Tuesday, December 21, 2010

Follow-Up Thoughts on the Innovations Conference

In a prior post, the Disease Management Care Blog examined the emergence of "trade association" behavior among the presenters at the Health Affairs "Innovations" conclave. Yet, the DMCB does not weep. Between the doctrinal belief in large provider systems and the allure of $10 billion in government largess, who can be blamed for a fall from academic grace?

The DMCB can only hope that this new business-oriented posture may portend some flexibility in health system redesign. Which is why it's important to note that the disease management vendors know a thing or two about simultaneously delivering programs and conducting outcomes studies. They've developed "real world" approaches to study design, understand how to partner in large regional interventions and, what's more, know the good, the bad and the ugly of dealing with Washington DC. Who cares what color the cat is so long as it catches mice?

The bad news about the Health Affairs confab (and maybe many of the other Center for Medicare and Medicaid Innnovation "listening sessions") was the apparent lack of any mention of, invites to or presentations by any members of the mice catching disease management industry. Yet, the DMCB remains optimistic that the CMMI folks will welcome multi-dimensional proposals that include state-of-the-art patient/consumer outreach, engagement and coaching. That's why it may pay DMCB readers to (warning, it's a big file) download the PowerPoint presentations and ponder just how such a collaborative approach would work while they think about partners.

In the meantime, some other "Innovations" confab DMCB take-aways:

For many innovators, a low "N" and wide confidence intervals involving non-normally distributed data with big outliers may mean that detecting a "return on investment" will be statistically undetectable - not only at the individual work unit levels, but also at higher organizational levels. That's going to call for some "take-my-word-for-it" when these care management programs are evaluated.

One seemingly welcome innovation strategy is redirecting physician ordering to lower cost alternatives. In other words, if the name of the game is finding cheaper care options in absence of a managed care insurers doing that dirty work, that means the innovators have figured out a way of saying "no," "denied," and "not covered."

New term: "value streams," defined as clinical guidelines/care paths that are stripped of any recommendations that don't add consumer value.

One not-for-profit managed care organization executive's description of a key attribute they leveraged to get buy-in from their network physicians:

"We're the health plan they hate the least."


Last but not least, the DMCB was struck by unpolished yet endearing style of many of the presentations, which stands in contrast to the slick, jargon-filled and graphics-rich PowerPoints that is typical of its colleagues in the investor-owned care management industry. When dealing with this kind of audience, less may be more.

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