Changing Behaviors

"When you start looking at just five or six key lifestyle decisions that people can control every single day-there are those people who make what end up being consequently bad decisions over time," Leedle says.

The decisions include smoking or not smoking, exercising or not, and eating foods that are good for you or foods that might not be good for you.

Leedle remembers one case that left a lasting impression. After earning a master's degree in science and exercise physiology from Emporia State University, Emporia, Kansas, he was working at an American Healthways Diabetes Center of Excellence. He was helping lead and develop exercise plans for patients when he befriended an elderly male patient.

"This gentleman was a farmer who had secondary complications from cardiac disease that were very severe," Leedle recalls. "He had been through a generation of healthcare, but as a young man, perhaps did not have the support and education to understand and deal with the disease.

"One day I went to visit him, and he wasn't there. I thought he had been discharged, but he had died the previous night. I wish I could have met him early in life and educated him about lifestyle decisions that could have made a drastic difference in his health," Leedle says.

That is really the core of what American Healthways is about: helping people maintain and improve their health and quality of life one decision at a time.

Q. Recently, Thomson Medstat, the Congressional Budget Office, and the Institute for Health and Productivity Management have come out with reports saying that disease management savings results are inconclusive. Even Al Lewis, the strongest and most visible buy-side advocate of and commentator on disease management, has published a white paper saying that savings are more modest than others have thought because of a mathematical flaw in pre-post methodology. Do you stick to the Hopkins Methodology that says that DM produces high returns in the near term?

A. American Healthways believes and has validated through numerous outcomes studies that DM produces both clinical and financial returns in the near and long term. The so-called Hopkins Methodology was state-of-the-art when it was first introduced in 2002. Since then, much has been done to advance that work and to even more effectively address issues that impact ROI, particularly regression to the mean. In fact, American Healthways has been working with customers, with leading actuaries in the field of disease management and with researchers at Johns Hopkins on this very issue, and we believe we have greatly advanced the science behind the methodology. This new way of measuring, which you will hear more about in the near future, accounts for the fact that the cost of care for populations moves differently across time.

This new approach will lower the ROI in some cases and raise it in others, and as long as you have programs that are designed, implemented and executed differently, you will have variability in outcomes. American Healthways has and will continue to expend significant time, effort and financial resources to both establish a baseline standard-the Hopkins Methodology-against which purchasers could evaluate the performance of any DM program and, further, to make sure that our outcomes consistently meet the rigor required for third-party validation and peer-review publication.