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Downsides of Traditional Disease Management

In an effort to improve the health of employee populations, to both decrease direct health care costs as well as improve productivity, employers have for many years attempted to install Disease Management (DM) as well as Wellness programs. The key groups that are the focus of these efforts are those with, or at high risk of getting, chronic diseases. Based on a study by the Boston Consulting Group, these are the 35% of an average employee population that drive 75% of a health plan’s cost. The goal of the Disease Management programs, per the Disease Management Association of America, is to provide for these individuals a “system of coordinated health care interventions and communications to these populations with conditions in which necessary patient self-care efforts are significant.”

Though the goals are clear, traditional DM programs (both provided through insurance providers and through independent companies) have not achieved their desired outcomes. For many DM program subscribers, this has left the belief that DM programs are simply ineffective. This was succinctly stated in a recent Wall Street Journal article (May 5, 2010) about a large DM company, Healthways. It stated ““Healthways…..projects revenue declines this year as doubts linger about the effectiveness and value of disease management programs”. Within companies themselves, it is not uncommon to hear HR professionals simply state: “Disease Management just doesn’t work”

Despite these dismissals, there are many potential benefits of DM programs, including:

  • clinical benefits to patients (i.e., by preventing disease exacerbations, complications, hospitalizations, and invasive procedures by preventing conditions from worsening)
  • decreasing health care costs for health care payers
  • improved productivity/absenteeism for employers

Significantly, there are in fact ways to make DM programs effective. These methods simply aren’t readily available in the service provider market today. Instead, traditional DM programs have many limitations, making them both less effective and less able to demonstrate a positive return on investment. Limitations include:

  • Data Sources: information is claims based (and thus doesn’t include all provider interactions) and is self reported (thus not necessarily accurate)
  • Data Collection: real time information is not available or, if data is collected real time, systems are not in place to ensure its real-time use
  • Patient Interactions: Patients are generally contacted greater than 30 days after any event, which is long after a truly “teachable moment” has passed
  • High Cost: Each interaction requires a high level of costly nursing resources, thus making the service either very high cost, or (when costs are controlled) limited in its level of service
  • Remote Monitoring: When remote monitoring is utilized, it is not associated with real-time responses

In this series of blogs, we will explore what elements can be included in DM programs to make them truly effective – as well as what an HR professional can do to get the most out of their current programs.

Rebecca Dubowy MD, Chief Medical Officer, HealthPoints



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