Leaders take DM from concept to reality: Part 2

In this second installment of the Top Disease Management Leaders, the basic selection criteria remain the same as in part 1. However, this month’s candidates also must meet other standards: endorsement by their peers–election to DMAA leadership posts; recognition through honors such as the DMAA’s Karen Coughlin Award for Outstanding Individual Achievement or by the marketplace as illustrated by selecting the CEOs of the largest DM firms or consultancies; or, in one case, by all three.

George B. Bennett

Chairman/CEO, Health Dialog Services Corporation

Boston, Mass.

Bennett co-founded Health Dialog in 1995 after successful tenures with three other companies, including starting Bain & Company…Qualifies for Top 10 on MHE’s  DM leadership list…Serves on the DMAA Board and on three of its committees…Health Dialog developed the Collaborative Care program to support patients across the entire healthcare spectrum…Invented the Shared Decision-Making model, utilizing health coaches to empower patients to more fully engage in their healthcare…Promotes technology–evidence-based software to identify and support patients with multi-chronic diseases…Grown to one of top three largest DM companies.

In 2001, Health Dialog helped Highmark develop Blues on Call, a program that emphasizes the whole person care management approach, which became key to Medicare’s Voluntary Chronic Care Improvement Program. It combines shared decision-making, health coaches, streamlined services and support for all of a patient’s healthcare needs, including chronic conditions and preference-sensitive decisions.  The program enables Health Dialog to access Highmark’s real-time data, resulting in seamless member interactions, post-hospital discharge calls to members with chronic disease and employer support.

Health Dialog is one of the first DM companies to receive certification for HIPAA Business Associate Privacy Compliance from NCQA and JCAHO. It is fully accredited by NCQA for coronary artery disease (CAD), diabetes, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) for members and providers.

Health Dialog is a 2004 winner of American Medical Writers Association Neil Duane Award for Outstanding Medical Communication, the National Health Information Merit Award and the National Mature Merit Award. 

Bennett has made numerous presentations and written a variety of published articles on disease management and innovative approaches to treating disease.

Jack Lord, M.D.

Senior Vice President/Chief Innovation Officer, Humana

Louisville, Ky.

If this list were based totally on firsts, Dr. Lord might be #1…First senior executive to transition from vendor side to payer side…Humana was the first payer to highlight DM in its annual report…First to institute chronic kidney disease management…First to implement personal coaching to help members at high risk develop a customized action plan…First to develop its own patent-winning predictive modeling system…Earned the Disease Management Purchasing Corsortium’s designation of “very top tier” of all HMOs in 2001.

Al Lewis, founder of DMAA, calls Dr. Lord “one of the three great visionaries in the field,” and predicts that the industry has just seen the beginning of what Humana and Dr. Lord have in mind. Humana’s new Chronic Kidney Disease Program, which targets members with high-acuity kidney disease, coordinates resources across the entire health care delivery system and life cycle of kidney disease, including patient and provider education, early referral to a nephrologist, psycho-social support and the prevention and management of associated comorbidity complications.

The insurer developed a Personal Nurse Service two years ago, which supplements its DM programs for individuals at risk of significant future health expense.  Registered nurses help members develop personal action plans and gain control over their healthcare. Outcomes indicate reduction in emergency room and hospital visits, more visits to the physician, an increase in pharmacy use, better compliance with physician-recommended care and 95 percent satisfaction. All of Humana’s DM programs are accredited by NCQA and/or URAC.

Dr. Lord is past president of DMAA, a current board member and recipient of its Karen Coughlin Individual Disease Management Leadership Award.

Samuel R. Nussbaum, MD

Executive Vice President/Chief Medical Officer. Anthem, Inc.

Indianapolis, Ind.

Multistate Blue with the greatest commitment to DM under Dr. Nussbaum’s leadership…Only commercial health plan which has undertaken the kind of large-scale prospective controlled trials endorsed by CMS…The results: average medical costs decreased 13% compared with members enrolled in standard DM programs…Nationally recognized by Harvard Medical School as one of the best Blue Cross Blue Shield Association programs that improve the affordability of healthcare…Outgoing DMAA president.

