Obama's Present to Population Health

Les Masterson, for HealthLeaders Media, March 11, 2009

President Barack Obama sent a belated Valentine's Day bouquet to the population health industry when he released his $3.1 trillion 2010 budget plan.

Times have been tough in population health (disease management and wellness companies) over the past year. Experts have increasingly questioned disease management's effectiveness and CMS ended the DM-inspired Medicare Health Support demonstration, claiming that it was not successful.

Recently, another study, this one focused on the Medicare Coordinated Care Demonstration (MCCD), showed that care coordination programs with "substantial in-person contact that target moderate to severe patients can be cost-neutral and improve some aspects of care."

On the flip side, Randall Brown, PhD, director of health research at Mathematica Policy Research, Inc., in Princeton, NJ, and co-author of the MCCD study, questioned whether the typical DM program with a nurse call center and little or no face-to-face interaction would actually improve patient outcomes and reduce costs.

The MCCD study that was published in JAMA is just the latest to question whether call center-based nursing programs are cost-effective or spark patient behavior change.

Brown questions the DM model and said the population health industry has not provided strong evidence about its programs' successes.

"They are just not the right model if what you are trying to do is improve care for people who have chronic illness," says Brown.

His concerns are an example of what population health is facing. These questions are also causing forward-thinking companies to test other ways that could bring about long-lasting behavior change.

But don't count population health out just yet. In his budget 2010 proposal, Obama included two provisions that could reinvigorate the population health industry:

  • A focus on prevention. In his budget document, Obama wrote "The plan must invest in public health measures proven to reduce cost drivers in our system—such as obesity, sedentary lifestyles, and smoking—as well as guarantee access to proven preventive treatments."
  • Changing the way Medicare pays for hospital stays. Obama proposes paying hospitals under a bundled system that combines payment for the hospital stay as well as care for the patient for 30 days after release.

Population health companies could play a vital role in helping hospitals oversee patient care after discharge through its health coaching and remote patient monitoring programs. Though Obama hasn't put a dollar amount on preventive efforts and the administration is vague on specifics, the population health industry is not waiting to find out.

Tracey Moorhead, president and CEO of DMAA: The Care Continuum Alliance, released a statement saying the president's budget is a "welcome step toward a national commitment to chronic disease prevention and care." The population health industry believes they are well positioned to help effect change. "Population health improvement providers—prevention and wellness companies, disease management organizations and others serving people with and at risk of chronic disease—are uniquely qualified to assist policymakers with designing and evaluating prevention, care coordination and care management programs," said Moorhead.

This is all good news for population health except, in his budget, Obama said the country needs to invest in prevention that has been "proven to reduce cost drivers." There is still the lingering question that many in healthcare believe population health has not answered: Do disease management programs actually save money?

Industry naysayers say DM has not released objective studies about which offerings work best for particular disease states. At the beginning of this year, I predicted DM would need to fund research in that area in order to resolve those questions.

I wrote at that time, "In order for DM to have a seat at the healthcare reform table, the industry will need to fund research and look critically at its programs. Otherwise, 2009 could become the year in which DM was lowered into the ground alongside other healthcare acronyms that did not prove their value."

Now, here we are two months later, and population health could soon enjoy a renaissance, but there is still the same barrier—questions about program savings. Obama's stimulus and budget could be just the spark the industry needs, but population health needs to fund objective research and answer the nagging questions now.

Otherwise, the industry could miss its opportunity for rebirth.

Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com.
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