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DM to the rescue?

Countries look to United States for chronic disease programs

With the rest of the world facing many of the same chronic diseases as the United States, DM organizations have stretched beyond this country’s borders to help other nations fight life-threatening ailments.

A month doesn’t pass without at least one U.S. DM company announcing a global expansion. Over the past few months alone, Aetna Global Benefits (AGB) announced it was making its DM services available to international members, U.S. Preventive Medicine promoted its expansion to the United Kingdom, and Health Dialog added France to its international work in the UK and Germany.

Martha Temple, AGB president, says other countries are facing similar health issues as the United States. “Chronic diseases are increasing throughout the world. Every system is feeling the strain of chronic disease,” Temple says.

George Bennett, chairman and CEO at Health Dialog, says the idea of health management has taken hold. People now see that the patient’s care outside the physician’s office is a critical piece of healthcare. “The idea has emerged now and is alive all over the world,” he says.

Health Dialog

One of the leaders in the international—as well as U.S.—DM space is Health Dialog, based in Boston. Health Dialog opened its first international office in the UK in 2005 when the company won a predictive modeling contract with the UK’s National Health Service (NHS). After laying that foundation, Health Dialog worked with the country’s Primary Care Trusts (PCT), geographic units that provide healthcare, to establish telephonic support for chronic diseases.

Although there were initial concerns as to whether the reserved British would open up about their health via telephone, Bennett says that has not been a problem. “We are finding that interest in telephonic support seems to be fairly universal,” he says.

Bennett says the company provides many of its U.S. offerings to UK consumers as well. Health Dialog is one of 14 companies that qualified for NHS’ Framework for procuring External Support for Commissioners (FESC), which is a federal stamp of approval that allows PCTs to choose from government-approved companies. Bennett says working with the trusts and UK government is not a large departure from dealing with the myriad U.S. health plans, because no U.S. client provides the same services in the same way.

“It was business as usual for us to do an adaptation of that,” says Bennett. “Health Dialog’s characteristic is to always figure out where the client is and meet them there. We are a pretty adaptive bunch.”

In Germany, Health Dialog is not employing its own nurses but providing programming and training for German companies employing nurses.

“Basically, the German model is to support them in their efforts, where they supply the labor and we are supplying the intellectual property in the form of software and analytic insights to help them, which seems like a good model for us in the non-English-speaking countries, at least in the short term,” says Bennett.

Health Dialog continued its international expansion in February with the announcement that the largest primary care health insurer in France had selected the Boston company to support France’s first whole-person care management pilot program.

Caisse Nationale de l’Assurance Maladie de Travailleurs Salaries (CNAMTS), which covers 85% of the French population (about 50 million lives), will target 136,000 diabetics living in 10 of the country’s 97 departements, which are political and geographic areas in France.

Health Dialog will provide CNAMTS with services and methodology for developing and implementing a program that will include DM, decision support, and general health and wellness. The U.S. company will train CNAMTS nurses, who will provide telephonic health coaching. Accenture, a global management consulting, technology services, and outsourcing company based in Paris, which previously worked with Health Dialog in Germany, will assist in the implementation of support materials and outreach efforts that require translation and customization.

Bennett says Health Dialog’s expansion isn’t over yet. The company is also speaking with representatives from Japan, China, Canada, Australia, and Switzerland. Health Dialog is primed for further growth with British United Provident Association’s (BUPA) recent purchase of the company. The UK’s leading provider of private healthcare insurance and services, BUPA has facilities in 18 countries, with international employees who coordinate services in 180 to 200 countries. In fact, the majority of BUPA’s revenue comes from outside the UK, says Bennett.

Bennett says BUPA has “an enormous presence and experience adapting to other countries.” Having BUPA as its owner will enable Health Dialog to extend to other areas, he says.

