Disease management moments: Al Lewis is passionate about DM

For a growing number of providers, plans and other organizations in the healthcare industry, disease management is indeed an idea whose time has come-and Lewis, founder and president of Disease Management Purchasing Consortium International (DMPC) and MHE Editorial Advisor, is credited by many as being a "Johnny Appleseed" who's taken it upon himself to plant and nourish the disease management concept.

The Disease Management Association of America, which Lewis founded seven years ago, defines disease management as "a system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant." Disease management, says the association, "supports the physician or practitioner/patient relationship and plan of care; emphasizes prevention of exacerbations and complications utilizing evidence-based practice guidelines and patient empowerment strategies; and evaluates clinical, humanistic and economic outcomes on an ongoing basis with the goal of improving overall health."

Lewis, 49, founded DMPC in 1996. Prior to that, he served as chief executive officer of Peer Review Analysis Inc. and executive vice president of InterQual Inc. (now part of McKesson). He earned undergraduate and law degrees from Harvard University, Phi Beta Kappa, and a visiting scholar appointment at the Heller School for Social Policy at Brandeis University.

In December 2004, Lewis was designated No. 1 on Managed Healthcare Executive's overall list of the Most Influential People in Disease Management, and four years ago, Managed Healthcare Executive credited him with "inventing disease management."

Q. There must be reasons why you've been such a champion of the disease-management concept in the healthcare industry. Why do you feel so strongly that disease management is, as Victor Hugo put it, "an idea whose time has come?"

A. Plenty of people advocate for prevention, but for a private organization, the numbers aren't really there to go out and do primary prevention. Primary prevention is a public-health issue. My value-added for the DM field-and what makes it 'an idea whose time has come'-was to identify areas where prevention would be cost-effective for an insurer and also to measure that cost-effectiveness and get the vendors to guarantee it. It turns out that so-called secondary prevention-prevention in very high-risk people-is indeed quite cost-effective for a private payer.

Having now participated in many reconciliations, I am, if anything, even more passionate about DM. Time after time, one sees ROIs of 1 to 1.5 or higher, and you're getting these ROIs by making people healthier and more productive-a true win-win for everyone.

Q. How successful have you been in getting industry institutions and organizations to buy in to the concept of disease management? In other words, what's in it for them?

A. To paraphrase George Stephanopoulos, 'It's the economics, stupid.' Quality by itself doesn't sell-the CFO needs to approve these budgets, and they won't do that if they don't see an ROI.

My experience is quite consistent: If I can convince a payer that the economics are there, they will do disease management.