Disease management is not only here to stay but it's bigger than you realize - Disease Management

Physician Executive, Nov-Dec, 2002 by Jaan Sidorov

Discover why one physician executive is convinced that disease management will be around For a long time to come.

GROWING DISSATISFACTION with managed care, worsening access for consumers and mounting financial losses among many health care providers are likely to precipitate upheavals in health care systems.

Few are willing to predict how this will turn out, and those who attempt to read the future will probably be wrong. However, one prediction is a safe bet: disease management will not only survive the coming upheaval, but will thrive.

What is disease management?

Disease management is any coordinated system of health care interventions and communications for populations with conditions in which patient self-care efforts are significant. (1)

This strategy is suited for patients with chronic--and costly--illness, striving to provide timely, cost-effective care at the most appropriate location and level of service.

This contrasts with relying solely on the "provider-patient" encounter to deliver health care. Instead, this strategy packages multiple other treatment modalities, such as nurses case management, telephonic and Internet-based strategies, clinical guidelines and self-care in systems of care devoted to achieving specific outcomes.

There is widespread belief in this approach. Insurers gave at least $500 million to the estimated 160 disease management vendors in the year 2000, and that the figure could easily grow to $20 billion by 2010. (2)

Two widely known features of disease management account for such optimism:

(1.) Disease management is just beginning to demonstrate it can reduce downstream utilization, improve clinical outcomes and achieve a high degree of patient satisfaction. While credible data proving this are lacking in the peer review scientific literature, if companies offering disease management services take the time to share their results outside of their proprietary business relationships, purchasers of health care are likely to compel health care insurers to include disease management alongside traditional hospital and physician-based care.

(2.) Disease management is adaptable in any health care financing arrangement. Vendors typically assume control of a portion of the insurance premium devoted to medical care, in effect becoming a health care provider. They differ from traditional hospital or physician providers in that:

* They assume and profit from varying degrees of insurance risk

* Are not bound by geography or referral patterns

* Typically maintain lean cost structures.

These three key features are very well suited for the uncertainty of the health care environment and are independent of the current poor prognosis of managed care.

While managed care has been all about cost, disease management is about cost, quality and value.

The next generation of health care

Given its independence from managed care and success in lowering utilization and achieving outcomes, disease management is likely to grow. However, there are two additional reasons to believe that this strategy will not only grow, but could profoundly transform the health care system.

1. Disruptive Innovation

In The Innovator's Dilemma. When New Technologies Cause Great Firms to Fail, (3) Clayton Christenson points Out how low cost alternative "disruptive technologies" are constantly undermining the complex systems developed in response to yesterday's problems.

While it's a reach to apply the lessons of the demise of the mainframe computer industry from smaller cheaper hard drives and desk top computers to health care, the current complicated, unwieldy and costly system of hospitals and office practices may be more vulnerable to disruptive technologies than ever imagined.

Christenson takes this point of view in a follow-up Harvard Business Review article.4 Noting that traditional health care is unable to deliver simpler, more convenient and less costly services to the majority of consumers, he argues alternate strategies are "sneaking from below" to provide home-based self care or nurse directed care to replace the increasingly complex and unwieldy physician-patient encounter used as the dominant mechanism of health care delivery today.

Technologic innovation is already enabling patients with diabetes to monitor their own blood glucose, use sophisticated information systems to monitor medication adjustments and avoid complications under the virtual care of Web-enabled, non-physician health professionals.

Patients with congestive heart failure can have their fluid status and medication compliance virtually assessed and followed with periodic phone calls or email messages. These and other innovations are exactly what disease management packages and delivers for common and costly conditions such as congestive heart failure, asthma, hypertension, chronic obstructive pulmonary disease and cancer.

Critics doubt health care consumers would ever give up their local physician and community hospital. Advocates of disease management agree, but are actively promoting services specifically aimed reducing demand for these traditional services.