Anthem’s DM programs, most of which have been developed by its subsidiary Health Management Corporation, rely on two strategies to prevent health problems from escalating–identifying patients on the basis of a specific diagnosis and designing treatment regimens providing optimal clinical care, and identifying members based on their current medical condition, predicting their future need for medical resources and developing highly customized care management services.

Through the Anthem Care Counselor program, using trained nurses to oversee treatment plan compliance, members with diabetes and CAD show improvements in managing their diseases. Other DM programs for diabetes, asthma and CAD have resulted in overall cost savings of $1.43 per member per month. Its DM programs for asthma, CHF, diabetes and CAD are accredited by NCQA. Anthem earned the Best Disease Management Program for Medicare from DMAA in 2003, and its Baby Benefits maternity management program won the 2003 AAHP/Wyeth HERA Silver Provider Award.

Dr. Nussbaum played a key role in introducing care coordination and DM into the Medicare Modernization Act (MMA) of 2003.

William C. Popik, MD

Senior Vice President/Chief Medical Officer, Aetna

Hartford, Conn.

Visionary and chief mover behind Aetna’s DM programs, enhancing the insurer’s competitive position and visibility among large self-insured employers…Offers the country’s largest “hybrid” DM program, partnering with LifeMasters on heart failure and diabetes while developing its own programs for coronary disease, asthma and low back pain…Comparable programs in scope and intensity to those Aetna outsources…Won DMAA’s “Best DM Program in Managed Care” in 2003…Worked closely with Congresswoman Nancy Johnson (R-Conn.) to develop DM provisions for Medicare…Serves as DMAA secretary; is president-elect for 2005-06.

Aetna relies on  homegrown programs for CAD, asthma and low back pain and on the expertise of LifeMasters for CHF and diabetes and on Optimal Renal Care for ESRD. It employs a variety of techniques to deliver DM, including patient education, population and pharmaceutical management, predictive modeling and technology.

Aetna’s award-winning Healthy Outlook “Caring for Chronic Heart Failure” program has resulted in fewer emergency room visits, shorter hospital lengths of stay, lower costs and better compliance with appropriate drug regimens. All of Aetna’s DM programs with LifeMasters and Optimal Renal Care have received full accreditation from NCQA.

Christobel  E. Selecky

Executive Chairman, LifeMasters Supported SelfCare, Inc.

Irvine, Calif.

Grew LifeMasters into the fourth largest DM company…Recently promoted to new position as executive chairman…Elected 2005 DMAA president…Served on DMAA Governmental Affairs and Health Policy Committee since 2000…Key figure in ensuring inclusion of DM in the Medicare Modernization Act, creating a $5 billion to $10 billion opportunity over the next five years…Overtured highly unfriendly DM legislation in California, introducing DM to the California Medicaid program…Shaped the Chronic Care Improvement Program…Received DMAA’s Karen Coughlin Individual DM Leadership Award in 2004…Serves on the Robert Wood Johnson National Advisory Committee of eHealth Technologies.

LifeMasters’ innovative Active Intervention Model (AIM), a next generation program for delivering DM services, develops customized, evidence-based intervention plans for individuals. Sophisticated database technology produces patient indicators, including clinical symptoms, laboratory results, utilization patterns, psychosocial factors and self-care practices. 

LifeMasters has a number of prestigious awards to its credit: DMAA’s “Comprehensive DM Company Leadership” award in 2004, AstraZeneca-National Managed Health Care Congress Partnership Award along with Florida’s Agency for Healthcare Administration for reducing Florida’s Medicaid healthcare costs by $12.6 million; and DMAA’s “Best DM Program” award for Aetna’s Healthy Outlook CHF program in 2003. The DM company also is a six-time Health Industries Research Companies (HIRC) award-winner.

LifeMasters holds full patient and practitioner-oriented accreditation from NCQA for five of its DM programs.

Bob Stone

Executive Vice President/Co-founder, American Healthways

Nashville, Tenn.

If MHE attempted to rank everyone on this list instead of alphabetizing them, Bob Stone would appear in the very top tier and no one would argue the point…Served as DMAA’s fifth president and first from the vendor community…An original DMAA board member and tireless committee chair…Dedicated his own time on a volunteer basis and more of his organization's money to DMAA than anyone. 

