More On The "Death" Of Disease Management

At the email prodding of several colleagues, the Disease Management Care Blog next turns its attention to a blog posting by Archell Georgiou MD provocatively titled "The Death Of Disease Management (Finally!).  The Archelle on Health Blog contrasts the industry's early promises of evidence-based medicine plus patient self-care with the bitter fruits of non-existent savings, the disappointing Medicare Health Support (MHS) demo and a just-published anti-disease management New England Journal article. 

Using that last Journal article as the final word, Dr. Georgiou provides her readers with a graveside eulogy of what went wrong:

1. The NCQA promoted an "enroll and counsel all patients at risk" approach, when what was really needed was a focus on the patients at greatest risk.

2. The disease management industry relied on gimmicky marketing instead of reducing costs, and

3. Inflexible adherence to evidence-based medicine failed to account for individual patient circumstances.

Enter Al Lewis of the Disease Management Purchasing Consortium with a rebuttal, but, um, sort of.  Al points out that the DM industry still clings to life and, even worse, uses spurious financials.  Yet, thanks to ICD-10, inclusion of labs in predictive modeling, lower program costs, physician involvement and the marvelous insights of his soon-to-be-published book, he confidently predicts that the DM vendors will emerge from what is better described as a near-death experience.

Where to start?

Medicare Health Support's Lessons

That New England Journal article used by Dr. Georgiou to  nail DM's coffin was a really retread of Medicare Health Support's (MSH) failings.  Look deeper and what MHS really demonstrates is CMS' ineptness in demo design, program support and data interpretation.  Toss in this CBO Report and it's clear that the issue isn't whether DM "works" in in FFS Medicare, but that the administrators running FFS Medicare don't know how to implement DM. 

Disease Management Is In Use In Most Commercial Settings

CMS' bumbling stands in contrast the long term and continued reliance by commercial insurers on disease management in the commercial and self-insured sectors.  While nattering nabobs may suggest that the commercial sector isn't paying attention to the "evidence" of studies like MHS, a cursory search of the published literature can find studies like this, this, this, this and this that suggest that the commercial sector knows what it's doing and that patients and their premiums are better off for it.

Disease Management Ver. 1.0 Deserved To Die, But Didn't.  It Changed

Archelle On Health has it only partially right. When industry's own studies proved that a) an all-patient approach didn't work, b) it had to get serious about documenting outcomes and c) patients had to be "engaged" on their own terms, it didn't crawl into a hole and die.  It changed to what the DMCB has characterized in past postings as "disease management Ver. 2.0," otherwise known as "population health."

And What About Al Lewis' Insights?

The DMCB agrees with four out of five.  If his new book is anything like his last one (by the way, it included the DMCB as an author), make that five out of five.

But Wait, There's More!

In the original "Death" post, Dr. Georgiou points to six innovations that promise to further shake up the landscape of population health: social networking, gaming, remote biometric monitoring, wireless health management apps and "passive" environmental changes that lead denizens to lead more healthy lives.  The DMCB says she's right and finds the topic endlessly fascinating.  While the population health and disease management industry is using monitoring and social media, it remains to be seen how it will embrace the other innovations. 

That being said, the DMCB hopes that Medicare doesn't run any demos on any innovations like gaming, apps or environmental changes, lest future bloggers end up pronouncing their death too.

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