The Complete "How to" Guide for Selecting a Disease Management Vendor

Abstract

Decision-makers in health plans, large medical groups, and self-insured employers face many challenges in selecting and implementing disease management programs. One strategy is the "buy" approach, utilizing one or more of the many vendors to provide disease management services for the purchasing organization. As a relatively new field, the disease management vendor landscape is continually changing, uncovering the many uncertainties about demonstrating outcomes, corporate stability, or successful business models. Given the large investment an organization may make in each disease management program (many cost 1 million dollars or more in annual fees for a moderately sized population), careful consideration must be given in selecting a disease management partner. This paper describes, in detail, the specific steps necessary and the issues to consider in achieving a successful contract with a vendor for full-service disease management.

Using Visual Displays as a Tool to Demonstrate Disease Management Program Effectiveness

“…The most logical first step an organization must take before choosing to develop or purchase DM services is to assess the prevalence of various diseases in its population. 5 A simple tool available for this type of analysis is the Pareto chart. As an example, Figure 1 represents the use of the Pareto diagram in a hypothetical Medicare population.…”

“…Program implementation must be well thought out and executed according to the characteristics of the population, their health condition, and their healthcare providers. 5 Delays in enrollment or an inability to convince eligible individuals to participate will seriously hamper the program's ability to achieve tar- geted outcomes. Figure 3 uses a pyramid graph to illustrate the proposed implementation and enrollment plan for our hypothetical CHF program.…”

Disease Management Interventions: What's in the Black Box?

“…DM programs attempt to achieve these goals by (1) accurately identifying those in the population with the disease or at significant risk of developing the disease, (2) convincing those with the greatest risk of morbidity and health services utilization to participate in the program, and (3) intervening with physicians and patients to effect some change in health behavior. Provider-focused interventions include: identifying patients on suboptimal medical therapy for their condition and encouraging physicians to change the therapeutic regimen, educating and encouraging providers to use lower cost treatment options when available, and coordinating care between providers to reduce redundant or unnecessary services.…”

Using an Empirical Method for Establishing Clinical Outcome Targets in Disease Management Programs

“…The DM industry is being scrutinized now more than ever before, due to the newly introduced accreditation programs of the National Committee for Quality Assurance (NCQA) and the American Accreditation Healthcare Commission (better known as URAC); the introduction of demonstration projects sponsored by the Centers for Medicare and Medicaid Services (CMS); and the heightened awareness of purchasers as to what they should expect and demand from DM programs. 3 As such, these programs are now being asked to demonstrate improvement in clinical quality in addition to a reduction in medical costs.…”

“…Linden Consulting Group, Portland, Oregon 2. RAND Corporation, Santa Monica, California 3. Providence Health System, Portland, Oregon.…”