Not to be overlooked is Stone's vision for American Healthways, formerly Diabetes Treatment Centers of America. Years before American Healthways became a darling of NASDAQ, it was a small but stagnant company selling to hospitals.  The decision to transition to the new business of DM was highly unpopular with some shareholders, as the company spent money with no ROI for several years. Despite strong opposition, Stone, co-founder of the company, stuck to his decision which has richly rewarded loyal shareholders.

American Healthways not only targets common chronic diseases, but also addresses conditions such as acid-related disorders, atrial fibrillation, inflammatory bowel syndrome, osteoporosis and urinary incontinence. In addition, American Healthways provides care management services to the 0.5% to 1% of health plan members who are of highest risk for imminent acute and high-cost health episodes.

Its unprecedented 10-year partnership with Blue Cross and Blue Shield of Minnesota (BCBSMN), delivering 17 DM programs to plan members, has resulted in savings of $35 to $50 million during the first year, bending the overall health care cost trend by 200 to 300 points. Using a total population approach, American Healthways delivers an entire suite of programs to nearly 20% of BCBSMN members.

American Healthways is the first DM organization to be accredited by all three governing bodies–JCAHO, NCQA and URAC–and its programs have been reviewed and approved by Johns Hopkins. The DM company is the recipient of the 2004 AstraZeneca-National Managed Care Congress Partnership Award for its collaborative program with BCBSMN.

Stone has made numerous presentations on the value and measurement of DM at national conferences. Like many of his peers, he lobbied on behalf of the industry for inclusion of DM in Medicare reform and helped influence the creation of the Chronic Care Improvement Pilot program to be launched in 2005.

Warren Todd

Executive Director, DMAA

Washington, D.C.

“No one in the early days put more uncompensated effort into making DMAA successful,” says Al Lewis, DMAA founder…DMAA past president, founding board member and now day-to-day strategist…Put DMAA and DM on the international map… Published first book on DM, Disease Management: A Systems Approach to Improving Patient Outcomes, in 1997…Developed one of the first asthma DM programs with National Jewish…Facilitated changes in HIPAA legislation, waiving DM programs from restrictive privacy rules…Helped push legislation to integrate DM into Medicare…Received the DMAA excellence award for the “Most Influential Individual in DM” in 2001.

Todd has been involved with DMAA since its inception in March 1999, assuming the full-time position as executive director in 2002. He has shared his expertise in DM with healthcare leaders worldwide to develop their own programs. Besides his international involvement in DM, Todd has served as a consultant to several pharmaceutical companies–Pfizer, GlacoSmithKline, Merck, Novartis and Roche–and to other clients.

His1997 book on DM is recognized as the premier book on the topic, selling more than 10,000 copies in hard cover. One of his greatest accomplishments has been creating an organization and board of directors that has become a “who’s who” in the U.S. healthcare market. 

Richard P. Vance

President/CEO, CorSolutions Inc.

Rosemont, Ill.

Made successful transition from buy-side (Humana) to vendor side…Nurtured growth of CorSolutions into third largest DM company with unique focus on self-insured employers…Transformed company into a customer-centric health intelligence and solutions company…Introduced real-time reporting package craved by employers and benefits consultants…CorSolutions has been honored by DMAA three times for DM leadership and programs...Led CorSoultions to become first privately held DM company to earn full patient and practitioner accreditation from NCQA.

Targeting more than 30 conditions, CorSolutions manages more than 700,000 program participants using a holistic, integrated suite of services, from wellness and prevention to acute, chronic and specialty/complex care. A key component of CorSolutions’ DM programs is patient education utilizing proven clinical best practices and interventions based on nationally recognized guidelines, including nutrition, exercise strategies, stress management, smoking cessation, early symptom identification and appropriate medication and treatment regimens.

Vance is a frequent lecturer on DM and has contributed many articles, sharing his industry knowledge and insight. He has served as a DMAA board member since 1998, and as chair of the accreditation committee during the development of industry accreditation strategies. DMAA awarded him a special recognition award for leadership in accreditation in 2001.

