More on HMO disease management programs

April 1, 2006

HMO-offered DM programs are in transition, according to Art Taft, president of MedWorks, a DM consulting firm in Greensboro, N.C.

HMO-offered DM programs are in transition, according to Art Taft, president of MedWorks, a DM consulting firm in Greensboro, N.C.

"The measured evidence suggests that these programs are providing positive results, but the difficulty in calculating the exact benefit make an absolute conclusion unlikely," Taft says. "To date, HMO executives have apparently decided to focus generally on disease states with defined NCQA requirements that ensure that the programs produce definite value, albeit in plan accreditation or in higher HEDIS measures." However, this situation is about to change, Taft says. "Patient-centered care models have always been challenged by patients with more than one chronic condition," he says. "There has also been a continuing overlap between disease management and other HMO services including nurseline services, case and utilization management, employee-assistance offerings, lifestyle programs and Web services, to name but a few. This combination of medical management services is both inefficient and ineffective. Patients can become confused when they are engaged by multiple HMO offerings, the messages provided by the different services may be inconsistent, and the cost of maintaining and managing these different infrastructures is not insignificant."

Employers are asking HMOs to build an integrated care management infrastructure, according to Taft. "These environments will use one information system infrastructure that coordinates all of a patient's care issues, whether they have a chronic illness or a acute event-or both," he says. "HMO executives should realize they are being asked to step up to the plate and truly manage patient care for the long term." "In the future, we'll see DM entities becoming more involved at the employer level to offer new and innovative offerings around less chronic disease states, as well as new methods of home monitoring and interaction," according to Thomas Young, MD, senior vice president, corporate medical director for Connextions Health, an Orlando, Fla.-based provider of integrated healthcare services solutions.