Sunday, January 4, 2009

Disease Management Predictions for 2009

The Disease Management Care Blog believes prophesying about 2009 is so easy because predictions are only remembered when they turn out to be true. Lacking any downside risk, the exercise it makes for a future self-congratulatory post if even one divination randomly hits pay dirt. One prediction the DMCB can make with great confidence, however, is that if even one of its 2009 forecasts is accurate, it will not hesitate to remind readers and DMCB spouse of its prowess as a budding futurist.

So here, in no particular order, are the DMCB Predictions for disease management in 2009:

The death of the Disease Management Business Model will turn out to be greatly exaggerated thanks to:

1) adoption of remote patient coaching as one of many components of population-based care for chronic illness. The disease management organizations will finally be forgiven for acting in the past like they were the only component,

2) genuine belief in ‘disease management’ among Administration and Congressional supporters (with the Congressional Budget Office’s [CBO] lukewarm agreement) of national healthcare reform,

3) expansion of disease management programs in the commercial market as more employers become self-insured and use business assumptions (not scientific certainty) in their benefit designs,

4) continued reliance on successful disease management in Medicaid settings,

5) the realization that good health care doesn’t necessarily save money and

6) the next prediction.

The first reports from the multiple insurer sponsored pilots on the patient centered medical home (PCMH) will be a mix of

1) reality-checking reports that show modest gains in quality and disappointing lack of savings,

2) failures,

3) lack of uptake among many of the non-entrepreneurial primary care sites that have either a) tight cash flows and simply can’t afford a practice redesign today based on tomorrow’s revenue or b) an existing successful business model that minimizes overhead, maximizes patient throughput and can still afford that Lexus, and

4) lack of support from specialist physicians who believe primary care physicians were supposed to be 'medical homes' all along.

The rise of Disease Management Lite (defined by the DMCB as any remote intervention that doesn’t principally rely on expensive nurses) thanks to:

1) pushback price pressure in an insurance industry having to make due with fewer member months

2) the emergence of price competition among disease management organizations,

3) the unwillingness of DMOs to cut prices on their traditional U.S based nurse coaching offerings,

4) adoption of technology solutions that are otherwise prohibitively expensive at the provider level but attractive at a PMPM level

The Medicare Medical Home Demonstration will lumber along and will ironically slow adoption of the PCMH as an ingredient in health care reform because a) we have to wait for the results and b) the CBO's lukewarm non-support.

Blogs will become even more important in the shaping of health care policy. Policy makers will monitor and try to shape their reactions in the evolving healthcare debate, start their own blogs and build alliances with existing like-minded bloggers. Ask the health policy bloggers how many times they’re detecting 'U.S Senate Sergeant at Arms' or 'Centers for Medicare Services' in their daily traffic. It’s not small.

Early reports of health care reform will be tempered by vexing unhappiness over lack of progress for the middle class. Testy impatience will drive a political/policy mandate to include all that looks good, including disease management (and electronic health records).

Lacking any credible short term fixes, primary care shortages will spike. Not only will appointments for new patients continue to evaporate, but appointments for old patients will be squeezed. The continued unraveling of primary care will make disease management services even more attractive to policy makers.


PookieMD said...

I sure wish I was one of those primary care physicians that could 'still afford a lexus.' I drive a subaru with 200,000 miles on it. You've got the wrong speciality, if you think that primary care docs earn that much. I do agree with much of your other points, and feel that the Patient Centered Home is unattainable for most practices.

Jaan Sidorov said...

It's amazing, I know. However, I'm personally familiar with one primary care group in PA that, among other things, has no offices for their docs, minimize inventory, have highly motivated nurses that really help, are open every day of the year, are aggressive with insurers etc etc. They do "OK" and yes, drive nice cars. These kind of practices are uncommon, but insurers point to them as one reason why they don't necessarily need to change their fee schedules.