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Article Excerpt
Disease management is a growing industry with more than $2 billion in annual spending, up from $1 billion in 2005. While the five most common conditions among DM programs--diabetes, asthma, cardiovascular disease and chronic obstructive pulmonary disease--have remained steady, there are far more up-and-coming conditions with potential for DM investment.
Hypertension, gastrointestinal and HIV/AIDS patients stand to benefit from interventions similar to those in traditional DM programs, such as medication adherence, diet and exercise. As the base of clinical evidence grows around the world, a solid DM strategy has the capability to leverage evidence to improve patient outcomes.
With such prospects for disease management and its wider stance alongside wellness, the healthcare industry has placed great confidence in the concept and great hopes for its return on investment.
In 2004, MANAGED HEALTHCARE EXECUTIVE highlighted Leaders in Disease Management from health plans and disease management companies, largely based on their program size and commitment to DM. In keeping with the evolution of disease management and its ever-broadening scope, the 2008 list of MHE Leaders in Disease Management presented here is based on accomplishments in disease management rather than on program size. To make our determinations, we evaluated these leaders against objective criteria, such as blinded outcomes reports, while considering current industry activities.
The leaders generally fall into three categories--consultant/academic thought leaders, vendors and health plan or employer executives.
The question to answer: To what degree is the disease management field shaped as a result of this person's active involvement? Leading consultants and academics in the field who have authored DM research or achieved one-of-a-kind accomplishments qualified. Vendors with comparatively superior outcomes also qualified as leaders. Generally, the larger vendors have shown the most innovation and have the most experience.
Executives at regional and provider-owned health plans in particular--as well as a few among the national plans--have made the most progress toward greater accountability and greater innovation in disease management. To measure accountability and validity in health plans, we looked at third-party validations, such as recognition from the Disease Management Purchasing Consortium (DMPC); Health Industries Research Companies (HIRC); DMAA: The Care Continuum Alliance; or the Blue Cross & Blue Shield Assn. Outcomes reports delivered to employers were reviewed to be sure that they were actuarially sound.
Measuring health plan innovation can be subjective, of course. An innovation that appeared to deliver results and was at least in part an original implementation was deemed superior to a program that simply applied a typical product. In order to be named as an MHE Leader in Disease Management, health plan executives had to qualify for both innovation and accountability/validity.
Many physicians, executives and DM advocates submitted impressive credentials and success stories, but not all achieved the same level of industry leadership and influence. Those who have leveraged their knowledge and created clinical and financial value for members have been named among the 2008 MHE Leaders in Disease Management.
--The Editors
GEORGE B. BENNETT
CEO
Health Dialog Services Corp.
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As co-founder and CEO of Health Dialog, Bennett has seen the company grow from a $3 million firm in 1999 to more than $300 million this year.
Bennett says he relies on predictive modeling, sophisticated outreach, cause-and-effect research, and "whole person," nurse-based coaching. Special emphasis is placed on database architectures and software systems.
He has worked with Jack Wennberg, a pioneer in studying care variation, whose son, David Wennberg, serves as chief science and products officer of Health Dialog.
Leveraging the company's predictive modeling capabilities, Bennett and his colleagues have developed segmentation techniques able to tailor messages to high-need populations. The "whole person" approach, which he believes is the future of DM, is designed so that individuals and their physicians can work together to manage overall health efficiently.
Bennett also founded Symmetrix Inc., a management consulting firm as well as Braxton Associates, a global strategy consulting firm, and consulting firm Bain & Company.
He serves on the board of DMAA: The Care Continuum Alliance and was a 2004 MANAGED HEALTHCARE EXECUTIVE Leader in Disease Management.
PAUL A. BLUESTEIN, MD
Senior Vice President, Chief Medical Officer
ConnectiCare
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Dr. Bluestein says ConnectiCare is known as the employer of choice among managed care organizations in Connecticut. "We have been developing remarkably good stuff for more than a decade, and our staff has longevity, which puts our team on the same page strategically and tactically."
ConnectiCare has one of the longest running DM programs in the region and has maintained ownership of its programs, rather than outsourcing. The plan received full DM accreditation from the National Committee for Quality Assurance (NCQA).
"Even though we are a small, local health plan, we can still operate as though we are national," he says. The plan also received certification for savings measurement validity for all chronic diseases from the Disease Management Purchasing Consortium (DMPC) and was awarded top honors in 2008 as a "Leading Disease Management Organization" from Health Industries Research Companies (HIRC).
Dr. Bluestein predicts that in the near future, DM will adopt a broader definition and move beyond traditional member stratification and instead, will focus on members at-risk, emphasizing wellness and disease prevention.
Prior to joining ConnectiCare in 1994, Dr. Bluestein was vice president of managed care for NYH Care Network, and national medical director and national director of quality improvement for the MetLife Managed Care Services Group.
JOHN CASTIGLIA, MD
Senior Vice President, Chief Medical Officer
Premera Blue Cross
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A unique collaboration among Premera Blue Cross, its pharmacy benefits manager, Medco, and its DM provider, Healthways, drives the Faster ID initiative, which aims to identify potential DM-program participants quickly. Medco stratifies pharmacy claims information daily and passes it onto Healthways...
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