Comments on Archelle On Health: The Death Of Disease Management (Finally)

As a veteran of the disease management industry, a...

2012-01-21T13:43:12.058-06:00

As a veteran of the disease management industry, and most recently, spending several years assisting provider organizations to manage their patient populations, I fully appreciate the problems inherent in traditional employer-based and health plan-sponsored disease management programs. However, like Al Lewis, I also disagree with the statement that disease management is dead. Although some models have failed in the past, disease management models continue to evolve and are being transformed and incorporated into new physician-led population health models such as the Patient-Centered Medical Home. Further, as health systems assume more financial risk and move towards Accountable Care Organizations, they will take on responsibility for managing entire populations and will be using population health tools and services that evolved from the original disease management principles and fundamentals.

I emphasized several points that strongly indicate that disease management is alive and well on my blog post here:
http://blog.phytel.com/2012/01/death-of-disease-management/

Art, great comments...and I agree that information...

2012-01-14T10:25:47.455-06:00

Art, great comments...and I agree that information technology can be very valuable in managing disease (while not in the context of traditional DM). But "Accountable Care Organizations" also run the same risk of failure as DM as accrediting organizations get involved. In addition, the even bigger risk is that the government's shared savings approaches will undermine the opportunity for financial success on the part of ACOs and participating providers. Physicians in large MSP based medical groups have done said to me that even in Year 1, the financial gain from the shared savings isn't worth their time. National experts much smarter than me have very publicly suggested that ACOs are just a transitional strategy since the shared savings will only be meaningful for a few years as the "fat" in the system gets addressed. After that, the savings are likely to be too low to make this a viable business model.

What is in a "name?" The basic process o...

2012-01-14T10:13:09.625-06:00

What is in a "name?" The basic process of identifying a patient with health information and support needs, then addressing them with interventions, and measuring outcomes is a core part of all care delivery, past, present, and future. The limited scope 'payor' based offerings to which this article refers have not succeeded in unambiguously demonstrating their value, but the methods, particularly the use of information technology, are far from 'dead.' These are being adopted, perhaps resurrected?, in Medical Homes, Accountable Care Organizations, adherence programs, and even marketing support programs. Many of the innovation grant applications should be using these same processes, tools, and even measurement strategioes. So, Disease Management is dead. Long live Accountable Care organizations!

Al, You definitely get credit for spearheading al...

2012-01-12T20:43:32.040-06:00

Al,
You definitely get credit for spearheading alot of the growth in this industry. Now we all know better. Your caution around mHealth is valid...and it, too needs to be measured. But at least it's a cheaper investment so that a smaller clinical impact has an opportunity to translate into a positive financial return.

Chris, agree with your comments. Hopefully, I emph...

2012-01-12T20:38:13.381-06:00

Chris, agree with your comments. Hopefully, I emphasized that its "traditional," nurse call center based condition-specific DM programs that have failed to demonstrate value. Those that are highly targeted with aligned incentives have more promise.

There's no question that creating social netwo...

2012-01-12T18:12:26.712-06:00

There's no question that creating social networks of patients with chronic diseases can have lasting impact on medication and treatment compliance. The problem with institutionalized DM was expecting the same interventions to work for a diverse population with a wide range needs, motivations and barriers to change.

Don't discount smart, adaptive population health programs. Employer such as Safeway Stores have created a culture of healthcare consumerism which requires active participation rather than passive reaction to disinterested providers going through the motions.

It reminds me of cigarette black box warnings and ...

2012-01-12T17:37:33.501-06:00

It reminds me of cigarette black box warnings and smoking cessation classes, both with little to no efficacy relative to public and workplace bans on smoking, which really moved the dial.

hmmm... Reports of the death of disease managemen...

2012-01-12T14:02:22.706-06:00

hmmm...

Reports of the death of disease management may be greatly exaggerated. There are programs that work, but many that don't. A lot of over-measuring and over-promising has severely damaged the credibility of the field. But others work modestly well enough to pay for themselves and then some.

Don't put too much stock in mHealth. The numbers don't add up there either, for the most part. Very few programs relying on voluntary compliance with no big economic incentives move the needle.

And just for the record for people keeping score at home, that article had very little to do with the growth spurt. This is the first I've heard of it. The growth was caused by Humana's dramatic, high-profile adoption of multiple programs across multiple markets (at my urging). Others soon followed.