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Limited evidence to support DM programs
While disease management programs have steadily gained popularity in recent years, there is a relative lack of evidence that they improve quality and save money, according to a report from the Washington, DC-based Center for Studying Health System Change (HSC).
"Although interest in targeted, condition-specific disease management programs is growing, evidence of their clinical and cost-effectiveness remains limited," wrote the authors of Disease Management: A Leap of Faith to Lower-Cost, Higher-Quality Health Care, which appeared in an October 2003 "Issue Brief" published by HSC.
"We did this study as part of a larger community tracking study to follow how local health care systems are changing, and what the implications of those changes are," says Glen Mays, PhD, senior health researcher with Mathematica Policy Research, consultant researcher for HSC, and one of the study’s authors. "There has been growing interest in this type of intervention as it may rein in health care costs and improve quality and patient satisfaction."
HSC researchers visited 12 nationally representative communities — randomly selected communities from all metropolitan areas of the United States that statistically represent average areas. The report was based on interviews with representatives of health plans, employers and providers.
Are employers acting on faith?
"I think overall that the most significant finding in the study is that compared to two years ago we have seen a marked increase in employer interest and involvement with disease management, despite that fact that employers indicate they do not have much evidence about its impact; the evidence is limited," says Mays.
Why, then, would employers invest in these programs? "In absolute terms the cost is not insignificant, but [it may be] in terms of the overall rate of increase of health care costs, if this is one of obvious potential solutions," he offers. "In addition, they are not that many alternatives [to save money] other than cutting back on benefits, which is not that attractive; disease management, on the other hand, is not a take-away."
The study goes on to note that employers have not really tried to systematically model the health or economic effects of these programs. "Most employers who now use disease management programs admit they haven’t taken steps to look at what the impact of these programs is," says Mays. "It’s not from lack of interest. Many employers simply don’t have the data; it may be captured by the health plan or the pharmacy benefit manager, who is not able to provide that data to them. In addition, for many of these programs, the rates of participation are still quite small, so you can’t make reliable generalizations."
Evaluation is key
The report goes on to stress that ongoing evaluation should be a component of any disease management program you undertake. And perhaps, in response to the aforementioned lack of evidence, the industry is responding. "We’re seeing an increased emphasis in the disease management industry on evaluating, and adopting standards, so purchasers can have some degree of reliability when presented with results," notes Mays. "This way, you can begin to compare apples to apples."
The evaluations can be done by a number of different entities, he says, including outside evaluators or individual health plans, a number of which now do their own internal evaluations. "One plan offered incentives to employers who agreed as a condition of their buying the program to provide data to allow assessment," he reports. "Clearly, health plans and other disease management vendors are seeing an increase in the marketplace in the demand for evidence to demonstrate value and impact."
So, if you are considering a disease management program for the first time, "first and foremost, it makes sense to gather as much information as you can up front on what is known about the program, the impact it has had both clinically and economically, the cost of care and satisfaction levels," Mays recommends.
Additionally, he notes, a number of employers have created ways to build in performance guarantees with vendors, to reduce some of the risk of buying a program that may be untested, or that has not demonstrated significant success to date. "For example, the guarantees can be structured around participation levels; if you don’t enroll 80% of the workers with diabetes into your diabetes management program, there will be a penalty on the vendor," Mays explains. "This way, employers can reduce some of their risk."
[For more information, contact:
• Center for Studying Health System Change, 600 Maryland Ave. S.W., Suite 550, Washington, DC 20024-2512. Telephone: (202) 484-52161. Fax: (202) 484-9258. Internet: www.hschange.org.]