Wednesday, February 23, 2011

The Cost Effectiveness of Diabetes Management Programs, Courtesy of Our Neighbor to the North

The Disease Management Care Blog is broadcasting tonight from Ottawa, Canada, where it is furiously preparing for tomorrow's Health Canada sponsored conference on the cost-effectiveness of diabetes management programs.

So what will the DMCB have to say?

1. Whoever owns the insurance risk should own the disease management (DM) program. That's because DM is ultimately a strategy to mitigate the risk of chronic illness and reduce claims expense.

2. There is an emerging body of evidence that shows DM reduces claims expense and that the savings can benefit the risk-holders' bottom line. See here, here and here.

3. While the U.S. leads the world in per capita health care costs, the rate of increase (a.k.a. "trend") year over year is remarkably high among all industrialized countries. DM is one evidence-based option among many that can blunt that trend.

4. If a nation, province, state, organization, insurer or provider group wants to sponsor or initiate DM, what should it look for? There are several ingredients that are truly universal:

~ nurses that have experience in primary care, are mobile, are credentialed, can work at "the top of their license," are change agents and ultimately enable patients to participate in shared decision making. Docs can't do it alone.

~ information systems that can identify and recruit optimum patients into DM programs. That's because modifiable risk is not evenly distributed in any population. Some persons with chronic illness are not candidates for DM because they are doing well or because they are too ill.

~ it's not enough to achieve outcomes, it's also a matter of documenting them. "Field" research is well within reach, assuming you know how to do it.

~ if you strike the right balance of keeping them in the loop, making life easier and demonstrating real value, docs often support it. Woe to you if you mess it up.

The DMCB will be keeping notes on what others have to say and report on it tomorrow.

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