Evidence-Based Medicine is Pivotal in Advancing Care Management

Evidence-based Medicine and Managed Care: Applications, Challenges, Opportunities
Results of a National Program to Assess Emerging Applications of Evidence-based Medicine to Medical Management Strategies in Managed Care
Vanderbilt Center for Evidence-based Medicine, December 2003

Health plans touch all facets of healthcare and therefore have a unique opportunity to stimulate adherence to evidence-based practices….The purpose of this program was to explore how managed care is applying principles and concepts of evidence-based medicine to its delicate balancing of cost and quality management.

Some of the key findings include:

1. The role, scope and functions of medical management in managed care organizations are expanding dramatically. There are five key impact areas: a) Disease and case management, b) provider profiling & reports cards, c) pay for performance, d) consumer-directed care, and e) coverage & denial management.
2. Current resources/budgets for medical management programs do not correlate with enrollments or other measures of plan size.
3. Reducing health costs is a primary consideration in most medical management programs.
4. Medical directors in managed care believe the application of evidence-based medicine is central to enhancements in each of the key impact areas.

PEW Internet Project Updates Web Usage Profiles

America’s Online Pursuits: The Changing Picture Of Who’s Online And What They Do
Pew Internet & American Life Project; December 22, 2003

A broad analysis of over three years’ worth of Pew Internet Project data illustrates shifting trends in Internet use by Americans:

• Online activity has consistently grown
• Despite this growth in activity, the growth of the online population itself has slowed.
• Different people use the Internet in different ways.
• Experience and the quality of online connections matter.
• Online Americans’ experience with the commercial side of the Internet has expanded dramatically in spite of the economic slump.
• Email continues to be the “killer app” of the Internet.
• Big news stories drive lasting changes in the news -seeking audience online.

There has been a surge in use of the Internet for health or medical information.

• 66% of Internet users have said “yes” when we asked the simple question: Do you ever use the Internet to get health or medical information? However, when we asked about 16 specific kinds of health searches (seeking diet and fitness information, material about health insurance, mental health information, etc.), the percentage of Internet users who had done health searches came to 80%….
• The number of those who have done health searches online grew at least 59%, from a figure of 46 million in March 2000 to 73 million in December 2002.
• Online women are much more likely than online men to have done health searches using the Internet.

The Internet has increasingly become an important source of health-care and medical information for the majority of online American adults. Those health seekers who turn to the Internet as a reference for health information grew substantially from 54% in March 2000, to 66% of the online population in December 2002.

Return on Investment for DM? – The Debate Continues

The Cost Savings of Disease Management Programs: Report on a Study of Health Plans
American Association of Health Plans, November 2003
Yes!
Consistent with the single-plan studies reported in the peer-reviewed literature, the eight evaluations that AAHP/HIAA surveyed found that enrollees in DM programs had fewer hospital admissions and fewer emergency room (ER) visits, and lower overall costs. Thus, these evaluations are supportive of the hypothesis that DM programs contribute to reductions in health care costs….The eight evaluations presented here break new ground in overcoming the limitations of previous research on disease management. Unlike some earlier studies, these evaluations are valid because they address important methodological issues, such as the statistical phenomenon known as regression to the mean. And these evaluations are generalizable because they cover multiple health plans, different areas of the country, and a diverse range of people of various ages from different socioeconomic backgrounds.

Disease Management: A Leap of Faith to Lower-Cost, Higher-Quality Health Care
Center for Studying Health System Change, October 2003
No proof!
Despite high expectations, evidence of both disease management and case management programs’ success in controlling costs and improving quality remains limited.

Evaluating ROI in State Disease Management Programs
Academy Health Issue Brief, November 2003
Be careful out there!
Measuring the financial return associated with DM is difficult because changes in health care costs over time cannot be assumed to be solely due to the DM intervention in the population that received DM services…. Given the uncertainty associated with DM analyses, it is probably not possible to “prove” that DM positively affects ROI by the legal standard of “beyond a reasonable doubt.” A more reasonable goal is to aim for a “preponderance of evidence.” That means that ROI assessments should not be based on a single study. Rather, evidence should be refreshed constantly with new data. This will assure those who pay the health care bills that the investments they made months or years earlier were intelligent ones.

Why We Can’t Wait to Implement Disease Management
Business and Health; October 15, 2003
Just do it anyway.
True, we don’t yet know if the promise of cost reduction will materialize fully, but the target is enormous and the early indications are encouraging. We can hold back until every single skeptic is satisfied, or we can get to work on the roots of health expenditure with a potent new tactic.

