How do you help people think logically about the future?" asks healthcare forecaster Matthew Holt. "First, you have to tell
the truth about the present."
"This is the first real experience at putting disease management into the Medicare population."
And that's what Holt tries to do. At his day job, he works as a consultant and editor of the FierceHealthcare newsletter.
But after hours, Holt writes about a more three-dimensional truth on his site
Holt says the blog gives his ego a microphone. But the several hundred readers that check out the blog daily, and who write
in, say it puts daily developments in the context of the healthcare environment. Indeed, the blog offers readers a holistic
perspective (mixed with a dollop of humor) unlikely to be found in newspapers—or boardrooms.
Here, Holt deciphers the hype around disease management (DM) and discusses how those programs will continue to evolve.
Why are DM programs growing so slowly?
Holt: The savings DM programs offer are significant, but they are not absolutely enormous. You've seen, for example, cohort studies
where one cohort gets the intervention and the other one doesn't. The savings compared to the control group are in the range
of 15 percent, which is great, but it's not absolutely incredible. Then there were a couple of studies that came out fairly
recently saying those programs produced no savings at all.
The point is DM programs are not going to save managed care companies 50 percent of their medical costs overnight for their
most expensive patients. If that was the case, they would have done it a long time ago.
What is the size of the DM market?
Based on a little bit of a back-of-the-envelope analysis I did, it's somewhere in the billion dollar range in terms of
dollars paid out to DM companies and programs. That's growing, although future programs will be targeted to populations where
savings are more easily attainable.
What DM programs are successful?
Currently, DM programs are driven by telephone-based or call center-based programs—not online programs. It is not like
thousands of congestive heart failure patients are entering their data onto the computer everyday. They are being bugged on
The programs that are growing relatively faster are tied to some kind of device. You have probably seen Health Hero Network's
Health Buddy—a small survey device that attaches to a telephone and can communicate with other devices like scales. In that
program, nurse intervention is reserved for exceptions rather than serving at the program's core. So they're more cost-efficient
and probably more effective.
Why did Medicare bring more attention to disease management programs?
Medicare has a bunch of demonstration projects going on called the Continuing Care Improvement Programs (CCIP) which were
put into the Medicare Modernization Act (MMA) partly as a payoff to health plans and disease state management (DSM) companies,
but more importantly to see if the DSM rhetoric can hold water when studied in a general Medicare population.
This is the first real experience at putting disease management into a general Medicare population, and among the 12 projects
there'll be some 200,000 to 300,000 enrollees.
What are those programs' implications?
Once you start putting people on DM programs and monitoring them versus a control population, it helps make pay-for-performance
much easier—an area which Mark McClellan is very interested in. Because you now say, "What's working? What isn't?" So over
the next few years, we'll see a lot more activity of that type around Medicare, both in the service program, but also in the
now re-growing private sector Medicare Advantage Plans, which were basically subsidized to recruit more members in the MMA.
They too are figuring out how to manage seniors using DSM.