DM outcomes key to improving nation’s health
Measuring only return on investment not enough
Extensive outcomes studies to document the value of disease management are necessary to convince the health care industry that disease management is a viable solution to gaps in health care and poor outcomes for people with chronic diseases, asserts Derek Newell, vice president of outcomes measurement and product manager for LifeMasters Supported Self Care, an Irvine, CA-based disease management company.
"There is a lot of scientific knowledge among the academic and scientific community about what tests and treatments result in optimum results for people with certain conditions. But there’s a big difference in what we know and what we do. Disease management is designed to help close that gap," says Newell, who directs LifeMasters’ new outcomes research group.
Disease management is still in its infancy, and only a tiny faction of health care expenditures are for disease management, he points out.
"There still have not been large-scale trials to document the value of disease management. We need more and better research on outcomes of disease management to convince the market that this is a viable solution to our current situation," Newell adds.
Clinical literature and research are far ahead of actual practice when it comes to improving the outcomes for people with chronic diseases, he states.
"The clinical literature is there to support disease management, but the health care industry isn’t sure how to tackle the problem. Everybody is certain that the status quo is unacceptable, but they aren’t sure how to change it. Outcomes research and reporting may point the way," Newell says.
Outcomes measurements are important in disease management not only to demonstrate the cost-effectiveness of the program but to show which interventions are most efficient and effective, he adds.
"If you’re not measuring outcomes, you’re not doing disease management," Newell flatly says.
LifeMasters monitors external outcomes, including financial outcomes and clinical outcomes, to show that they are meeting their customer expectations, and internal outcomes, which they use to make program improvements.
Return on investment is an important outcome to measure in disease management programs because it goes to the people who are going to approve the expenditures, Newell points out. "It isn’t about convincing the clinical people. It’s about convincing the financial people," she adds.
However, he concludes, the real outcomes are human outcomes and clinical outcomes. "Financial outcomes are usually done on an annual basis. You need to track clinical outcomes in order to learn how to maximize the effectiveness of the interventions," he says.
The Health Plan Employer Data and Information Set measures are among the key clinical indicators of success every disease management program should measure, Newell adds.
But outcomes measures should go further and track other interventions that are a key to managing a disease but may not be as easy to measure, he adds.
For instance, in addition to the better-known indicators for diabetes patients, LifeMasters tracks hypertension control, often a problem with diabetics.
LifeMasters reports to its clients on factors such as patient interventions, physician interventions, educational calls, and other processes.
"We show what interventions we make, what the activities are designed to affect, and how they affect them," Newell notes.
The interventions and reports differ in different diseases.
In addition, LifeMasters tracks internal outcomes to shows which activities are most effective in improving patient outcomes.
For instance, among its patient bases, LifeMasters has tracked whether particular types of interventions, such as mailings or telephone calls, are most effective in encouraging participants to go for a recommended test.
Global lessons
The company test-markets various materials to see how many people respond to each type and if they get better results when they offer the members a financial incentive. It also tests to see if the most effective type of letter comes from the patient’s physician, the patient’s health plan, or the disease management company.
"We do a lot of analysis around different types of interventions and what is effective, even to the point of analyzing results by call centers, by health plans, and by clinical professionals. When you have data on hundreds of thousands of people, you can find out things you can’t find out from a small group," Newell says.
If the data show that a particular case manager is performing extremely well, the company sends someone to interview her about how she works with her patients and what she does to motivate them to comply.
"We look for global lessons that we can build into training or methodology that we can put into a tool to improve the results for all our clients," Newell says.
The U.S. health care industry is made up of disconnected, disintegrated players with no real means to share knowledge, he says.
"The national guidelines say a person with a certain condition should be on a certain drug, but it doesn’t happen. It may be that their physician didn’t get the lab report or doesn’t know that the clinical information exists.
The role of disease management is to coordinate the patient information and the appropriate treatment protocols and get them to the physicians, Newell adds.
"Our industry exists because the health care system is performing suboptimally. Our job is to increase the performance of the health care system as a whole by providing information to the various players when the health care system does not," he says.
For instance, new clinical guidelines are being issued almost daily, and physicians don’t have time to keep up with the latest ones. In addition, there is no systematic way for a physician to get information about his patients who are not in compliance with their treatment plan.
"Physicians may not have a whole picture of the patients’ health care services. They have what is in their chart, but there is no common medical record. We have access to all the data from all the providers the patient is seeing and can help the physicians manage their patients," Newell says.
When LifeMasters contracts with an insurance company for disease management services, the company starts to build a complete medical record for members using the insurance claims data.
The company supplements the information with the results of a 150-question questionnaire sent to members who are stratified into the disease management plan.
A good disease management program creates personal interventions for the members whose health it is managing, Newell says.
"When we get claims data that show a member with a certain disease is not on the recommended education, we get in touch with the physician and get the member scheduled for an appointment. We believe this is more effective than blanketing the physician with guidelines. We let them know the recommended treatment at the time they need to act on it," he adds.
Extensive outcomes studies to document the value of disease management are necessary to convince the health care industry that disease management is a viable solution to gaps in health care and poor outcomes for people with chronic diseases, asserts Derek Newell, vice president of outcomes measurement and product manager for LifeMasters Supported Self Care, an Irvine, CA-based disease management company.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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