Tuesday, November 18, 2008

Here Comes Ted Kennedy! Implications for Disease Management

Here comes Ted Kennedy (D – Massachusetts) and he's looking remarkably trim and energetic. Details on his health care reform legislation are not being reported in the media, but it's clear that he’s getting ready to unveil something that will be ultimately aimed at universal coverage.

You may recall that Mr. Kennedy was one of four Senators who wrote to CMS Administrator Kerry Weems about continuing the Medicare Health Support initiative. Will he continue this support when his legislation is introduced? The ever optimistic and naive Disease Management Care Blog hopes the answer will be yes, because.....

1. There are few patient friendly interventions out there that have any hope of blunting health care cost inflation. Disease management is one of them. (Looking at this contrarian post and scrolling down to November 13 may make you think that the EHR is not necessarily a cost savings slam dunk either)

2. Disease management - either as a carve-in or a carve-out - is embedded in most commercial insurance plans. Why not build on their optimism about the value of this approach?

3. Widespread support for the unproven medical home is not incompatible with support for disease management. In fact, this is a chance to craft language that recognizes their complementary nature and supports innovative insurance benefit designs that capitalizes on the value of both. This is a theme in the Baucus Plan.

4. Legislation aimed at major health overhaul could use all the help it can get, which means inclusivity rather than exclusivity. A big multi-dimensional problem requires a big multi-dimensional approach with the support of a host of stakeholders.

5. President Elect Barack Obama has voiced support for disease management. His HHS Transition includes the anti-tobacco and primary care center-experienced William V. Corr and former SGIMite (they are smart people) Nicole Lurie, who, by the way, has written about disease management and is familiar with the good:

'While numerous studies described such interventions, we found only 45 studies that formally evaluated their effect and only six that contained any information on the cost of the intervention or the savings it achieved relative to the no-intervention baseline. All six of these studies, all
on disease management for asthma, found the interventions to be cost effective. One intervention that provided 60- to 90-minute, one-on-one educational sessions was even found to have produced annual net savings of almost $2,000 per patient.'

and the not so good:

'However, a recent RAND review of the effectiveness of disease management interventions found no conclusive evidence that disease management for asthma can reduce direct medical costs. To summarize, we found insufficient evidence to try to answer our questions on the cost of reducing the gap in quality and the return on investment for programs that attempt to close the gap.'

6. A major highly regarded disease management organization is headquartered in Massachusetts.

The DMCB looks forward to learning about the Kennedy approach in the not to distant future. By the way, considering the news coming out of Tennessee, it suspects Healthways hopes inclusive reform is put on a fast track: time may be running out.

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