Health Plans: DM's Struggle to Remain Relevant

Four ways disease management can reclaim a vital role in healthcare.

While employers and health insurers have been turning to higher copayments and deductibles as a way to control health costs, another area that once held promise is being given greater scrutiny.

Disease management, once trumpeted as a way to control costs and improve patient outcomes, has been the subject of a number of recent reports questioning whether it actually reduces health costs.

Industry trailblazer Bob Stone, executive vice president and cofounder of Healthways in Franklin, TN, says DM is back to the early days when industry leaders argued for the concept.

"The question whether disease management actually produces a positive ROI is the industry's Groundhog Day. This question will not go away and I, for one, an industry observer, don't understand the apparent need for self-flagellation on this issue," says Stone.

With so many questions swirling around DM, what can the industry do to remain relevant? Here are four ways.

1. Create a uniform outcomes methodology
The industry organization, DMAA: The Care Continuum Alliance, is working to create an outcomes methodology, which those in the industry say is critical for DM's success. Employers and health plans have grown more skeptical of DM programs, which means the industry will need to develop transparent tools that allow customers to know what they are getting from the many different types of DM programs.

Stone says part of the problem is that gauging ROI for one disease state is simple, but patients involved in DM programs often have comorbidities, which complicates finding accurate ROI.

"In the absence of that, there is no meaningful way to distinguish real outcomes to those that are byproducts of the methodology," says Stone. "I hope that everybody recognizes that in most industries a single agreed-upon set of standards advances the industry's objectives and doesn't diminish competition for artificial reasons. It in fact enhances it for all the right reasons," says Stone.

2. Care for the person, not the disease state
People are more than their diseases, and the industry has learned it must treat the whole person. For instance, a person with diabetes might have hypertension and depression, which means the DM company will have to tackle those issues at the same time.

"One thing that is key is to start thinking of more personalized interventions," says Bryce Williams, director of prevention and wellness at BlueCross BlueShield of Massachusetts in Boston. "That's thinking about an individual approach rather than a disease-state approach."

Ted Dacko, president at HealthMedia in Ann Arbor, MI, says health management companies must combine population health with disease management, wellness, and behavioral health to offer seamless solutions. Having all under one roof, rather than a health plan or employer contracting with two or three companies to offer the services, allows individuals to "wander freely between issues in any category," he says.

"The user controls where they go, not the buyer, not the vendor," says Dacko.