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-------------------------------------------------------------------------- 3 Lessons learned from initial DM programmes -Tracey Wright-

'J"1te benefits of disease management (OM) programmes are obvious to all involved ~ the stumbling block for many involved in this area lies in implementing their programmes, according to Dr Bettina Kurowski, president of the US consulting firm Kurowski & Company, Inc. Speaking at a symposium at the Second Annual Disease Management Congress [Washington DC, US; Sep 1997], Dr Kurowski shared with delegates some of the lessons learned from developing OM programmes, and speculated on the look of 'next generation' OM programmes. The benefits of adopting a DM approach are obvious to both patients and providers, said Dr Kurowski.

Included among these benefits are the following: • improved patient satisfaction • increased access to health services • more appropriate and more efficient care • increased business for practices and potential financial benefits. However, being able to identify the benefits does not mean that DM is easy to do. There are a number of impediments that can make it very difficult to achieve the desired benefits. Contracts for DM programmes can be extremely complex, particularly for broad-scale DM efforts (e.g. a cancer DM plan may incorporate radiotherapy and surgery as well as chemotherapy). Integrating the different systems - both at a contract level and in practice - creates a significant problem for developers of DM programmes.

Integrated systems needed Without integrated systems, obtaining the required data on different aspects of a DM programme from disparate sources becomes a significant impediment. Also, the lack of systems integration makes it difficult to shift funding from 'one silo to another', according to Dr Kurowski, and to redistribute any resulting cost savings. Experience with initial DM programmes has shown that it can be difficult to measure any resulting savings. In fact, analysis may show that for some programmes the costs of implementing DM programmes outweigh the financial benefits, noted Dr Kurowski. However, the clinical benefits of a DM programme should always be clearly demonstrable.

SUlVey data highlight difficulties Disease Management News has published data from a recent US survey conducted by Decision Resources Inc.** showing that the majority of responding health maintenance organisations (HMOs) do not support the idea of a direct relationship between improved patient outcomes and a decrease in total per-patient costs under DM programmes. I Notably, survey data showed that among the 14 DM therapeutic areas assessed, programmes in less than

** The company surveyed 282 HMOs in the US. 1173-550319710142-00031$01.00° Adl. InterMtlonal Limited 1997. All rights reHrvecI

half these areas resulted in cost savings for> 50% of respondents [see figure]. Fig. Percentage of HMOs reporting cost savings in 5 OM areas·

o ~

0

• HMO"" health ma intenance organ i.ation; OM

%

di••ase management

The survey results also highlighted a large gap between development of DM programmes and subsequent implementation. The top 3 DM areas for developing programmes were asthma, diabetes mellitus and high-risk pregnancy; 65.9, 62.8 and 55.8% of HMOs reported working in these DM areas, respectively. However, only 57.4, 50 and about 50% of HMOs, respectively, reported implementing these DM programmes.

Gap between developing & implementing Further analysis of the data showed that the largest gaps between development and implementation occurred for DM programmes focusing on diabetes mellitus, congestive heart failure, asthma and depression (percentage difference of 12.8,8.9,8.5 and 7.8%, respectively).

Looking to the next generation Those working in the DM arena are going to have to adopt a broader customer focus, suggested Dr Kurowski . In addition to working with health plans, customers will include practice management companies and provider-sponsored organisations (PSOs). To date special population groups, such as the Veteran Affairs Administration and the Indian Health Service in the US, have been overlooked as potential customers. Such groups could provide an attractive opportunity for DM companies since there are certain patterns of disease that are prevalent in these populations that could be targeted, she explained. PharmacoEconomics & Ou1comes News 13 Dec 11197 No. 142

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DM lessons learned - continued In addition to expanding the customer base, those working in OM will need to rethink what is being sold and who to work with. Dr Kurowski believes that customers will want a full service product, with the option of 'unbundling' the package. There may be opportunities to license the OM programmes to HMOs and PSOs who do not want OM companies running the programmes. Instead, such organisations might work with the OM companies to learn how to manage care and to gain those components that they lack the expertise to develop (e.g. guidelines or measurement systems), she commented. Concluding her presentation, Dr Kurowski emphasised that 'in order 10 service large populations, we need to move out of the mindset of always providing care . .. into really managing care '. 1. Asthma called top DM program despite cost woes. Disease Management News 3: 1 & 5, 25 Nov 1997 _, ...,

PharmacoEconomics & Ou1comes News 13 Dec 1987 No. 142

1173-5503197/0142-00041$01.00° Adl. International Limited 1997. All right. r_rved