Predictions for Healthcare in 2004

Healthcare’s Top Business Issues and Responses for 2004
Cap Gemini Ernst & Young; December 16, 2003

The Top 10 Issues:

1. A new level of business rigor in technology investments.
2. Transformation of clinical care through technology.
3. Detailed redesign of core business processes.
4. Outsourcing of non-core functions.
5. Protracted efforts to comply with HIPAA requirements.
6. Collaboration between payers and providers at an operational level.
7. Proliferation of “new” benefits models.
8. Redirection of medical management efforts.
   With efforts to reduce administrative costs largely exhausted and medical costs continuing to rise, healthcare organizations are taking a new view of medical management. They are looking at advanced care management, or population health management approaches. This involves the use of predictive modeling techniques to identify “at risk” patients who are about to incur large claims. Technology enables prioritized outreach to these people to prevent complications. Employers (typically) offer support programs to modify patients’ behavior and thus avoid costly hospitalizations or procedures down the road….
9. Emphasis on organizational ethics and institutional governance.
10. Community approaches to new biological threats

Six Prescriptions To Ease Rationing In U.S. Health Care
Summary by KaiserNetwork.org; December 22, 2003
Original Wall Street Journal article (paid subscription required)

1. Wiring the health system
2. Evidence-based medicine
3. Fixing reimbursement
4. Disease management
   Many experts agree the best opportunity to improve care and stave off costly complications is disease management — the strategy of monitoring people with chronic conditions such as diabetes, congestive heart failure and coronary artery disease. Those diseases are expected to cost $510 billion this year and soar to $1.07 trillion by the 2020. But many of those costs are related to preventable hospitalizations and emergency-room visits….
5. Redesigning the intensive care unit
6. Getting patients involved

Forrester’s Top 10 Healthcare Predictions For 2004
Forrester Research, December 15, 2003

Predicts 2004: Healthcare
Market challenges and increasing volatility have resulted in a floundering and troubled U.S. healthcare industry. However, there are glimmers of hope for 2004.
Gartner Research; December 16, 2003

Diabetes Info on the Internet – Patient Beware

Design and Testing of a Tool for Evaluating the Quality of Diabetes Consumer-Information Web Sites
Journal of Medical Internet Research, Oct-Dec 2003

There is wide variation in the accuracy and comprehensiveness of online diabetes information and no existing mechanism for consumers to get detailed, objective information about true Web site quality. Furthermore, this research also demonstrates the limited utility of using proxies such as sponsorship characteristics to help guide consumers in searching for health Internet information.

This research also highlights the alarming amount of inaccurate and incomplete Internet information on diabetes. Given the increase in consumer use of the Web to make health care decisions, the potential threats to patient care are substantial. If diabetes information is incomplete, a consumer may not be aware of all the various complications of diabetes and thus not know to get tested for certain conditions. If a consumer finds inaccurate information on the Web, he or she may not be aware, for example, of the symptoms that indicate the onset of an acute diabetic event.

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A primer and practical planning guide.

Future Care 2004 Healthcare Web Summit
Presentations by 30 faculty on key trends shaping the business of health care
“Disease Management: State-of-the-Industry 2004 and Beyond”
Vince Kuraitis, Principal, Better Health Technologies
Live teleconference on Tuesday, January 20, 2004 at 12:00 PM Eastern Time
Sponsored by Managed Care Online (MCOL)

Emerging Technologies in Disease Management: Improving Quality, Controlling Costs
Frank Martin, Chairman and CEO, I-trax
Vince Kuraitis, Principal, Better Health Technologies
Live teleconference on January 28, 2004 at 1:30 PM Eastern Time
Sponsored by Healthcare Intelligence Network

Recent Research on Patients with Comorbid Conditions

Multiple Chronic Conditions: A Challenge to the 21st Century
Center on an Aging Society, Georgetown University, November 2003

Adults with multiple conditions, however, are substantially more likely than adults with one chronic condition to report accomplishing less, spending more time in bed sick, missing work, not working, living with less income, and having poor mental health.

Trends in Chronic Condition Comorbidities in a Group Health Plan
Partnership for Solutions, October 2003

This analysis looks at some basic trends among the privately insured who have chronic conditions by analyzing claims data from 1999 through 2001…. among enrollees with a chronic condition, the proportion with multiple chronic conditions increased slightly and there was a commensurate decrease in the proportion of enrollees with no chronic conditions.

Managing Multiple Conditions: A Challenge For Medicare
A Medicaid project in North Carolina has cut costs and improved care for patients with chronic diseases. Can Medicare do the same?
American Medical News; December 1, 2003

Telemonitoring for Heart Failure

A Systematic Review of Telemonitoring for the Management of Heart Failure
European Journal of Heart Failure, October 2003

Eighteen observational studies and six randomised controlled trials involving telemonitoring and heart failure were identified.

