Disease Management: The New Face of Managed Care

TUESDAY, Jan. 6, 2004 (HealthDayNews) -- If you suffer from a chronic problem such as diabetes, heart disease or asthma, chances are your health plan is offering a "disease management program" to prevent your condition from worsening.

Now, sponsors of these programs are beginning to target a wider array of medical conditions -- from migraine to lower back pain to lupus. These new efforts take aim at common health problems that add significant costs to the U.S. health-care system and often are poorly managed by patients.

"I think the concept is beginning to resonate," says Robert Stone, executive vice president of American Healthways, a national provider of disease management programs.

The Nashville-based company added 11 new programs in 2002. It now offers services for conditions ranging from acid-related stomach disorders and irritable bowel syndrome to osteoarthritis and urinary incontinence.

Disease management is growing in popularity as employers grapple for new tools to control costs and improve the quality of patient care, says a recent report from the Center for Studying Health System Change, a Washington, D.C.-based think tank.

But not everyone is buying into the concept.

"I think the hesitancy from employers relates to the fact that these programs are not free to implement," says Glen Mays, a senior health researcher at the center and one of the authors of the report.

Employers must make an up-front investment, with very little evidence the programs are going to be effective, he says, "so it's really a leap of faith."

Then there's the turnover issue. If an employee leaves the company or switches insurers before the disease management initiative has produced results, there's little incentive for employers or health plans to invest in those programs in the first place.

"Some plans have actually backed off on some of their investments in disease management, particularly those programs that take a very long time to realize a return," Mays adds.

What's more, many of the traditional disease management programs, such as cardiovascular care and diabetes, target conditions affecting an older population. The programs don't always fit a younger workforce.

That's one of the reasons health plans and disease managers are now beginning to offer a broader array of programs targeting more conditions affecting working-age individuals.

While evidence of longer-term cost savings and improved quality remains limited, an increasing number of employers and health plans are moving ahead for lack of better options for squeezing costs.

Geisinger Health Plan, a 240,000-member health maintenance organization (HMO) in Danville, Pa., is planning to roll out an expanded program for women and men who are at risk of osteoporosis or who have had a previous bone fracture. The revamped program will tailor services to a member's risk for the disease.

Nurses will encourage low-risk members to exercise, get recommended levels of calcium, quit smoking and avoid safety hazards, such as throw rugs in the home, that could cause someone to slip and fall. High-risk individuals, with a history of fracture, will be urged to get their doctor to perform a bone mineral density test and to prescribe a bone-strengthening drug.

"I think we've really finally recognized that osteo is a significant health problem [and] appropriate interventions can really make a difference," says Janet Tomcavage, a registered nurse and manager of Geisinger Health Plan's Care Coordination Department.

An estimated 44 million Americans aged 50 and older suffer from osteoporosis or low bone mass, according to the National Osteoporosis Foundation. Preventing bone loss should cut costly hospitalizations and reduce potentially deadly medical complications, Tomcavage says.

Nashville-based American Healthways is another HMO expanding care to more members to hold down costs. Early results of a pioneering program it runs with Blue Cross and Blue Shield of Minnesota seem to bear that out.

Under the program, nurses help coordinate care for 140,000 participating Blue Cross members with 17 chronic health problems. Eleven conditions, including osteoporosis and low back pain, are ones American Healthways recently added.

In the first six months of the program, the St. Paul-based insurer saved $4.23 for every $1 spent on the 11 new categories of care. It expects a slight decrease in savings over the first 18 months, to $3.70 for every $1 of investment.

"The results are beyond any of our expectations," says Dr. Bill Gold, chief medical officer and vice president of the 2.6 million-member health plan.

Buoyed by the experiment's success, Blue Cross and its disease management partner are considering the next group of conditions to be added to the program. Depression and cancer-related diseases are possible targets, Gold says.

More information

To learn more about disease management programs, visit the Center for Studying Health System Change or Cedars-Sinai Health System of Los Angeles.