Monday, August 29, 2011

The Uncertain Certainty of Population Health Management Outcomes

So which is it? Alive or dead?
The Disease Management Care Blog is trapped in universe of perpetually shifting probabilities. It knows events may or may not result from multiple overlapping inputs arrayed against a distribution of likely and unlikely events.  Closer scrutiny only generates more shades of grey in a world that forces the DMCB into a dense unsatisfying miasma of cognitive dissonance. Sorting cause from effect from association from randomness (and from occasional miracles) was tough enough when humankind was spearing woolly mammoths by torchlight. No wonder we're debating the merits of early detection of cancer.  Like it or not, ours is a cat-is-BOTH-alive-and-dead "quantum" world.

Little wonder, then, that the DMCB is simply unable to answer the spouse when she asks "if" the "trash" has been taken "outside."

That's why the DMCB sympathizes with authors Suzanne Felt-Lisk and Tricia Higgins when they tackled the potential benefits of population health management (PHM) in an August 2011 Mathematica Issue Brief.  Recall that Mathmatica is a highly regarded policy and research outfit that performs a lot of analyses for the Feds, including (for example) this one.  When they talk, it pays to listen.

Recall that PHM may be thought of as Ver. 2.0 "disease management," newly defined as any "set of interventions designed to improve people's health across the full continuum of care" that includes a full scope of disease management plus preventive services and health promotion," typically on behalf of "an employer, health plan or other purchaser that bears responsibility."  PHM also emphasizes individual patient centeredness and outcomes measures to tailor and constantly adjust the program delivery.

A Mathematica "environmental scan" determined that 68% of purchasers currently and 84% plan to buy PHM services.  Yet, while the future is bright for the PHM industry, "it is not clear whether [these] programs can deliver better health outcomes." 

Two problems that stymied the report's authors are 1)"methods" for improving the health of populations have yet to be "identified" and 2) more has to be done to determine how they will be "fit together."  They noted that while some interventions work (for example, health promotion directed at blood lipid levels), the specifics in terms of programs and participants vary considerably.  As a result, they found that 66% of purchasers of PHM services are skeptical about whether they are getting their money's worth.

Nonetheless, "desirable" features of PHM include 1) integrating it into the benefit, i.e., covering it, 2) using a combination of interventions, 3) offering beneficiaries incentives for participation, 4) individually tailoring the interventions and 5) pursuing NCQA Wellness and Health Promotion accreditation.

So there you have it: a state-of-the-art assessment. While the answer is continued monitoring and evaluation, the decade-old industry is still in its "infancy."  There is uncertainty over outcomes, yet many desirable features.  It's being bought by a majority of insurers who simultaneously doubt its effectiveness.

The DMCB understands Mathematica's pain, especially on Tuesday nights.  That's when the trash may or may not make it outside in time for the morning pick-up.

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