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Health Plans: DM's Struggle to Remain Relevant
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3. Use technology for better self-management
Though the DM industry was built on the nurse call center model, many now suggest there may be more cost-effective ways to improve health.
"The modality used to deal with these people is wrong," says Dacko. "It's a warehouse full of nurses or people working from home, but it's a modality that is a very expensive one to deliver."
There is also the issue of nurses specializing in specific disease states and then needing to transfer patients to other call center staff to help the person with other diseases.
In response, some population health management companies are turning to more cost-effective ways to deliver care. HealthMedia, for instance, has a self-management digital coaching program that looks to empower individuals to take better care of their health through interactive programs that offer a health coach or counselor.
4. Work with docs in the medical home
Disease management has often been seen as an interloper in healthcare.
"I think one of the major weaknesses and the biggest challenges we have had is we have always been outside the doors of the physicians' offices," says Mary Jane Osmick, MD, vice president and medical director at LifeMasters Supported SelfCare Inc. in Irvine, CA.
The industry is trying to change that now by promoting its importance in a medical home model, working with providers to help care for patients in between office visits. This is quite different from the current disease management model, which features DM companies contracting with insurers and employers. But DM advocates think being part of the medical home would show the doctors how DM is valuable to healthcare.
"When physicians, health plans, and disease management companies are fully aligned, the focus will be to support the physician's plan of care and meet the patient needs," says Osmick about the fractured nature of care.
—Les Masterson
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Gorman Kitornsky (11/4/2009 at 2:07 PM)
Different buyers have different timelines for DM benefits to accrue, and program design, technology and benefit design count. Programs with biometric devices like COPD and CHF have an entirely different value proposition than those who are 'behavior change' centric like CAD and DM.
The farther you get from managing / mitigating actual care delivery (steerage, ER avoidance, etc.) the harder the value proposition and the longer the time commitment...the amputation, the kidney disease, the blindness are all years away from the sweet spot of intervention...and a thousand "smart, but tough choices" away on the part of the member.
A close friend of mine runs the school nutrition program for one of the largest school districts in the Atlanta area, and told me an anecdote of a kid who just this week TOPPED OFF his free, nutritious lunch choice from school with a #1 from McDonalds and a McFlurry, delivered by his overweight mom sitting next to him in the lunchroom...oy vey is all I can say...
Until Washington allows Payors and Health Management companies to take the shackles off and make people feel the impact of their cumulative behavior NOW vs. LATER, we're missing the entire catalyst for the entire equation...member behavior...with no incentive for most people to behave differently other than pending death or dismemberment, DM companies are left with nothing but nice nurses attempting telemarketing...
But pressing for personal accountability and allowing the 'villains' to write benefits structures that actually get people off their rumps to take care of themselves doesn't get a democrat reelected to Congress or the Presidency...better to demonize an entire industry...imagine what you might see when you allow an insurance company to escape the (admittedly shortsighted but pragmatic) fear that their investment in a Diabetes program will accrue on someone else's books after the member's employer pulled their business because some consultant at Mercer toted some cute 'best in market' spreadsheet jockey network analysis out and broke up their momentum with the member?
America...she's getting what she's paying for...who's gonna stand up and say what needs saying????