Al Lewis, one of the founding fathers of DM, has shaped the face of the DM industry probably more than other any single individual. (This is all fine unless you happen to be the person whose face is being shaped by Al.)
Al has been unabashedly pro-DM. Until now. Al writes in a recent article in Managed Healthcare Executive:
Disease management as we now define it may be on its last legs, though no one knows it yet. The Disease Management Purchasing Consortium has noticed that the savings in all but a few diseases doesn’t offset the costs, and nowhere does it generate the level of return on investment (ROI) that some people think they are getting.
But fear not, Al foresees a new DM:
The good news for the DM industry is that just as organizations are figuring out that they are measuring wrong, a revolution from within is replacing this old model. The new model will bring far more impact, more easily measured for the buyers. …
Al describes that the essence of the difference in the emerging model of DM is a higher integration of services:
The new model works because it is vastly more inclusive than the old. It doesn’t just involve chronic diseases. It combines wellness, 24/7 nurseline, preference-sensitive conditions, complex case management, and care coordination into a one-stop shop. Most importantly, it promises to bend the trend, not just on chronic care events (which make up surprisingly little of many employers’ health spend, according to Health Dialog), but on the entire healthcare budget.
Where Al and I Agree
As we learn more about what works and what doesn’t work in DM, there’s no question that higher levels of integration lead to better financial and clinical outcomes. No disagreement here.
The DM industry learned its first lessons about the need for integration back in the late 1990s when most single disease companies gave way to companies that managed multiple diseases.
We’re learning the integration lesson again in understanding that DM is not an island — that ideally it should be part of a broader population health management approach within an employer and/or health plan population as Al suggests.
Where Al and I See Things Differently
I’d agree with Al that the need for higher levels of integration is a driving force in chronic disease management. However, I don’t believe that Al’s new model takes the integration far enough. Al suggests the need to integrate services across a broader membership of the employer and/or health plan population
That’s fine as far as it goes, but I believe that the real integration opportunity will be in integrating services with health care providers. More specifically, I’m referring to better integration of health care providers in chronic disease management workflow, enabled through integrated information and communication technologies (ICT).
Dr. Emad Rizk of McKesson describes the necessary additional step in an interview with Managed Care Magazine:
I believe the old definition of disease management, which often boils down to a nurse call center, has run its course. There will be a merging of technology, products, and services, to create a new disease management paradigm. The new model that will evolve is a fuller medical management utilizing multiple interventions and technology, including personal health records and electronic health records. We’re starting that now.
The opportunity to integrate health care providers through shared workflow and ICT will be most pronounced in the Medicare population. The lack of integration with local providers is one way to explain the lack of successes in early Medicare DM demonstration/pilot projects (BIPA, the Medicare Coordinated Care Demonstration (MCCD) and Medicare Health Support (MHS)).
HOW this integration will occur is the real question. Will providers lead the new DM? …or will they simply participate through shared workflow and ICT?
Your thoughts? Al? — shyness is not one of your issues.