The International Teachings on What Real Health System Alignment Is All About

There is nothing like being a speaker at an international conference to make the Disease Management Care Blog rethink all its U.S. based assumptions, biases, and wishes. That kind of baggage can end up cluttering the intellect like the castaways in the DMCB's crowded basement.

During its long round-trip flights, the DMCB had a chance to ponder the mysteries of health insurance, savings, revenue, cost, expense, charges, claims and quality. Maybe it was being 34,000 feet closer to the stars, or perhaps it was being bombarded by more intergalactic tachyons or maybe it was the flight attendants' generosity with the French white Bordeaux, but by the time the DMCB had completed its migrations, many of its notions had undergone a reappraisal.

That's a good thing, because fewer assumptions means more brain space. That, in turn, enabled the DMCB to learn that, while the United States spends more healthcare treasure per capita than any other country in the world, many other countries' year-to-year budget increases or cost trends are distressingly similar to our own. What's more, their taxpayers and policymakers "on the ground" - despite favorable discernible inter-country differences in quality - are not necessarily convinced their local health care systems are giving them their money's worth. Little surprise, then, in foreign interest in "disease management" (examples here, here, here and here). Ditto, by the way, for the chronic care model (CCM).

Yet "interest" isn't the same as acceptance. What will it take for disease management (DM) and the CCM to gain international traction in a worldwide environment of rising costs and consumer discontent? The DMCB simplistically thinks it comes down to the macro-economic alignment of three key stakeholders:

Insurers (including payers, government and ultimately taxpayers): it's hard to underestimate their worry over the unsustainable trajectory in health care costs. When it comes to DM, they'll need to be convinced that there are savings. Absent savings, they need to be convinced that DM is ultimately cost neutral. Absent cost neutrality, the notion of cutting current costs or future fee schedules elsewhere is possible but politically unpalatable and time consuming.

Healthcare Providers (including DM companies): if an insurer will cover DM and CCM, the providers will be happy to offer the service, assuming the revenue provides sufficient margin over costs. Several providers in the field may lead to some price competition.

Consumers: if DM and CCM translates into perceptible betterment, they'll want more.

This is hardly big news, but there are some lessons:

1) the U.S. is not alone when it comes to reconciling cost and quality.

2) disease management has a role to play in reconciling cost and quality beyond our borders.

3) "aligning incentives" is not necessarily about using provider payment incentives to trump value over volume. Overseas, there is a more fundamental interest in aligning payers, the providers and the consumer.

4) any company that succeeds in aligning the incentives will win. It should be no wonder that American disease management companies are active overseas. It they serve the insurers, the providers and the patients, they'll win.