CorSolutions’ leader developed policy for DM demonstration projects with the U.S. Congress and CMS and consequently, the company has been granted demonstration projects from CMS and the Department of Defense.

Victor Villagra, MD

President, Health & Technology Vector, Inc.

Farmington, Conn.

One of two multiple award winners for DMAA's Karen Coughlin Individual DM Leadership Award (2001 and 2003)…As national medical director for strategic medical affairs at CIGNA, one of the first health plan executives to embrace DM…Early proponent of "population-based" approach rather than focusing only on high utilizers…Built CIGNA's program with American Healthways into the largest single vendor relationship in the field…Served as third president of DMAA…Published three major top-tier, peer-reviewed papers in 2004.

Along with his two Karen Coughlin honors, Dr. Villagra was a 2004 nominee for DMAA’s “Individual DM Leadership” award for his commitment to population health, his promotion of DMAA initiatives for inclusion into the Medicare and Medicaid benefit, development of standards of measurement for DM and his long-term contributions toward shaping the DM industry.

His insightful paper, “Integrating Disease Management Into the Outpatient Delivery System During and After Managed Care,” which appeared in Health Affairs this year, is one of many published articles.  He collaborated with others in the development of last year’s Health Care Leadership Advisory Council on “The Role of Disease Management in Reducing/Eliminating Disparities in Health Care.”

Paul Wallace, MD

Executive Director, Kaiser Permanente Care Management Institute (CMI)

Oakland, Calif.

One of the field's least known but most effective stalwarts…Long overdue

winner of the DMAA Karen Coughlin Individual DM Leadership Award (2003-04) and the 2002 “Improving Chronic Illness Care Vision” Award…As a nonprofit exclusive group arrangement with mostly premium-based customers, KP tends to be somewhat quieter in the marketplace than the large, publicly traded national plans… Started doing DM before most health plans could even define the term.

All KP regions are aggressively enrolling and supporting many adult members with diabetes in the delivery of aspirin, lisinopril and lovastatin, based on a predictive modeling program that projects substantial reductions in cardiovascular events and cost savings within one month for this population at increased risk for cardiovascular complications. The program integrates population management and primary and specialist care, supported by clinical data reports and alerts and reminders for clinicians.

CMI received certification as an early adopter in the NCQA DM program and was recently recertified for diabetes, asthma, depression and CHF. A frequent lecturer at healthcare conferences, Dr. Wallace serves on the DMAA board and on the board nominating committee.

CMI earned the 2003-04 DMAA Award for the “Best DM Program-Managed Care Organization” and an honorable mention for the C. Everett Koop National Health Award for 2004.

Alfred Lewis

Founder/president, Disease Management Purchasing Consortium (DMPC)

Wellesley, Mass.

Editor’s note:

When MHE decided to produce this DM list of honorees, we immediately turned to Al Lewis, DM guru and member of our editorial advisory board, for his suggestions and selection criteria. As a member of our board, he was specifically asked not to nominate himself for this list because that could be a conflict of interest for him.

Fortunately for everyone involved, it’s not a conflict for MHE editors. Excluding someone of Al Lewis’ status and accomplishments from this list would be grounds to call its legitimacy into question. His name appears on this list, but not because he’s an MHE advisor. Rather, he’s an MHE advisor because his name belongs at the top of any list of influential and groundbreaking DM luminaries.

-- The editors

 Lewis could easily be viewed as "first among equals" in this listing … According to Disease Management News, he is the acknowledged guru of DM outsourcing … Founder of DMAA and namesake of its Alfred B. Lewis President's Award, which has been presented to Tom Scully, Rep. Nancy Johnson (R-Conn.) and Tommy Thompson … Two-time winner of DMAA's Karen Coughlin Individual DM Leadership Award … Named "most influential person" in the field by virtually every poll, corporate annual report, and trade publication  … Serves as president of the Disease Management Purchasing Consortium, the broker/consultant of choice for most health plans, states and, increasingly, employers for DM strategy and procurement … DMPC is the unofficial leader in ROI measurement and the only entity to offer certification for payers, whose ROI calculations are deemed valid … Holds two Harvard degrees (phi beta kappa) and is currently a Visiting Scholar at The Heller School for Social Policy, Brandeis University.