From the Blog

Disease management: failure to engage

Disease Management (DM) has a simple problem.  It doesn’t work very well.

The recent disease management demonstration projects for Medicare (widely reported in the New England Journal of Medicine) were uniformly disappointing – with low enrollment rates and low-to-no clinical impact.  I won’t oversimplify the complexity behind these data, nor will I throw the baby out with the bathwater – but I will propose some simple, high-level reasons why the ROI of DM is under fire.

  • Bloated cost structures.  DM cost structures are rigid and built around highly trained people.  Great coaches, nurses and other experts cost real money – even if these roles are shipped overseas (another interesting trend).  Empowering – and yes, in some cases replacing – human experts with cutting-edge technologies is probably the only way to take big bites out of the cost of doing business
  • Many “customers” have no interest in changing.  “Hey, you’re obese and pre-diabetic.  Call me, because your health plan and your company want to spend less on your healthcare.”  Not only do highly trained coaches hate it – it doesn’t work!  Every assessment, screening and improvement approach needs to find the costly people who actually care about changing.  Adapting from a claims-driven, “call them till they scream” approach to a more behaviorally-focused human approach is not only possible today – it can cut half the costs.  The industry needs positive, viral and social self-referral mechanisms – anything but toxic water-cooler chatter about how to avoid the health plan cops
  • Singling people out sucks.  “Hey – I won the DM lottery!  My coach is calling me!”  People hate that first inbound call.  They avoid it.  They don’t call back.  Why?  Behavior change is hard enough when you ARE intrinsically motivated to volunteer – imagine how hard it is when you feel like you’re picked out of a police lineup.  Perhaps more importantly, ignoring the “other 90%” of a population leaves untapped the improvement potential in everyone who doesn’t fall in the “extreme cost” category.  This fundamentally negative approach (“managing disease” says it all, eh?) loses the potential for peer support, inefficiently allocates scarce dollars, and creates no population-wide business intelligence for employers
  • Sidetracked by lobbying.  Yes – we know there are buckets of money about to start swirling around in this little phone booth.  But any good business succeeds with or without government intervention.  Focus on delighting customers and human beings first…
  • Arrogance.  “You can’t build that in two months!  We’ve been working on this for 2 years – and ours will be better!”  We have heard this (in various forms) from big DM firms for years – and are still waiting.  We know from painful experience that in larger, established companies, systems evolve around ever-changing customer demands.  This introduces cumulative complexity and cost that serve as barriers to delivering cool s**t.  (Yes, we see the potential hypocrisy in a small company saying small is better, and then calling THEM arrogant – but we trust you will indulge the nerdy weaklings vs. the big boys just this once)

And yet, in spite of all of the obvious and solve-able industry PAIN, and high-octane population-wide engagement juice in our tanks – our advisors warn:

“Beware.  DM sometimes confuses their clinical expertise, health plan data connections, actuarial expertise, epidemiological/clinical frameworks and advanced coaching methodologies for compelling population-wide engagement systems.”

“And they’re not.”

For this reason, it’s an industry sitting on the launch pad, waiting for some bold and irreverent thinking to spark its massive engines.