While traditional sickness care organizations have trepidations about investing in proactively managing the health of populations, whether government or commercially insured, or employees of employers that see their workforce as assets, there are plenty of other organizations that see huge potential there. The “Disease Management” industry alone, focused on managing patients with chronic diseases in order to proactively minimize crises, complications and worsening thereof has already exploded on the radar for over ten years, growing toward a multi-billion dollar industry.

The other elements of PHM are catching up, as health/wellness promotion becomes a major focus of the growing number of employer-sponsored worksite medical clinics, which have the advantage of saving in both costs of medical care and lost productive time thanks to onsite availability. These, along with a growing list of private “vendors” are promoting people’s overall health and fitness, preventing and correcting unhealthy behaviors, managing, even “reversing” risk conditions, to complete the proactive domain.

A whole new type of physician practice has emerged in the past decade, the retainer-based practice with a major focus on proactive management of each patient’s health. Such management is precisely the kind of separate and non-covered service that Medicare allows physicians to charge separately for, while not jeopardizing physicians’ participation in Medicare. MDVIP, for example, an organization of almost 150 retainer physicians is already established in 16 states and 40 markets.

Venture capitalists are betting that there is a significant future for PHM. Summit Partners, for example, demonstrated their confidence by buying into MDVIP, as did Procter & Gamble earlier this year. Revolution Health, an investment firm focusing on promoting health is invested in health spas, health information media, and a chain of retail clinics that combine traditional primary sickness care with proactive wellness care.

Just a few days ago, a Wall Street Journal article noted the interest being displayed by venture capitalists in the growing market of employers seeking ways to control their sickness care insurance costs. [“Healthcare Gets Attention of Venture Capital Firms” HealthLeaders News Apr 11, 2007]

There are already many hospitals and large physician practices engaged in some dimension of PHM, though mainly on a piecemeal basis to a modest degree. Mayo Clinic has a substantial health management program for large employers, with roughly 70 already involved. Numerous large academic medical centers offer executive health programs to area employers, and hundreds of others offer fitness centers and programs. Occupational health was once thought a major opportunity, but it did not turn out well when focused exclusively on sickness care.

The new kinds of healthcare organizations, with modest physician involvement as medical directors and major numbers of nurses on staff as health coaches have most of the market so far. Whether traditional providers can compete on both effectiveness in reducing sickness and its total economic impact, and in doing so at competitive prices, is still to be learned. But clearly those who are looking at the “healthy living” market, already predicted to reach the $1 trillion size in the next five to fifteen years, are betting that there is money to be made there by somebody.