Is Self-Management the Future of DM?

Les Masterson, for HealthLeaders Media, December 3, 2008

This year has not been kind to disease management.

Experts have increasingly questioned DM's effectiveness and CMS ended the DM-inspired Medicare Health Support demonstration, claiming that it was not successful.

Those who question DM say call-center based nursing programs are simply not cost-effective, which is causing many in the industry to find other ways to reduce costs and improve outcomes and quality.

Employers are also demanding services that reach all employees (not only the sickest), and DM companies have found that DM programs are not as effective for some chronic illnesses.

This combination has led DM companies to add wellness programs to their chronic care offerings and create an expanded industry now called population health, which has replaced disease management as the industry term.

Population health companies have moved beyond call-center programs and expanded into technology, remote patient monitoring, and automated call centers.

At the recent DMAA: The Care Continuum Alliance conference in Hollywood, FL, two industry leaders discussed another potential option: chronic illness self-management.

The healthcare system does not prevent illness and disease; empowering the individual patient to take control of his or her health could become the next frontier for DM, said Kevin J. Wildenhaus, PhD, director of behavior science and data analytics at HealthMedia Inc. The Ann Arbor, MI-based company, which was purchased by healthcare giant Johnson & Johnson in October, specializes in combining technology and behavioral science to emulate a health coach via the Web.

Chronic illness self-management programs move away from member education to empowerment and away from information to intervention, said Wildenhaus.

It's one thing to place health information on a Web site. It's quite another to make it informative and something that people can integrate into their lives. This can be accomplished by gathering information from an individual's health risk assessment and claims records, and then creating a member-specific Web page. Employers can help by giving incentives for employees to visit their pages.

"The information is out there. People are accessing it, but what are they doing with the information," said Wendy Vida, RD, clinical preventionist at Highmark Blue Shield in Pittsburgh. Highmark created the Blues on Call program that seeks to empower members through a 24-7 condition management program, interactive voice recognition telephonic outreach, resources for members and providers, self-management education, nurse case management, and online chronic condition program.

Vida said self-management is especially important given the growth of consumer-driven health plans (CDHPs). Having to take a greater responsibility for their healthcare bills, people must gain a better control of their health and self-management dovetails with CDHPs, she said.

Wildenhaus said self-management programs include:

  • Management of medical, emotional, and personal issues
  • Motivation and self-confidence associated in managing their conditions
  • Management of sleep, pain, fatigue, and depression
  • Improved doctor, patient, and pharmacist relationships, and communications
  • Medication adherence and overall treatment compliance
  • Social support
  • Setting goals and planning skills
  • Accepting personal responsibility for managing conditions

Wildenhaus said both Highmark and HealthMedia's programs get people engaged, improve patient conditions, and reduce medical and productivity costs. For instance, participants reported improved health, quality of life, self-confidence, self-management skills, provider relationships, and medication adherence as well as decreased stress and worry. A medical claims analysis showed that the Highmark program saved nearly $1,000 on medical claims per each member annually compared to projections.

HealthMedia has been successful in areas such as depression, insomnia, and eating disorders, but there are a whole slew of barriers to overcome if self-management becomes the norm across the population health landscape.

Here are just a handful of questions:

  • Will doctors view this as a direct attack on their autonomy?
  • How can you help at-risk populations self-manage their conditions?
  • What do you do with the millions who are not ready to commit to better health?
  • Will health insurers, population health companies, and technology vendors be able to create networks that effectively engage members?
  • How much will human intervention (i.e. nurse call centers) play a part in self-management programs?

The industry is interested in learning more about the idea as was evident in the packed meeting room when the two industry leaders spoke.

However, there are still many unanswered questions about how to make health a part of everyone's daily life. Integrating health into lives will take a coordinated effort from all stakeholders, including physicians, population health, health insurers, nurses, and most importantly the patients.

A person has to feel motivated before he or she is activated. That activation level for each individual will ultimately decide whether chronic illness self-management is a winner or another interesting idea that doesn't work.

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