“Disease Management” RIP

The Care Continuum Alliance has mercifully and wisely rebranded it’s name and eliminated the initials “DMAA”. See its press release: Care Continuum Alliance Launches New Brand for Population Health Improvement. (As a reminder, DMAA originally stood for Disease Management Association of America.)

I for one say “hurrah, and good riddance”.

Where Did the Term “Disease Management” (DM) Trip Up?

1) DM Was a lousy term to begin with…but the name stuck. The founders of DMAA were well aware of the incorrect connotations and the ambiguities of the term in the first place.

DM connotes that it’s the “disease” that’s being managed.  This suggests a reductionist view of the world — that patients are akin to commoditized bricks and the only thing that’s different among them are their diseases.

The “management” part of DM also connotes that the process of care management is being done TO the patient, rather than for the patient or even better with the patient.

0 for 2 on the term DM..but the name stuck.

2) The term “DM” was used loosely and imprecisely.  The slide below is one I used back in 2002 in attempts to clarify the multiple meanings of DM.

DM

There’s an irony here. Over the past decade the need for care management as a clinical process has become widely understood and appreciated — it’s even gained national prominence as part of health care reform which recognizes the need to shift away from an acute system of care to one which is better designed to care for patients with chronic conditions.

IMHO, its the the business model connotations that were are officially burying. 

3) The term DM has become widely negatively perceived.

Why?

DM is perceived as not having proven its ROI beyond a reasonable doubt. Never mind that this threshold isn’t applied to traditional medical procedures — what’s the ROI on a heart surgery?

DM had negative perceptions with doctors. “We don’t get paid to do DM, the DM process is parallel to my own care management process, there are liability risks if a fax from a DM care manager arrives in my office and I don’t act, etc.…”.  I’m reminded of the words of Chris Selecky, former CEO of LifeMasters, who wisely observed “The DM industry would never have arisen if doctors had taken integrated care management processes into their practices in the first place.”  (I’m paraphrasing here — Chris, please correct me if need be.)

DM is negatively perceived on Wall Street.  While Healthways was the poster child for success through most of the 00s, it’s stock collapsed from $67 to about $7 in 2008. Healthways then became the poster child for DM failures.

DM is perceived as having failed in Medicare, especially through the highly visible Medicare Health Support pilot.  As my colleague Tom Wilson and I have written, never mind that Medicare’s version of DM was 1) a misplaced adaptation of the 2002 commercial DM model, and 2) only one of many possible flavors of DM that Medicare  should be testing.

A Different POV

My esteemed colleague the DMCB (Dr. Jaan Sidorov) has a different POV.  He laments the loss of the term DM and plans to stick by it.

The DMCB’s column on this topic is a must read — his humor, wisdom and knowledge of the world of DM shine through, although we disagree in the end.

He notes

the DMCB is one of the remaining intellectual redoubts that’s still loyal to the term “disease management.” …the term “disease management” will make a comeback.

The DMCB notes that the phrase “disease management’ returns 1.2 million Google hits, including widespread references in academic literature.

Yeah, well, I entered the term “dog sh*t” into Google and it came back with 6.7 million hits.  Draw your own conclusions.

I for one will discontinue use of the term DM and say once and for all “disease management RIP”.

10 thoughts on ““Disease Management” RIP

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  2. As I read I kept thinking, “Oh, the DMCB doesn’t think so,” and then you had him in your post before I could even comment. I’m not experienced enough in the matter to make a judgement call, but it sounds like we’re still talking about the same basic policy, just semantically changing focus. For those interested, Dr. Sidorov has promised a future blog post explaining why he thinks the term will rise again.

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