Disease Management – Does it Work? Yes and No!

A recent article in Business Week reported that "Washington wants to pump big money into disease management, even though there’s scant evidence that it works". So what is disease management anyway? Essentially, it is a process where people with certain chronic diseases are flagged and contacted by disease management professional to assist them in doing the things necessary to control their condition. Typically, this disease management professional works for a company that provides this service over the phone. The disease management professional is armed with good ideas but is not someone who is known (or always trusted) by the patient.

Disease management sounds great. Who could argue with managing your disease better? This great idea created yet another layer of healthcare bureaucracy between patients and their doctors adding more costs to the healthcare system under the guise of saving money. GE, who was a leader in this movement, poured a lot of money into their program over a ten year period only to find out that it didn’t really work. According to Bob Galvin, GE’s chief medical officer, GE didn’t see any compelling evidence that it saved money or substantially improved workers health.

Why didn’t it work? Conceptually, it makes so much sense that disease management interventions that have strong evidence of improving patients health and wellbeing has to be a winner. In a typical analysis, if the concept is sound, one looks to the execution as the cause which leads me to believe that the message about health and wellness is coming from the wrong messenger, i.e., anonymous hired agents by health insurance companies. Instead, if the message came from a person or organization that the patient knows and trusts, it would seem logical that the results would be far better. So who do patients know and trust? Why their doctors’ of course.

What if doctors were given incentives (payments that would otherwise go to disease management companies) to establish a disease management program and the word came from the doctor’s office not from an unknown voice over the phone. I believe that patients would take this advice more seriously and it would eliminate conflicts between what the doctors recommend and what a disease manager from an unrelated company recommends. So if this makes sense, why isn’t done? I believe that answer is that there is a lack of collaboration between providers and payers (the doctors and the health insurance companies). For us to make any progress in this area of health care, there needs to be a why to bring the payer and provider forces together.