The repeating findings that disease management (DM) yields mixed returns is bound to be discouraging to many, particularly with so many payors depending on it to control the rate of healthcare cost increases. Medicare in particular, with the highest proportion of covered lives having chronic diseases, is probably the most dependent on reducing annual cost increases, though commercial insurers and self-insured employers are often invested in DM as well.

Among the many handicaps that DM bears is the fact that diseases are often discovered late, rather than early in their usual progression. Often they are diagnosed only when people incur outlier levels of healthcare expenditures, rather than being diagnosed early enough to prevent such spending. And often, they are “managed” using high-cost technology, including plenty of physician visits and nurse coaching contacts by phone.

There have been significant innovations in computer and communications technologies that should enable the costs of DM to be matched to the probable consequences of its use. Computer health risk assessment and predictive modeling is improving its ability to determine the relative risk and reward potential of individuals with particular diseases and multiple co-morbidities. This should enable more accurate matching of the management techniques and costs to the potential savings from DM.

Moreover, computer technologies enable the creation of individualized management plans and ongoing communications to particular consumer based on their disease, risk/reward potential, personality characteristics, readiness to change, and other factors that guide such communications toward increased effectiveness. Truly tailored communications have been widely shown to be significantly more effective than are one-size-fits-all methods formulated by DM providers.

Communications between DM providers and participants in DM interventions can be individualized and delivered online, combining participants own visits to personal web pages with outbound e-mail messages generated by consumers and delivered at costs of pennies per message. These have been found to have comparable effects to those achieved through phone and face communications.

The challenge is to improve the matching of such innovations to the risk/reward potential of each DM participant in ways that will ensure positive ROI ratios and total savings. Until and unless we identify the best matching of methods with DM challenges, there is no way to determine if DM itself is working, nor to learn its full potential for reducing healthcare cost increases, or even overall healthcare costs.