrial psychology, marketing and consumerism that are designed to a) maximize self care and b) mitigate insurance risk (usually within one fiscal year) for populations defined by the presence of a chronic condition.

A less technical definition may be:

Any package of consumer-focused education activities that help health insurance enrollees with lifelong diseases take better care of themselves and save money.

Note that the definition depends on the insurance concept of 'risk transfer.' The DMCB believes that is generally outside the bailiwick of mainstream clinical medicine (unless my physician colleagues want to get back into taking global cap) and is one of the features that distinguishes it from the Patient Centered Medical Home. This brings up the second point about the definition: while the defintion doesn’t explicitly mention physicians, they are a necessary but insufficient ingredient in the ‘activities’ mentioned above. Furthermore, risk ‘mitigation’ doesn’t necessarily mean ‘has a positive return on investment.’ It means reduce the risk of a loss and increase the chance of money being left over at the end of the year. Last but not least, it makes no apology for inclusion of the ‘fiscal year,’ because that is how insurance, business, budgets and health care are financed in general.

The DMCB believes the employers and their insurers are using a working definition of disease management based on much of the above when they’re thinking about chronic illness. It’s relatively simple and builds on the notion that patient education translates into savings: it’s common sense. Combined with over 10 years of experience, no wonder the business community, according to Mr. Bos, isn’t asking ‘if’ disease management works, but ‘how’ to best measure it and use those measures to extract maximum value.

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