Conclusion: Telemonitoring might have an important role as part of a strategy for the delivery of effective health care for patients with heart failure. Adequately powered multicentre, randomised controlled trials are required to further evaluate the potential benefits and cost-effectiveness of this intervention.

DM and Telehealth Technology Updates

Emerging Technologies
Semantic Web • Smart Bandages • Contamination Information • RFID • Intelligent Agents • 3-D Computer Imaging • Artificial Intelligence • Personal Monitoring Networks • Email Protocol • Radiosurgery • Smart Cards • Data Storage
Healthcare Informatics, January 2004

Gadgets help baby boomers navigate old age
USA Today; November 17, 2003

E-Mail A Day May Keep Doctor Away
Some patients go online to renew prescriptions, or describe symptoms
The Detroit News; January 4, 2004

Assessing Technology Needs for the Elderly: Finding the Perfect Match for Home
Telehealth Opportunities for Home Care Patients
The Cardiac Connection Program: Home Care That Doesn’t Miss a Beat
Home Care Technology and Telehealth-The Future Is HERE!
Home Healthcare Nurse, October 2003

Computer-Based Technology And Caregiving For Older Adults Conference
Setting Priorities for Retirement Years (SPRY) Foundation; October 9, 2003

Big Sites Enter Into Diabetes Monitoring Market
Companies offer millions of patients the means to manage chronic conditions over the Internet.
American Medical News; September 22/29, 2003

Home-based Health Services: Telefónica’s Pilot
Sandy and Dave’s Report on the Broadband Home; September 23, 2003

Heart Patients May Benefit From Sensors In Clothes
Forbes; October 8, 2003

Technology That Makes You Healthy
CNN.com, October 16, 2003

Telemonitors Can Provide ‘Virtual Assisted Living’
Minneapolis-St.Paul Star Tribune; December 1, 2003

Worth Reviewing!

DMAA Applauds Medicare Prescription Drug And Modernization Act Of 2003
Disease Management Association of America, December 2003

The Hidden Epidemic: Finding a Cure for Unfilled Prescriptions and Missed Doses
Boston Consulting Group; December 15, 2003

How Broadening DM’s Focus Helped Shrink One Plan’s Cost
Managed Care, November 2003

Promoting Prevention Through Information Technology
Association of Health Center Affiliated Health Plans, October 2003

Reducing The Growth Of Medicare Spending: Geographic Versus Patient-Based Strategies
Health Affairs; December 10, 2003

Predictive Models Make Smart Purchasers
Business and Health; January 10, 2004

Obesity Is on the Rise and Costing Employers Billions
A Towers Perrin Point of View, 2003

Diabetes cases could double in developing countries in next 30 years
World Health Organization; November 14, 2003

Disease Management — Attracting and Retaining Participants: A Checklist
Healthplan, November/December 2003

A Report on the Evaluation of Criteria Sets for Assessing Health Web Sites
Consumer WebWatch; September 30, 2003

Chronic Conditions and Disabilities: Trends and Issues for Private Drug Plans
Commonwealth Fund, October 2003

Examining Chronic Care in California’s Safety Net
California Healthcare Foundation, October 2003

How Different Is California? A Comparison Of U.S. Physician Organizations
Medical groups and IPAs provide better chronic illness care and report being no worse off financially.
Health Affairs; October 15, 2003

Payers See Savings in Eliminating Risk Clauses in Disease Management Contracts
Managed Care Week; November 3, 2003

The Decade Preceding Medicare Coverage
Center on an Aging Society, Georgetown University, October 2003

Disease Management for Chronic Obstructive Pulmonary Disease
National Pharmaceutical Council, September 2003

E-CareManagement News is a complimentary e-newsletter sent to over 3,000 worldwide readers courtesy of Better Health Technologies, LLC.

For business and clinical decision makers who are developing innovative approaches to managing chronic diseases, Better Health Technologies is an eHealth and disease management consulting company that can assist you with strategy/business planning, finding financing, finding initial customers, and developing key partnerships.

Disclosure — No clients were mentioned in this issue.

You may copy, reprint or forward all or part of this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 2004, Better Health Technologies, LLC. All rights reserved

We welcome your opinions and comments. Write or call Vince Kuraitis JD, MBA at vincek@bhtinfo.com, (208) 395-1197 or Harry Leider MD, MBA at harryl@bhtinfo.com, (410) 252-7361.