DM's Future is in Technology

Les Masterson, for HealthLeaders Media, October 29, 2008

Disease management's future is not in call centers, but in a convergence of DM, physicians, and technology. That technology includes remote patient monitoring, patient registries, electronic medical records, and personal health records.

Early pioneers in this technologically advanced DM met this week at the Center for ConnectedHealth's conference at Harvard Medical School and showed how DM, physicians, and technology are coming together. Their thesis: Greater connectivity will transform healthcare.

DM leaders know that the only way DM can work is if technology is integrated into their programs. DM/population health is no longer considered the enemy by forward-thinking physicians and health leaders. Instead, they realize that DM can be an effective member of the care team.

As this convergence continues, DM and technology will ultimately go hand-in-hand, and technological companies will take a greater role in disease management leadership. But that's in the future. Let's talk a little about the present. Here are four subjects discussed at the conference:

Medical home

One of the first questions DM companies ask about the patient-centered medical home is: Is there a place for disease management in the medical home?

The short answer is yes, because DM companies have experience in remote patient monitoring, call centers, and health coaching, which are complementary in the medical home. The change for DM is the companies will contract with physicians (either individually or in geographic groups) rather than health plans.

Though physician and DM groups support the concept, I still expect some physician resistance. The relationship between DM and physicians remains cool after years of DM bypassing doctors, and it's going to take plenty of collaboration before the relationship thaws.

Groups like the DMAA: The Care Continuum Alliance have built bridges to physician organizations, but one has to wonder how long it will take for most physicians to view DM/population health as part of the care team rather than a third wheel.

And then there are the questions about whether the medical home can even work. CMS is planning a demonstration project that will gauge the effectiveness of the medical home in the Medicare community.

Medical home advocates trumpet reported successes, including a North Carolina medical home project. One of DM's pioneers, Al Lewis, president of the Disease Management Purchasing Consortium, was not so sure about the medical home. He said the North Carolina study is flawed and called it a "shrine to regression to the mean." Lewis added medical home supporters can back the medical home because it improves quality, but should stop claiming that it will save money.

"It sounds good on paper, but when you do the math, it simply doesn't work," says Lewis.

Future of DM

DM has had a rough year. It's been under attack from various sides: CMS ending the DM-inspired Medicare Health Support (MHS) demonstration project, Healthways' stock nose-diving, studies questioning whether DM is worth the investment, and DM companies changing their focus from chronic disease to a larger population health improvement model.

Lewis said the MHS project was doomed to fail because of CMS' project design, and Gordon Norman, chairman of DMAA: The Care Continuum Alliance, said it is too premature to know whether MHS was a success or not. In fact, CMS' preliminary performance report only included the project's first six months and that is not long enough to know what worked and what didn't.

"The real question is who did and who did not benefit from these pilots? That is what will be interesting," said Norman.

So, what's the future of DM? Norman suggests a hybrid of call centers, Web applications, wireless communications, and face-to-face meetings with both clinical and non-clinical staff.

Election talk

With the presidential election next week, politics was a popular topic at the conference. Most polls are showing a Democratic win for both the White House and Congress. So, what would happen to healthcare in an Obama presidency?

Troy Brennan, MD, MPH, chief medical officer at Aetna, predicted an Obama administration would move healthcare away from the Republican idea of a consumer-driven model to a government-backed solution. Brennan suggests Obama will first tackle the nation's uninsured problem, which will include government program expansion. Greater government involvement will not kill innovation. Entrepreneurs will simply deal more with the feds rather than commercial entities, he said.

As an example of how the feds can spark innovation, Mariah Scott, worldwide director of digital health group at Intel Corporation, pointed to the Department of Veterans Affairs, which is a leader in the areas of electronic medical records and telehealth.

Consumer-driven healthcare

One of the leaders in the consumer-driven healthcare movement, Regina Herzlinger, spoke via video conference to the healthcare leaders. Herzlinger, the Nancy R. McPherson professor of Business Administration at the Harvard Business School, said policymakers should see healthcare consumerism through the prism of global competiveness.

Healthcare is sapping dollars away from mega companies like GM, which are struggling to compete against foreign carmakers.

If the country moves away from its employer-based system, what will the future look like? Herzlinger said the country's future is not in a single-payer system, but one that is consumer-based. Consumerism doesn't mean simply high-deductible plans with health savings accounts. Herzlinger's view of consumer-driven healthcare includes health plan variety that will allow members to choice between copays, deductibles, and personalized medicine options.

Herzlinger says consumer choice is good for the individual and sparks innovation and she points to a number of new movements that help the consumer: concierge medicine, medical home, and retail clinics.

A key to greater consumerism is in sharing information. Herzlinger says greater transparency is a way to drive consumer-driven healthcare.

However, both Herzlinger and Emad Rizk, MD, president of McKesson Health Solutions, raised the issue of whether consumer-driven healthcare can work in the underprivileged population, and this is one of the most important takeaways from the event. How do we improve care and lower costs for the poor and uneducated population?

As a consumer, I am excited about the opportunities in a fully-integrated consumer-driven system, but I wonder how much it can actually decrease costs if the most vulnerable are not actively engaged. I'm also looking forward to seeing the results from medical home demonstrations and interested to see how DM and technology converge into a larger industry.

Will any of these initiatives actually work? I guess you can call me an optimistic skeptic.

Les Masterson is senior editor of Health Plan Insider. He can be reached at
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