Wednesday, December 30, 2009

A Review of the Disease Management Blog's Predictions for 2009: How Did It Do?

The Disease Management Care Blog is not above the blogosphere's emerging tradition of marking the end of an annum with bloggy predictions. Unlike many other corners of the blogmos however, the DMCB is also willing to publicly review its earlier predictions and conduct a blogopsy. Just how did the DMCB do, or rather, how much did the DMCB readers benefit from it's blognostications?

Here's the post. In it, the hopefully prescient DMCB said:

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

The DMCB sure got that right. All of the big disease management organizations, save one, are still standing and, for example, looking healthy. The one bankruptcy was not due to any market forces but rather, some strange dysfunction of the Federal government. Who could have predicted that? Lesson learned.

The first reports from the multiple insurer sponsored pilots on the patient centered medical home (PCMH) will be a mix of reality-checking reports that show modest gains in quality and disappointing lack of savings, failures, lack of uptake among many of the non-entrepreneurial primary care sites.

Once again, the DMCB got it right with its doubts over the business case of the current generation of the Ver 1.0 PCMH. There are reports of quality gains, but no proof of savings and no spontaneous uptake outside of money-sweetened pilots or collaboratives, especially among small physician owned practices. In fact, the DMCB wonders if the lack of any peer-reviewed publications showing definitive savings doesn't mean the research is pending, but that the studies are negative and subject to publication bias.

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

Well, while the DMCB predicted a groundswell, this particular trend turned out to be more of a wavelet. However, the future for this still looks bright. For example, iPhone aps.

The Medicare Medical Home Demonstration will lumber along.

The DMCB was too generous. While others expected great things, it lumbered along, alright.... right into a corner where it curled up and died.

Blogs will become even more important in the shaping of health care policy.

What better example than the President having a phone conference involving the big liberal bloggers to whip up support for health reform?

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).

The DMCB says bingo! Unfortunately, this was powered by the economy unpredictably tanking and allowing too many in the middle class to lose their employer-based insurance. The rest of us have come to realize how close we were to having to personally pay $1500 a month for insufficient health insurance. What the DMCB missed was how subsequent reform would include all that looks good, fair or resembling a kitchen sink in demos and pilots.

Lacking any credible short term fixes, primary care shortages will spike.

Well, it didn't quite spike, but interest in the topic certainly did. Folks have come to realize that health insurance reform won't help access to primary care.

Not 100% accurate, but pretty good. The DMCB takes a lesson from the President and awards itself a B plus.

Next posting: the DMCB's predictions for 2010.

In the meantime, here's wishing you a Happy and Healthy New Year.

No comments: