Contracts may herald 'arrival' of disease management

National reports -A trio of business agreements announcedthis spring are indicators that the healthcare industry may befully embracing the concept of disease management to help lowercosts, improve care and focus on a "whole-person" approach toproviding patient care.

NATIONAL REPORTS -A trio of business agreements announced this spring are indicators that the healthcare industry may be fully embracing the concept of disease management to help lower costs, improve care and focus on a "whole-person" approach to providing patient care.

McKesson Health Solutions landed a contract with the state of Illinois to provide disease management services, while Healthways Inc. (formerly American Healthways) entered into alliances with a prescription drug benefits manager and a payer.


"This is the largest Medicaid contract to date, and the latest in the movement toward full disabled, 'bend-the-trend' management," says Al Lewis, founder and president of Disease Management Purchasing Consortium International in Wellesley, Mass., and a MANAGED HEALTHCARE EXECUTIVE editorial advisor. "It will touch more people than any other Medicaid contract but, more importantly, those will be the right people-the disabled population.

"The measurement metrics are also state-of-the-art, and the projected savings is the largest ever. Illinois should immediately join Wyoming, Georgia and Florida as the leaders in state Medicaid contracting."


Also in mid-May, N.J.-based prescription drug benefit manager Medco Health Solutions Inc. and Nashville, Tenn.-based Healthways announced a 10-year alliance on a project called Optimal Health, the first in a series of integrated wellness, disease management, high-risk care management and pharmacy management programs between the firms.

The alliance will target products and services to established Medco clients, which include health plans, employers and public sectors representing more than 55 million Americans. Programs initiated by the alliance will focus on:

Of particular importance to the alliance is targeting patients within the first 30 days of a potentially long-term, life-altering health event, when patients are more accepting of changing behavior to promote better health, according to studies. Prescription data also will be available immediately via the alliance, further speeding exchange of information.

"I think it's a great idea, and I hope more people do it," Lewis says. "The gap between when someone is eligible and when someone gets contacted by a program is often measured in months when it should be measured in days.

"I'm even amazed that organizations that do their own disease management and have their own pharmacy benefit and case managers can't coordinate quickly between the date of knowing about a member and the date of contact. A major-if not the major-readiness to change moment passes by unnoticed like a perfect wave on a deserted beach."


In late April, Healthways and CareFirst BlueCross BlueShield announced a three-year agreement to provide services including health promotion, disease prevention and disease management to CareFirst's 750,000 fully insured members beginning in July.

Disease management services provided to members by Healthways address diabetes, coronary artery disease, chronic obstructive pulmonary disease and asthma. Also included are health risk assessments and, if needed, tailored health and lifestyle coaching or electronic lifestyle interventions.

"Besides being the single largest private-sector award to date, the CareFirst-Healthways contract is the most innovative I've seen, truly taking a health plan to the next level," says Lewis. "It also contains the 'next-generation' measurement metrics to ensure a valid reconciliation."

CareFirst serves members in Virginia, Washington D.C., Maryland and Delaware.

Related Videos
© 2023 MJH Life Sciences

All rights reserved.