December 10, 2007 
After landing (I often blog on the plane), I posted the last post about the Medicare pilot. When I looked at my iGoogle page that tracks many of the blogs I watch, I saw a new posting on the WorldHealthCareBlog about Disease Management. It is a good discussion on the value (if any) and talks about the different types of value (i.e., absenteeism versus lowering medical spend).
With such ambiguity, I think I would think differently. If you had $X to spend per year and you were responsible for your total healthcare spend, would you (a consumer) spend money on DM? At least intuitively, I would…assuming I had a chronic disease which was high cost and complicated. Having someone push me information, coach me on how to get better and/or manage the disease, helping me find resources, navigating my benefits, etc., seems like something of value.
Obviously, there are lots of challenges here, and I think the current models often use too high cost of channels and don’t leverage technology. At the same time, patients don’t have the same incentives today so they don’t necessarily always do what’s best for them. (Think of all the people that still smoke given all the research that shows how bad it is for you.)
Enabling Healthy Decisions 
Unfortunately, its just not about communication solutions. For example, here’s a description of a priority, “I only go to the doctor if I am really sick or injured.” Conventional wisdom is that people who think this way end up costing more. Research I’ve been involved with says the opposite.
People who strongly disagree with that statement generate higher health plan claims irrespective of their perceived health status, age or gender. In one sample of 8,000 health plan members, the 2,016 who strongly disagreed with that statement generated $2,921 more claims (pharmacy, doctor, hospital) per person than those members who strongly agreed with the statement. That’s an impact of $5.8 million that can be linked to a attitudinal/behavioral predisposition. In an employer sample of 815, the 72 employees who strongly disagreed with the statement generated $1,940 per person more in across the board claims than the employees who strongly agreed with it.
Of course all kinds of caveats can be applied to these numbers. But the fact is that the answer to one attitudinal/behavioral question identified nearly $2k to $3k of dollar risk per person. How can DM or population health management improve health and reduce costs without addressing how a person thinks?
Frederick – Thanks for the comment. I agree. In general, people in healthcare are anomalies so we shouldn’t use ourselves as a benchmark for anything. Obviously, from a research perspective, you have to start with the people. That is supposed to be my null hypothesis in the blog here. Of course, sometimes my opinion outweighs the theory in my writing.
The reality is that healthcare in general doesn’t focus on people. It has just been in the past year that I have seen healthcare companies hiring behavioral psychologists and linguists to help them analyze and develop communication solutions.
So what you’re saying is the problem is not the problem–the person is. You would pay for DM because of your priorities–attention to health and desire for a long life span. But chances are you wouldn’t need DM because you are self-motivated to do what needs to be done. You would find a way. DM is for people who don’t think like you. Among every disease or risk condition there are people like you and not like you. Because DM does not distinguish between the two, there’s tons of waste.
Focusing on problems instead of patterns of thinking within people is incredibly wasteful. Mind Set 1 can have elevated levels of all risk or disease conditions because of its nature while Mind Set 2 does not. So, why not focus on interventions for Mind Set 1 instead of making them condition or risk specific? Wouldn’t that be more effective and efficient than dealing with each issue piiece meal?
The problem is like the difference between the geocentric view of the solar system and the heliocentric view. When you put the earth at the center trying to predict every thing else is incredibly complicated. But if you put the sun at the center, it all turns into a few simple circles. It’s the same with today’s focus on disease conditions and risk factors. As long as they’re at the center it will remain incredibly complicated, redundant, and there will be little improvement in effectiveness. The focus needs to be on understanding people, perceptions and mind sets. That’s what needs to go at the center.
As a healthcare professional, I would pay for disease management solely because I am conscious of my health, I have responsibilities, and desire life longevity as long as possible. There is an array of information available to individuals to assist with disease management, however, information is not taken into consideration seriously.
The primary reasoning for these challenges within our communities is that individuals place pleasure, enjoyments, and addictions over one’s health. Utilizing smoking as an example, I personally know respiratory therapist, which are individuals that specialize in the respiratory systems (breathing) and the majority of these individuals smoke. There is a false believe that “if something has not killed me now or affected me, then I am good to go.” This mentality has lead our younger generation to believe that smoking is not only acceptable, but a required attribute to survive, calm never, and necessity
Diabetes is another issues and it involves that fact the people do not see this disorder as a serious disease in its initial stages of development. By this meaning, weight management not considered, life styles not change, and medication compliance not embrace. So, no matter how much preventive funding is spent individual will usually not embrace change if the element to be change is psychologically needed to survive.
In response to Dr. MacStravic of the WorldHealthCareBlog, disease management doesn’t save anyone money especially the medical facilities, clinics, or government agency integrating preventive tactics for their active communities.
HIV & AIDS is another case where preventive tactics have not worked efficiently. In South Florida, West Palm Beach, Miami, and Fort Lauderdale are in the top 5 or 6 cities within the U.S. that suffer from HIV. Individuals in South Florida are aware of the increase change of catching the disease, however, people still practice unsafe sexual acts.