The idea of managing disease, has caught on like a house afire, despite the continuing federal government skepticism about its cost savings performance. The disease management (DM) industry has grown dramatically in the past decade, as commercial insurers and employers have increasingly jumped on the bandwagon. Both have even become DM providers – CIGNA and Aetna insurance firms both offer DM services to employers, while Quad/Graphics has created its own “QuadMed” division to do the same. (www.quadmed.com)

But DM has been severely limited in its effects for two reasons; 1) by limiting itself to disease, it is already late in regard to the timing of its efforts; and 2) it has tended to focus on the most obvious and easily measured effects of its efforts, missing out on what are usually far more valuable impacts. Gradually, DM providers, customers, and health care reformers in general are pushing for redefining what it means.

The redefinition is focusing on expanding what is included in both the terms “disease” and “management”. Instead of management meaning efforts to control what happens to chronic or acute disease after it happens (if acute, it is usually called “care” or “case” management) – it is moving toward including efforts to reduce the incidence and prevalence of disease (and injury, for that matter) in the first place. However well disease gets managed, and the predictable crises, complications, and worsening of such diseases, along with the consequences to costs are reduced, the economic benefit is never as great as is preventing disease from happening.

The term “disease” is also being re-defined to include unhealthy behaviors that tend to increase the risk of disease, and even behaviors that tend to reduce workforce productivity and performance, imposing added labor costs on employers, not merely added healthcare, disability or workers compensation costs. In addition to unhealthy behaviors, risk and “pre-disease” conditions are also being included, since these are often both more common and a more cost-effective stage in disease development to focus, as well as causes of productivity and performance impairment.

Healthways, Inc. in Nashville, Tennessee, has expanded from focusing on disease to include what it deems “impact conditions”, though still mainly in the context of causes of healthcare costs. These conditions include GERD, fibromyalgia, low back pain, and urinary incontinence, for example, while obesity is included among the “core conditions” that are otherwise traditional “diseases”. Moreover, it offers “health support” services designed to prevent disease, focusing on fitness, nutrition, smoking cessation and lifestyle management, etc. Its lifestyle management program predicts that: “Participants who complete one year of coaching will eliminate an average of 1.6 health risks.” (www.healthways.com)

HealthMedia, Inc. in Ann Arbor Michigan goes even further to include a number of health behaviors and conditions that primarily lead to productivity and performance impairment among workers, rather than to high healthcare expense. These include: poor sleeping habits; unhealthy weight, nutrition, and physical activity levels; stress; depression; chronic pain, as well as smoking. The combined effect of these, along with conventional disease risks and chronic conditions create from 10-15% productivity impairment across the workforces they have analyzed, over 200,000 employees. Impairment reduction per participant has ranged from 1.89% to 9.03% across the varied programs it offers. (www.healthmedia.com)

Among the great advantages of redefining DM to include both factors that cause and lead to diseases, along with illness that already exists, along with factors that impair productivity/performance in the workforce is that instead of relying on a small minority of any given population for savings, virtually the entire population is likely to be capable of achieving better health and resulting savings. The sheer number of health and impairment factors, when reduced by one or two among participants can yield hundreds of dollars in economic benefit to insurers, and thousands to employers. And such savings over 90% of the population yield far more than when only 10% or fewer participate.

Only by re-defining both terms in “disease management” can its full potential be even predicted, much less achieved. Many DM providers and more of their prospects and customers are thinking and talking more in terms of “health management” as a broader alternative. While labels help in understanding what we’re talking about, the key is to define whatever labels we use in this case to include everything that will ultimately help not merely understanding, but successful implementation.