Wednesday, September 23, 2009

Random Observations On the Disease Management Industry Thanks to the DMAA Forum 09

The Disease Management Care Blog used the DMAA’s Forum ’09 exhibit booths as a window looking into the state of the industry. It came away with several impressions.

The first is that while the salespersons are infected with ebullient enthusiasm, there was a lot of optimism in that exhibit hall over the future of the disease management/population health industry. The DMCB discerned two reasons:

1) Tally ho! The exhibit hall denizens said there has been no decline in the overall number of commercial sector RFP’s. Despite the dour skepticism of the inside-the-beltway CBO and their academic friends, the customers still like what the industry is offering, and

2) Blue Ocean. Whatever shape health reform takes, it will include dumptrucks of money for wellness, prevention and chronic condition management. That means new customers and new markets with new opportunities.

Over and beyond the industry’s derring-do, the DMCB detected a considerable willingness to engage in modular multi-party partnerships that involve two or more companies plus whatever components that are kept in-house by their customers. Thus, while individual companies are offering a broadening suite of health information support, telephonic care management, wellness interventions, surveys, analytics and the like, they are paradoxically more than happy to offer their wares cafeteria style. What’s more, being able to share data, integrate work flows and play nice with other companies is emerging as a competitive advantage. The DMCB thinks this has implications for the advocates of the Patient Centered Medical Home, who will need to figure out how it can flexibly plug into evolving spectrum of care management services.

The DMCB is also disappointed to report that the excess of superlatives continues to infect the science of disease management more stubbornly than a MRSA outbreak at a humid fitness center. Examples include 'robust!,' 'unmatched!,' 'outstanding!,' 'rigorous!,' 'award-winning!,' 'innovative!,' 'proprietary!,' 'unique!,' 'cost-saving!,' 'proven!,' 'exceptional!' and on and on and on. The DMCB lessened its pain by increasing its bar-based beverage intake. Duly fortified, it then soldiered on through the silliness, wondering when these industry mouseketeers will stop being so tone deaf to the difference between evidence and proof. Now that policy makers, scientists, physicians and masters-prepared Congressional staffers are just as much an audience as all those naïve human resource directors, the DMCB suggests it’s time to reign in the vendoring run amok. The marketing may taste great, but it’s perpetuating the industry’s lightweight less-filling branding.

Outside of the Display hall atmospherics, the DMCB never expects to be so famous and busy that it will have to send a video of itself in lieu of speaking in person at a national conference. In the case of Dr. Clancy, the miracle of this substitutive technology ended up making her look almost alive.

Thanks to a DMAA Forum session, the DMCB is now aware of one more instance in which a State Medicaid Medical Director, along with some friendly jawboning from other State departments, has gotten multiple commercial insurers within the borders to cooperate in population-based care programs, including data sharing and pooling support for primary care. Perhaps the Medical Directors’ job descriptions need to be broadened to include words like convener, trusted intermediary, networking, and innovator. The States’ impressive work in this area seems largely under-recognized in the health care reform debate, and it’s only just been recognized by CMS. As usual, Medicare is late to the party.

Finally, a Harvard researcher provided an interesting plenary session on the topic of bias-free and evidence-based patient education that harnesses the patient’s ability to decide on whether or not to have a test or a treatment. The DMCB has been aware of the supporting peer review literature for quite some time, which convincingly shows that when patients receive this kind of state-of-the-art education, they are better able to discuss the risks, benefits and alternatives with their physicians. What's more, many, compared with usual care, will elect to not undergo preference-sensitive and unnecessary procedures. As a result, patients may appropriately elect to avoid controversial prostate cancer screening, decline an invasive heart procedure and refuse inappropriately extensive breast surgery. The DMCB asked what this means for a HEDIS measures, where patients may also elect to not have a mammogram or a flu shot. Maybe the denominators need to be changed.

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