Disease management changes course to improve its outcomes

August 1, 2010

When disease management began, it just entailed a series of programs with a singular focus. Whether you had asthma, coronary artery disease, heart failure, diabetes or COPD, disease management programs managed only one chronic illness at a time.

When disease management began, it just entailed a series of programs with a singular focus. Whether you had asthma, coronary artery disease, heart failure, diabetes or COPD, disease management programs managed only one chronic illness at a time.

This narrow view was perfect if you only had asthma. But if you had CAD and diabetes, you were at a disadvantage. In 2000 about 125 million Americans had one or more chronic diseases-most people fall into the latter group. By 2006, 28% of all Americans had two or more chronic conditions. By 2030, half the population is predicted to have one or more chronic conditions.

Program participants didn't consistently show improvement in traditional DM, most likely because they weren't completely engaged. And while vendors could show ROI, many were searching for the most accurate way to calculate something that seemed fleeting. Today, the focus is on delivering value.

Some programs seemed to work, while others didn't. Overall, success was hit-or-miss.

The industry began looking at multiple chronic illnesses in an attempt to manage the whole person and create improved clinical outcomes. Nurses became more adept at examining the whole person-everything from housing to food availability to chronic illnesses. They directed participants to community resources that could help solve some of the problems that negatively impacted their ability to engage with the program.

The industry continued to work with providers to coordinate care and to help ensure that patients who had chronic diseases followed the established care plan. Vendors assisted and met with office staff and program participants.

Programs improved, but the care management industry still needed to make more progress.

Today, disease management is exploring ways that technology can improve care management programs through better member engagement and by providing value.

Problem: Health plans have concern about adapting to health reform while continuing to find new ways to reduce costs.

Solution: As more costs are shifted to members, health plans should look to less onerous ways to rein in costs. The industry is moving toward even more reliance on technology, especially finding new ways to engage members using a variety of technologies. Healthcare professionals remain crucial to the programs, but rather than being the primary contact they should work with the most complex cases.

Problem: Health plans struggle with disjointed care management programs.

Solution: Using large data stores to integrate claims, lab results, and provider- and member-entered information will help every care management program work more efficiently and effectively. In addition, plans need to invest in improving the access, navigation of and consistent look and feel of their consumer tools to mitigate program fragmentation and low consumer tool adoption rates.

Problem: The need to focus on the consumer and long-term, consistent member engagement.

Solution: Programs should take a more active role in promoting technology and social networking among participants. Expand the use of technology like social networks, one-on-one peer support, mobile applications and devices that allow members to automatically upload health data to the Web. Program communications should happen through member-preferred channels such as e-mail, chat, text, phone and/or Web sites. Finally, health plans must consider long-term member incentives and plan design that aligns with the goals of care management programs.

Problem: Programs must generate ROI.

Solution: Vendors, health plans and others are critical of ROI savings studies, mainly in the way savings are calculated. Today, everyone is looking more at how care management programs can demonstrate value for both the health plan and the member, while focusing on just a few critical clinical metrics. Vendors want to engage as many members as possible and see positive movement on specific health measures, especially those that help health plans improve HEDIS scores.

Problem: Providers remain skeptical and disconnected from care management programs.

Solution: Health plans need to engage providers in programs and integrate. Providers should lead the care team and with this responsibility pay-for-performance needs to be part of the program. Bidirectional information sharing through the provider's EMR can help close gaps in care and aid in their transformation to becoming a medical home.

Addressing these problems can have a real impact on cost savings for health plans and members, while increasing long-term member engagement and overall program effectiveness.

Kevin Maher is vice president of product marketing and management at McKesson Health Solutions, a provider of care management services to commercial and government payers.