Although Health Dialog continues to look beyond the nation’s borders, Bennett says the company’s priority is still the United States. “The U.S. will be our principal focus, but we are now working out an international expansion plan, and the intent is how fast can we grow internationally without distracting the U.S. resources,” he says. Bennett expects DM to continue to stretch across the globe, as well as become a larger aspect of U.S. healthcare. “Worldwide services for care management is embryonic but promises to be enormous over the next 10–15 years. The U.S. is going to be much bigger as well,” says Bennett.

Aetna Global Benefits

AGB, which is the largest U.S.-based provider of expatriate benefits, recently announced it is providing its DM services to international members. AGB is focusing on the ailments that officials have found most prevalent in the expatriate population: diabetes, coronary artery disease, and asthma. “We are seeing that members are now more willing to travel the world with chronic diseases they have under control or a family member [who] has a chronic disease,” says Temple. “We’re seeing a rise in those diseases within our population.”

AGB is working with Aetna domestic to take advantage of the latter’s tools. The international arm of Aetna is taking that information, translating the materials, and making changes relative to a country’s standards of care.

In addition to the expatriate DM program of 350,000 members, AGB has a relationship with the NHS in the UK and has been approved as a provider within the FESC. AGB works with PCTs to help them analyze care management programs. Aetna has a UK office of approximately 20 people. In 2007, the company purchased Goodhealth Worldwide, an expatriate carrier with locations around the world, to complement its business. “What we are finding is that programs we have developed in the U.S. are applicable around the world,” says Temple.

U.S. Preventive Medicine

While the above two companies have laid roots outside this country, U.S. Preventive Medicine is just now looking to expand to the UK from its new headquarters in Jacksonville, FL. Frederic Goldstein, president and COO at U.S. Preventive Medicine, says the company plans to open the Centers for Preventive Medicine with iHealth UK Ltd. in that country.

In addition, U.S. Preventive Medicine purchased Specialty Disease Management Services in late 2007, which Goldstein says will help the company in its expansion.

“That gave us obviously a much more solid platform to build on in the experience that we can take to these countries and show them demonstrated results and success,” he says.

Goldstein says the UK is a prime area for DM programs. The daily newspapers feature articles about childhood obesity, and Prime Minister Gordon Brown has made converting the country’s health system to more of a prevention model a priority.

Goldstein says DM is resonating globally as nations face chronic diseases similar to those in the United States. Countries see that U.S. DM programs could help them with their health problems.

“Many of these government-funded programs have struggled because of bureaucracy or the ways the system is set up. [DM programs] are free-market ideas that could help them out,” says Goldstein.

Socialistic systems welcome DM

DM companies that have expanded beyond U.S. borders have found a welcoming home in countries with socialized healthcare programs.

A benefit to working with socialized programs is that DM companies don’t have to promote their programs to many health plans and employers. George Bennett, chairman and CEO at Boston-based Health Dialog, says those systems allow a company to work with an individual governmental department. Plus, a government is more apt to take a long-range view of a DM program than an employer, who may want immediate results.

“I think the socialized medical systems are a better environment to learn how to do longitudinal population health management than the U.S. is,” says Bennett.

Some examples of socialized healthcare systems are in Canada, Israel, and Cuba, but the country that has reached out the most to U.S. DM companies is the UK. Fourteen companies received the country’s stamp of approval with the designation of Framework for procuring External Support for Commissioners. The designation allows the UK’s Primary Care Trusts to choose from those companies without having to conduct exhaustive research into the background of each.

Frederic Goldstein, president and COO at Jacksonville, FL–based U.S. Preventive Medicine, whose company is expanding into the UK, believes U.S. DM companies and socialized healthcare systems can create a healthy marriage. “I think I see more interest from both sides. They’re interested in some of the techniques and approaches in the U.S., in addition to U.S. DM companies’ interest in trying to meet that need,” says Goldstein.

Whether a socialized system is best remains one of the most heated debates in healthcare, and the DM companies involved in international projects are not taking sides. Instead, Bennett says foreign socialized healthcare programs work well with DM. “I think the socialized medical systems are one of the biggest boons to U.S. DM,” he says.