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Just about every health plan in the U.S. has some significant investments in disease management programs. The plans are the major customers of companies such as American Healthways. These programs have been growing every year, for the last decade adding more and more components focusing on an increasing number of diseases. Plans usually have these programs alongside of work site wellness efforts and a myriad of other health promotion and preventative programs. What’s interesting to me is that the dm programs are opening up to healthy individuals to help keep populations within well known health parameters using the strategies they’ve developed in dm (outreach, facilitation, referral etc) to get folks more aware and proactive. It use to be a hard sell to plans, but now more are seeing the value of well constructed and executed programs. In fact I would say that the juice for innovation in this area will come from the private health plans.

Fred
http://ajfortin.com

You’re absolutely right. Health insurance plans were among the early adopters of DM, though they tended to start small, with a few diseases and modest involvevment among their total membership and the total workforce of their employer clients. They have since greatly expanded from disease to risk and health management, as have vendors such as Healthways, Inc., but are still primarily focused on reducing healthcare expenditures, where employers, themselves, are starting to realize that there are greater savings and financial improvements available in improving worker productivity and performance. This tends to shift employers’ focus from just the “diseases” that cause the most healthcare expenditures toward including the risk conditions and behaviors that cause the most negative impact on productivity and performance, with goal setting, implementation and evaluation including these broader dimensions of DM success. It also brings in employers as “partners” as much as “clients” for DM interventions, since the employers are the ones who can best determine the overall performance effects of workforce health efforts, rather than the insurance plans, and employers are usually better at promoting employee participation in DM programs.

We’re both on the same page here, but I would just say that competitive bar for health plans is going up in this area, and that the clinical staff working on these issues have multiple motivations beyond the cost imperative. These programs are now widely expected and employers who for years were disinclined to put money in these areas (due to wellness rhetoric being way ahead of the data) are looking harder as the desperation sets in on their bottom line, and the DM results get better. The plan I work for is a non-profit Blue that’s been around for over 70 years and is deeply embedded in the community. And it puts a ton of money into the community health programs. All I’m saying here is, from where I sit, I see less struggle in-house about the cost of these programs and more about the health impact of various emerging strategies.

Fred

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