Single-source DM likely to increase as industry consolidates

Single-source DM likely to increase as industry consolidates

September 1, 2006

When it comes to health, bigger is not necessarily better. The term "morbid obesity" has become common vernacular in recent years, even outside of clinics and hospitals. But can bigger mean better when it comes to finding the best approach to managing DM? Two schools of thought preside in the health plan market today: Compile a stable of disease-specific vendors and coordinate them in-house (also referred to as "best-of-breeders"), or choose a single vendor to handle all the disease management programs.

When it comes to health, bigger is not necessarily better. The term "morbid obesity" has become common vernacular in recent years, even outside of clinics and hospitals. But can bigger mean better when it comes to finding the best approach to managing DM? Two schools of thought preside in the health plan market today: Compile a stable of disease-specific vendors and coordinate them in-house (also referred to as "best-of-breeders"), or choose a single vendor to handle all the disease management programs.

Mike Norris, assistant vice president of medical outreach for Denver-based Great-West Healthcare, believes that this is the best available option, in spite of the trend toward single-source solutions. "Of greatest concern for us is the quality of the clinical health outcomes we provide for our members," he says. "While reviewing and choosing multiple vendors can be a time-consuming and difficult process, the clinical quality of the program is always going to be the determining factor for us."

"Just as PCPs look at their members holistically, we try to see our members in the same light," he says. "Conditions such as asthma or chronic obstructive pulmonary disease (COPD) are really just a starting point...utilization and morbidity usually are driven by clusters of comorbid conditions, not just one. Our integrated approach, which we refer to as complex case management, reflects that belief."

That makes IT fragmentation one of the most important issues that healthcare payers need to address. There might not be a right or wrong answer to the "single-source vs. best-of-breed" debate, but an increasing number of experts lean toward the integrated approach, including Al Lewis, founder of the Disease Management Purchasing Consortium and a member of MHE's Editorial Advisory Board, and Jennifer Gaudet, a healthcare analyst with Forrester Research Inc.

According to Gaudet's report, plans that effectively implement an IHM strategy will be rewarded with: