Just The Facts: Disease Prevention -Where's the Beef?

Just The Facts:
Disease Prevention - "Where's the Beef"

68 Percent of Americans Believe Prevention is the Solution to America's Healthcare Challenge [http://www.uspreventivemedicine.com/Press-Room/USPM-News/68%20Percent%20of%20Americans%20Believ.html] - Consumers overwhelming believe that greater emphasis on prevention is a solution to the nation’s healthcare challenges, according to a new consumer survey conducted by International Communications Research (ICR) and commissioned by U.S. Preventive Medicine, a company developing programs to advance a culture of prevention throughout America…..BUT:

While 50.2 percent of respondents said they knew of an instance where taking preventive health measures might have avoided a major illness for themselves, their family or friends….

…only 38.5 percent said they don’t worry about their health until

there’s a problem.

…only 39.5 percent said they don’t know what preventive health

measures they should take.

More Facts...

[http://www.magnetmail.net/images/clients/IDMA/attach/

PREVENTION92607.doc]

PREVENTION: JUST THE FACTS
[Courtesy of US Preventive Medicine]
http://www.uspreventivemedicine.
com/

· The American Heart Association reports that the lifetime risk of
hypertension is approximately 90 percent for adults
between the ages of 55 and 65. Disturbingly, one third of those
affected are not aware they have this condition.

· The World Health Organization reports that 50 percent of the
deaths and disability from heart disease and strokes (worldwide)
be eliminated by a combination of simple, cost-effective
national efforts and individual actions to reduce major risk
factors such as high blood pressure, high cholesterol, obesity
and smoking.

· The American Cancer Society reports that at least half of the
deaths from cancers (564,830 projected in 2006) could be
prevented by greater use of established screening tests and the
application of existing knowledge.

· Increasing the use of just five preventive services would save more
than 100,000 lives every year in the U.S., according to a new study
released today by Partnership for Prevention.

· The Centers for Disease Control and Prevention (CDC) reports that
preventive efforts can benefit the 17 million Americans with type 1
or type 2 diabetes.

o Regular eye exams and timely treatment could prevent up to 90
percent of diabetes-related blindness.

o Routine foot examinations and patient education could prevent
up to 85 percent of diabetes-related amputations.

· The United States spends $2.2 trillion on healthcare annually, yet

only four percent is devoted to preventive services, such

as health risk appraisals, simple blood tests, and smoking cessation

programs.

The good news is that legislative initiatives are being proposed and dozens of health care organizations across the country have begun to recognize the critical importance of developing initiatives that will encourage more aggressive prevention programs. An example is: the Knollenberg's bill, H.R. 853, that would offer a $200 tax credit to employers for every employee who participates in a workplace wellness program. The participating employee would also receive a $200 tax credit for participating. The wellness program would include screenings for chronic illnesses like heart disease and diabetes as well as seminars on healthy eating habits, smoking cessation, exercise, mental health and stress management among other preventive strategies. The bill also provides $20,000 of loan forgiveness for students who graduate with a degree in preventive medicine.

Source: US Preventive Medicine web site. [http://www.uspreventivemedicine.
com/]

Convenience Medicine

Commentary....Convenience Medicine...While there appears to be a consensus that the US healthcare industry is still “broken” [despite the wake up call of the “Crossing the Quality Chasm Report” in 2001] healthcare strategists are still struggling to find scalable solutions. The good news is that once again healthcare is at the top of the list of national issues for presidential candidates...the bad news is that it has been at the top of the list for 30 years! We are seeing animated discussions about a plethora of “strategies” ranging from universal health care, the “medical home,” disease management, and now convenience medicine. Dr. David Nash, my co-editor on the first book on disease management in 1997 and a prolific commentator on important healthcare issues has convened several healthcare industry colleagues to address the concept of “Convenience Medicine” and how disease management may fit into this new healthcare access scheme.

Disease Management and the Convenient Care Industry: Is it Just a Fad or Here to Stay?
National Disease Management Audioconference:

Monday, October 1, 2007. The Audio Conference is sponsored by Health Affairs and Harvard Health Policy Review.

Moderator:
David B. Nash, MD, MBA, FACPDr. Raymond C. and Doris N. Grandon Professor of Health Policy, and Chair of the Department, Jefferson Medical College, Thomas Jefferson Univ
Faculty:

Chuck Peck, MD, Chief Medical Officer, Take Care Health System
Tine Hansen-Turton, MGA, Executive Director, Convenient Care Association
Perte W. Carmel, MD, Prof. & Chair, Neurological Surgery, NJ School of Medicine
Information/Registration: www.DMAudioconferences.com/dmaudio20071001

Social Network Helps Care Givers

MyCareCommunity Establishes a Social Network for Care
Givers
facing serious illness and end of life care support issues
[http://www.mycarecommunity.org/]

The COMMENTARY section of the
August 8th issue of
the e-Report [[http://www.magnetmail.net/Actions/email_web_
version.cfm?publish=newsletter&user_id=IDMA&message_id=343507] identified "social networks" as a potential strategy to meet the
bi-modal challenge of a rapidly
aging society and expanding lack of healthcare professionals. Under the
auspices
of a National Cancer Institute SBIR Grant The NewSof Group and Talaria Inc.
have developed a potential solution to this pending crisis; creating an
interactive resource and support center for care givers...MyCareCommunity.

Participants Wanted: NewSof is recruiting "pioneers" to
evaluate the new MyCareCommunity (www.mycarecommunity.org) resource. For
more information about the MyCareCommunity Pioneers project contact ccmanager@enclarahealth.com or email Neal Sofian at neal@newsof.com.

US Firm Addresses Lack of DM Evaluation Standards

BREAKING NEWS: US Firm Addresses Lack of DM Evaluation Standards.
The “Great Debate” over how/if DM adds value/produces savings as a medical management strategy may finally have a solution ... but it is not the single method many of us methodological novices had hoped for.

A national accreditation program to examine the methods behind the claims of monetary savings and clinical improvements being made by health and cost management programs is being launched by the Population Health Impact Institute (PHII), a non-profit, 501(c)(3) organization founded by epidemiologist Thomas Wilson, PhD.

PHII has taken on reality-- there are, in fact, multiple methods being used, and there are nuances upon nuances even in the "same" method. PHII's innovative new accreditation program has taken a new direction concerning DM program assessment in that their new accreditation standards are based upon comprehensive scientific evaluation principles. The PHII new standards will finally enable employers, and others, to make more valid program-to-program comparison because minimum standards of "transparency" and "validity" have being engineered into the PHII accreditation program.

An IDMA COMMENTARY/Audio Interview with PHII will be available in next week’s e-Report to create dialogue on this decade-old problem of “standards of measurement” for the DM industry. Press Release: August 16, 2007[http://www.magnetmail.net/images/clients/IDMA/attach
/Populati.doc].

Contact:
Thomas Wilson, PhD
513-349-5846
QEP@PHIinstitute.org

Social Networks: Potential Impact on the Disease Management Industry

IDMA COMMENTARY

The Boom in Social Networks [Think…Blogs Get Organized] ‘More Than a Fad?’ – How Does the DM Community Respond?
[http://gigaom.com/2006/10/09/the-future-of-social-networks-communication/]

In the May 12, 2007 issue of the IDMA e-Report, the 1st COMMENTARY Section included a rather ‘random’ comment on my view of blogs and my concern that blogs may overwhelm good research…i.e., the "squeaky wheel syndrome". Upon further research it seems that “organized blogs”…called social networks have been making some remarkable progress in the healthcare arena. I retract all my comments about “blogs replacing research”...I think?

As indicated in last week’s COMMENTARY Section, we may now be seeing a new player in the DM world…the technology companies. Social networking may be one of the first “children of the technology revolution in communications for chronic disease management.”

Some history:

2004 – Social networks…Not so New!:
Based on a “post” in the Oct, 2004
issue of HEALTH CARE BLOG that comments on the “explosion” of healthcare
blogs, social networking is not as “new” as we may have envisioned [http://www.thehealthcareblog.com/the_health_care_blog
/2004/10/
technology_soci.html]

2005 - Five reasons social networking doesn't work
[http://www.
cnet.com/4520-6033_1-6240543-1.html]

2006 - Social Networking vs. NOTworking: A Cure for
the Me-Care Revolution?
[http://trusted.md/blog/mikeryan/2006/06/27/social_
networking_vs_
notworking_a_cure_for_the_me_care_revolution]

2007 - Social networking quickly taking global
hold: MySpace, Facebook and Friendster all show substantial worldwide
growth [http://trusted.md/blog/mikeryan/2006/06/27/
social_networking_
vs_notworking_a_cure_for_the_me_care_revolution].

Future - How will Yahoo address social networking? [http://blogs.zdnet.com/BTL/?p=5824] - The due date for Yahoo CEO Jerry Yang’s strategic plan isn’t here yet, but that hasn’t stopped the handicapping. Bear Stearns analyst Robert Peck has a 22 page report addresses Yahoo’s options. Yahoo to lay out strategic plan in next 100 days

The Downside:

OBESITY SPREADS THROUGH SOCIAL NETWORKS - 2007-07-26 [http://www.exduco.net/news.php?id=2041] - A study of 12,067 people over a period of 32 years has found that social networks have a marked influence on weight gain. For example, if a person’s close friend becomes obese, that person’s chances of becoming obese increase 57 percent; for siblings, increase is 40 percent; and for spouses, increase is 37 percent.

COMMENTS & DISCUSSION - The IDMA “DMBLOG” is open for comments and discussion on how social networking impacts disease management at www.DMAliance.org/DmBlog

Who/What is Driving Healthcare Costs: The Role of Pharma in the Future of Healthcare?

COMMENTARY

Who/What is Driving Healthcare Costs? In the early-mid 90s the finger of blame pointed to managed care as failing to control escalating healthcare costs. Around the mid-90s the managed care industry was able to pass the black hat over to the pharmaceutical industry as the total cost of pharmaceuticals as a percentage of total healthcare costs began to rise rapidly [hmmm….more old people/chronic disease and more drugs to help? You see where this is going!]

Professor Uwe Reinhardt, PhD, James Madison Professor of Political Economy, Woodrow Wilson School and Chairman of the Department of Economics at Princeton University kindly provided us with a very thoughtful [and as always very amusing] viewpoint concerning the role of pharmaceutical manufacturers in the healthcare Industry. This is worth listening to. His lecture reminds me of the early days of the home care industry when legislation to encourage the use of home care [get the patients out of the expensive hospitals faster] was enacted. It worked… but shortly after people noticed that home care was “growing” 25-30% a year. So….they “whacked home care.” No one ever stopped to consider that a 25% increase in a sector that represented a very small fraction of the total cost of health care was hugely offset by [in terms of total dollars] by a 1-2% DECLINE [or smaller increases] in total hospital costs which represented a much larger percentage of total costs. HINT: the systems was spending more on home care but saving much more on reduced more intensive care costs. It seems that we could have used some math lessons.

Professor Reinhardt has been kind enough to help us with this latest math exercise to demonstrate that rising pharmaceutical costs are “perhaps good”. Kudos to Professor Reinhardt for this important lesson in economics. And many more thanks for making the lesson so much fun.

From 2006 Pharmaceutical Regulatory and Compliance Congress

The Role of the Pharmaceutical Enterprise in the Future of American Healthcare

Uwe E. Reinhardt, Ph.D.
James Madison Professor of Political Economy
Woodrow Wilson School, Princeton University
Princeton, NJ

Link to view the audio-cast: http://icvclients.com/ehcca/pharma_2006/3_1145/

Comments and Discussion - The IDMA Blog site [www.dmalliance.org/dmblog] is open for comments on Dr. Reinhardt’s views. We have also provided a brief survey concerning whether or not reader agree or disagree with the viewpoints offered in the audio cast concerning the role of pharma in future of American healthcare.

Many thanks to Peter Grant and our colleagues at Health Care Conference Administrators, LLC for providing us with access to Professor Reinhardt’s noteworthy viewpoints. The Audio cast was originally presented at the 2006 Seventh Pharmaceutical Regulatory and Compliance Congress and Best Practices Forum, www.PharmaCongress.com, November 8 - 10, 2006, in Washington, DC:

FURTHER INFORMATION: To purchase a CD-ROM or Video iPOD of the 2006 Pharma Congress, click here. For further information, call 800-684-4549 or email registration@hcconferences.com. For more information about the 8th Annual Pharmaceutical Regulatory and Compliance Congress [November 7-9, 2007, Washington, DC] go to www.PharmaCongress.com

DM Industry at the Tipping Point?

COMMENTARY: “Is the Disease Management Industry at a Tipping Point: The Impact of the Technology Companies on DM?.”

See Feature Story on “Google vs. Microsoft”

LINK: Google Health vs. Microsoft e-Health: Medical search war for big profits [http://www.directtraffic.org/OnlineNews/Google_Health_
vs._Microsoft_e-Health_Medical_search_war_for_big_profits_20076263255.html]
Albeit while many/most of the major full-service DM players are working to develop “links” with large technology companies like Google, Microsoft, Intel, Philips, Trizetto, and IBM and at the same time are developing other distribution and integration strategies, some industry watcher are suggesting that the DM industry is approaching a new period of major change and may be reaching a major tipping point in terms of who will be the major players in the future. The rise of the technology companies in the chronic disease market also comes at a time when a growing number of “best-in-class” component suppliers of chronic disease management and prevention services are also pushing the envelope.
In addition any global solution to the chronic disease challenge is much more complex and has attracted billion dollar technology companies.

Comment & Discussion: A BLOG at www.dmalliance.org/dmblog has been set up to allow IDMA readers to “weigh in” on the potential impact of new players in the DM market.

National Expert Critiques MHS Initial Analysis

A Critique of Baseline Issues in the Initial Medicare Health Support Report

Thomas Wilson, PhD, DrPH
Epidemiologist
Trajectory Healthcare, LLC

July 18, 2007

Two important methodological observations follow from reading the initial report on the Medicare Health Support (MHS) project authored by the Research Triangle Institute (RTI), International[1]:

1) The metamorphosis of the MHS project from a randomized control trial (RCT) design to an observational study design.

2) The inability to examine MHS project data using standard observational study techniques.
It’s the one-two punch, using boxing “knock out” language. If these two observations are true, the scientific validity of this report – and subsequent reports on program impact if they continue to follow this pattern – will be questionable at best, and potentially meaningless from a scientific perspective.

It is important to review exactly what the authors said and the evidence behind their conclusions before arriving at our own.

Analysis of Point #1: Randomization Failure?

Addressing the first observation, the authors wrote: “Our analyses at the time of randomization confirm equivalency … [but] substantive differences between the intervention and comparison populations emerge in the interval between randomization and go-live.” (Page 4, 20-21).

What is the evidence for these “substantive differences;” this loss of equivalence?

1) The justification for the equivalence assumption at randomization was based on the results of a statistical test on per-beneficiary-per month (PBPM) cost differences (See Table 3-4 on page 21), Hierarchical Cost Classification (HCC) risk score differences (see Table 3-3 on page 20), differences in all cause hospitalizations, heart failure hospitalization, and diabetes hospitalization per 100 people (see Table 3-4). In all cases, the differences were reported as “not statistically significant.” (As would be expected if randomization was successful).

2) The justification for non-equivalence “prior to the start of the pilot” was based on percent differences in PBPM between the two groups only (see Table 6-1 on page 37). While statistical test results were not in the table several pages earlier (page 20), the authors wrote; “only the difference in one Medicare Health Service Organization (MHSO) group’s PBPM is statistically significant at the 5% level or better at the start of the pilot.”. Puzzlingly, similar data presented at the time of randomization were not presented. These include HCC differences, all cause hospitalization differences, heart failure hospitalization differences, and diabetes hospitalization differences.

So, it turns out that the argument for “substantive differences” between the time of randomization and the “go-live” (pre-enrollment) date, are based only on PBPM, a financial measure. Importantly, if statistical significance is a guide to scientifically acceptable differences, only one of the eight sites showed a statistically significant difference in PBPM.

Other important measures of equivalence, used by the authors at baseline, are ignored at the go-live date. These non-financial measures, e.g. those related to quality, utilization, and HCC risk score, seem to have been relegated to second-class status, for some unknown reason.[2]

Is there a bias here to financial measures only and against standard scientific practices of assessing differences between groups using statistical significance tests?

Analysis of Point #2: Observational Design?

Addressing the second observation the authors wrote: “the financial reconciliation protocols as initially agreed upon do not make adjustments for differences in payments at the start of the pilot.” (Page 21).

No adjustments possible? No back-up plan if equivalence is lost?

This is a potentially earthshaking strategy, especially if also true for non-financial variables. Have the MHS leaders put all their eggs in the randomization basket? If so, it is an unfortunate misunderstanding of the original intent of the study, a study that Congress mandated to be a randomized controlled trial[3] – this implies to scientists both randomization and control,

Sandra Foote argued in her seminal 2002 Health Affairs article on the potential value of disease management in fee-for-service Medicare: “The results of controlled trials would contribute greatly to the state of knowledge in the field and would be extremely valuable in setting benchmarks for future performance expectations if pilot projects prove to be successful.”[4] Foote’s article was an argument for a controlled trial, not just a randomized control trial, and it was also more than financial. Back in 2003, several observers (including myself) discussed the potential for non-equivalence in this trial.[5] But it never occurred to me that it would be impossible to deal with this issue if evidence suggested the initial equivalence did not hold!

As it now stands, it appears the MHS can only be observational--if equivalence was not achieved at baseline, so be it … nothing can be done. This is a sorry state. The numerous techniques available to the health services researchers to adjust for non-equivalence do not appear to be available here. If this is the case, the value of this study from the point of view of science is highly suspect.

Suggestions for Improvement

Following are a few suggestions to the MHS project sponsors:

1) Modify the agreement between the MHSOs and CMS to allow for statistical adjustments to control for non-equivalence if it, in fact, occurs … and is validated using standard statistical tests. Moreover, insure that any statistical adjustments made are completely transparent, and include equations, variance estimates, and all numerators and denominators for all metrics. [6]

2) Conduct a more complete analysis of baseline equivalence “at the time of the start of the pilot” including PBPM costs, HCC scores, utilization metrics, and quality metrics --- using statistical significance tests that are fully transparent.
To learn from the MHS project, scientifically valid methods must be used to fairly assess the impact of the disease management programs on both financial metrics and non-financial metrics

Summary

Based upon the information in this initial report, not enough scientific evidence was presented to support the authors’ statement of “substantial differences” between the intervention and reference group at the pre-enrollment period. While differences were presented in PBPM costs, in seven out of eight cases these were not “statistically significant.” It thus appears that only actual differences, not scientific-based statistical differences, are contractually relevant here. The authors’ apparent inability to adjust for differences in financial metrics between the intervention and reference groups seems to back up this point. It thus appears that we may not have a randomized control trial anymore. Indeed, if adjustments are not possible in the event of non-equivalence, we may not even have the ability to do a rigorous observational study! Has science been relegated to a second-class status? If so, who put it there? More information is needed.

As it stands now, this study, from the point of view of science, has been set up to result in little or no learning regarding the impact of disease management, as intended by Foote, Congress and other stakeholders. But things can change with appropriate adjustments. It is recommended that future evaluations of the MHS use standard statistical tests to assess differences between the intervention and reference groups on all metrics. Adjustments should be made, and these must be fully transparent, when and if statistically significant differences do emerge.

Finally, it is recommended that non-financial metrics (e.g., related to quality) should be evaluated with the same rigor and using the same credible methods as used to evaluate financial variables. It is in everyone’s best interest to back up the MHS results with credible, sound, and transparent scientific methods.

Dr. Thomas Wilson
513.289.3743
twilson@trajectory-inc.com

Copyright 2007. Thomas W. Wilson. All Rights Reserved

[1] McCall N, Cromwell J, Bernard S. Evaluation of Phase I of Medicare Health Support (Formerly Voluntary Chronic Care Improvement) Pilot Program Under Traditional Fee-for-Service Medicare Report to Congress. June 2007. http://www.cms.hhs.gov/reports/downloads/McCall.pdf

[2] What evidence was not shown?
1) The variance estimates (e.g. the method for standard deviations, and the results of the standard error) that are customarily presented in RCTs were not reported at either the randomization time period of the pre-enrollment time period. Such data would allow an informed reader to independently review of the validity of the tests that are designed to assess the level of random error in the data.
2) A data table was not shown supporting the authors’ statements of equivalence / non-equivalence of standard confounding variables (e.g. age, gender) at neither the post-randomization nor the pre-enrollment period. Some of these were discussed in the text, but quantitative information was not provided.
3) A data table showing the baseline comparison of intermediate outcome metrics[2] and ultimate outcome metrics[2] between intervention and reference groups was not shown at either the post-randomization or the pre-enrollment periods.
a. Intermediate outcomes (testing for HbA1c, lipids, micro-albumin, and retinopathy) were reported comparing outcomes six months post-intervention (Figure 5-1, page 32), but the results of these were not presented at neither the post-randomization period, nor the pre-enrollment period.

[3] Specified in Section 721 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. http://www.cms.hhs.gov/CCIP/downloads/section_721.pdf

[4] Foote SM. Population-based disease management under fee-for-service Medicare. Health Aff (Millwood). 2003 Jul-Dec;Suppl Web Exclusives:W3-342-56.

[5] DM News Editor. Biases Cloud DM’s Ability to Succeed in Medicare Pilot: Selection Issues May Present Industry with Framework for Failure. Disease Management News. Vol. 9, Number 11. April 2, 2003, page 1,4-5.

[6] Equivalence and statistical considerations, based on transparent impact methods, are principles espoused by the non-profit Population Health Impact Institute (www.PHIinstitute.org).

DM Industry remains challenged on how to calculate ROI?

Measuring ROI [Return on Investment] in DM Programs: The Economic Promise of DM…has it changed?

By Warren E. Todd
Executive Director, IDMA

I was recently asked by an international colleague from Germany about what types of ROIs one could expect from disease management programs.

Despite having a pretty good archive on DM I must admit that aside from the Goetzel et al meta-analysis [summer of 2005], most of the "recent" articles on DM ROI appeared to mostly address how to measure DM, what the methodology issues are, etc. While it was not a very rigorous search I was surprised by the seeming dearth of actual ROI data on DM programs. Perhaps I was looking “in all the wrong places.”

Notwithstanding, my “surprise” also raised a concern that perhaps the continued “great debate” over ROI, the best methodologies, etc. has caused some authors to “go underground” as far as talking about or, God forbid, publish anything with a hard ROI associated with it.

Base on discussions with a number of knowledgeable outcomes researchers, It does seem that we have moved from expectations [and declarations] of ROIs in the 3 to 1 or 4 to 1 …..or higher…. to maybe 2 to 1 or less.

Despite the many initiatives by DMAA that have resulted in several published "guides" on how to measure DM outcomes, plus the hard work of a number of industry actuaries, epidemiologist and outcomes researchers, there still seems to be very little published material that includes specific information on DM ROIs.

After investing many hundreds of millions of dollars on disease management over the past decade or more, it seems that we should have more data on actual performance including financial performance metrics like ROI.

I was also very concerned to have one of the recognized pioneers of DM in the United States suggest that a 1 to 1 ROI [in the short run] is probably the most likely performance for many of these programs and that it may take 2-3 years of program operation to begin to achieve 1.5 or 2.0 to 1 ROIs.

REQUEST FOR INPUT: IDMA will be researching this area more fully but in the meantime would appreciate readers submitting information on articles on DM that do in fact include on ROI data.

Please send this information to wtodd@dmalliance.org. We will compile the information submitted along with our own research and make this available to e-Report readers.

Growth of Medical Tourism

MEDICAL TOURISM

Some Facts:

* 1,000,000 patients receive treatment outside of the own country
Medical tourism growing at 30% per year
* Cost savings range from 25-70% with at least 50% savings most common
India, Thailand, Singapore, Brazil, Mexico and South Africa top the
list of the most popular destinations
* Plastic surgery and dental treatment are most popular with a full
range of other surgeries also offered
* Access to non-USA approved surgeries
* Dozens of state-of-the-art new hospitals are being built especially
for international patients in countries like India, Thailand,
Singapore and Malaysia

Resources - Conferences:

• 6th Annual International Smart-Sourcing Conference September 6-7,
2007 Atlantic City, New Jersey, USA
• Proud Asia 2007, September 27-30, 2007, at the Impact Convention
Center in Muangthong Thailand.
• Medical Tourism in the 21st Century, December 4, 2007, Sheffield,
England

Resources - Books:

• Patients Beyond Borders by Josef Woodman
[Health Travel Media], 2007.

• Beauty from Afar by Jeff Schult [STC Healthy
Living], 2006

• Hospitality 2010 by Marvin Cetron et al
[Pearson Prentice Hall], 2006

• The Complete Medical Tourist by David Hancock
[John Blake Publishing, Inc.], 2006

• Medical Tourism in Developing Countries
by Milica Z. Bookman and Karla R. Bookman, 2007

• Medical Tourism in India by Raj Pruthi, 2007

• Medical tourism: Sea, sun, sand and ... surgery
[An article from: Tourism Management [HTML] (Digital) by
J.Connell, 2007.

• Medical Tourism: A Role in Disease Management
by Chris Kozma viewpoint essay) Managed Care Interface, May 2007.

• Heads in Beds by Ivo Raza [Pearson Prentice Hall],
2005

Welcome to IDMA DM Blog

Dear Colleagues

IDMA is very pleased to offer a place to create dialogue on important current issues in disease management and disease prevention.

I hope that you will visit www.DMAlliance.org/dmblog on a regular basis to tune into new topics that warrant discussion and the collective input of our expanding DM community.

Topics will be both domestic and international.

While you may feel free to browse the blog and the comments of your colleagues, we have had to require "registration" when posting comments in order to prevent spamming and inappropriate access that could lessen the value of the service.

Best regards,

Warren Todd
908-806-3961
E-Mail: wtodd@dmalliance.org
Web Site: www.dmalliance.org
Blog Site: www.dmalliance.org/dmblog

Commentary: Impact of Blogs on the DM Industry

A COMMENTARY
The Impact of BLOGS on the DM Industry: WILL BLOGS RULE?

Top 100 Global Healthcare Blog Sites

Well, maybe not… and hopefully they will stimulate/challenge us to explore new ideas and exchange ideas. Lately however a number of healthcare blogs have been stirring the pot concerning what the implications are of several reports on various DM-type Medicare demonstration/pilot programs that have been less than favorable. More specifically, the two programs that recently reported some negative results were”.

• The Medicare Coordinated Care Demonstration Project – As reported in a recent issue of the weekly IDMA DM World Report, this 230 page analysis concluded largely negative results from the pilot. Certainly in terms of these programs generating any statistically relevant economic savings they were not were not successful.

• The Medicare Health Support Pilots – After about a year and a half the nine original programs have declined to only six that are still operating. In addition, even some of the remaining programs have reported [or are rumored to have] less than wanted/needed results. Apparently the DM pilots have been struggling to meet the net 5% savings requirement.

These reports and numerous BLOGS voicing concern about the future of the DM industry by a number of industry watchers have led to a recent “opinion article” by one of my fellow founders of the DMAA, Al Lewis. See link to his recent Health Leaders article, “New math provides epiphany for measuring ROI.” Al suggests, jokingly or not, that the current DM model may be dead, or at least “may be on its last legs,” and goes on to propose a future model. A vastly more integrated model.

As discouraging as these “headlines” appear to be, my primary concern, and the motivating force behind this COMMENTARY, is the potential impact of all these BLOGS [which frequently get picked up by the wire services and Google.com] could distort what is really happening in the industry because of the tendency to only read HEADLINES.

I would hope that serious trend watchers are also well aware that the DM industry is both new and evolving, for many reasons. The cry for more “integration” still resonates, as does the pending potential of “the docs are back” per the medical home and other more physician centric models that are popping up in the United States….and especially outside of the United States. The bottom-line 1ine is that new markets EVOLVE…and so will the DM “market.” That is what new markets DO.

If we want to see what the new world of disease management may look like, one needs only to look at the internationally adopted “Ed Wagner Chronic Care Model.” This highly integrated model is likely to be the next generation of DM in the US…as it is shaping up to be in Europe and Canada. Even in the US states the physician communities are adopting the Wagner model.

So, as Al did conclude at the end of his article, DM must “morph” into new models.

I do think this is already happening as the commercial DM companies are already aggressively acquiring prevention capabilities/companies and some of the DM Medicaid companies have pretty good experience in how to leverage the various important capabilities that already exist in the community.

So, no DM is not dead…just evolving. This is good…at least for those organizations that have good financial resources and are “light on their feet.”

Again, we may want to also look to the international community as there are a number of more “Wagner Model-oriented” DM programs that are surfacing in other countries.

The IDMA DM World e-Report is working hard to try to bring you news on what is happening both inside and outside of the United States.

In the meantime….as the IDMA also looks at weighing into the BLOG world soon, I believe that BLOGS as they exist today may be a double-edged sword.

At a time when we are all looking for our “teenager industry” to become more “research-based,” as demonstrated by some DM companies that have invested in more intensive research studies, I hope that the world of BLOGS does not pull us back into being an industry of mere opinion, sound bites, and headlines.

I only hope that BLOGS do not replace RESEARCH. Given our culture of “sound bites” it does concern me.

…….Just an opinion!!

Respectfully,

Warren E. Todd
Executive Director, IDMA
Email: wtodd@dmalliance.org
www.dmalliance.org
Tel: 908-806-3961

HealthLeaders - Jun. 29 2007:

The Blog and its Growing Impact on Healthcare
Tony Chen, director of new business development at Evanston Northwestern Healthcare in Evanston, IL, talks about the evolution and benefits of the healthcare blogosphere.

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Go to...and scroll down...[http://www.healthleadersmedia.com/media/]