Compare and Contrast CIGNA's and General Electric's Approach to Disease Management. What's the Difference... Really?

After reading the latest CIGNA earnings call transcript, the Disease Management Care Blog couldn't help thinking some more about the Business Week (BW) faux exposé of the disease management (DM) industry.

CIGNA seems to have had a very good year thanks to a total income of $1.1 billion or earnings of $3.98 of per share. This represents an impressive 16% increase compared to last year. Not only have their capital levels been clawing their way back to healthy levels, but the insurer has also been tackling overhead, including a reduction of $100 million in its healthcare operations, while simultaneously providing a 24/7 service model with 'a broad portfolio of capabilities to achieve health improvement, including risk identification, lifestyle and wellness programs, incentives, coaching, and engagement services.' Armed with a motto of 'Go Deep, Go Global, Go Individual,' the company said that '(t)here is no question (that), regardless of what happens with US healthcare reform, there will be more individual accountability for health and healthcare. So "Go individual" is a fundamental philosophy as well as part of our growth strategy.'

Critics of DM would probably say that CIGNA's commitment to the principles of DM described above isn't based on proof, but to unsophisticated market demand. Yet, there is still a telling contrast between CIGNA's many 'believing' customers versus the experience of General Electric that was described in BW. If many pilots and trials of DM are conducted in multiple settings, a distribution of outcomes is pretty much guaranteed. Is the one company's experience with DM described by BW typical, or a statistical outlier? The DMCB can't tell, but has learned to distrust the media's ability to distinguish between the two.

The faultfinding BW article ends with a description of a curious decision by GE:

This spring, GE will start an outreach service that shares some elements with traditional disease management. Nurses will use claims data to identify gaps in care, such as unfilled prescriptions or missed checkups. But rather than just contacting patients, the nurses will also call the treating physicians, if patients agree....

What about the company's pronouncement that its experience with DM was a failure? It's more likely that, much like the rest of the DM industry, there is ongoing innovation, building on the lessons of what has worked and what doesn't work. Much like CIGNA, it appears GE appears to have a commitment to population-based care management that includes remote nurse coaching. Does that include what BW portrays as foolish DM? You be the judge.

In the meantime, good for CIGNA, good for GE, good for the DM industry and most of all, good for the moms, dads, grandparents and all the American workers and dependents that are lucky enough to be insured by CIGNA or to be working in companies like GE.

Let the evolution continue.