CareScientific: MythBusters

A few former co-workers and friends of mine (Brenda Motheral and Steve Melnick) have formed a new company called CareScientific.  This is a follow-up to Brenda’s paper a few months ago on Disease Management.  You can now go to their site and see more about what they are doing:

• Custom program evaluation
• Provide a proprietary algorithm for selecting cost-effective patients for intervention

They also offer a Disease Management (DM) plausability and VBID plausability calculator to help you assess whether the saving you need are rational expectations.

I had a chance to see them officially launch this a few months ago at a conference.  Here were a few of my notes and some of their slides from the event:

• To reduce healthcare costs, you can look at pricing, disease management, and utilization management.  If you’re looking at DM, you need to focus on outcomes from both a quality and an ROI perspective.
• The early models for DM were much more multi-disciplinary.
• In a recent care coordination project, only 1 in 15 people showed a reduction in hospitalization…none showed an ROI.
• Hewitt says that less than 40% of plan sponsors are satisfied with DM.
• In 20 CMS studies, not one has shown an improvement in Rx adherence.
• Most DM savings are simply regression to the mean.
• Key things to focus on:
  • Behaviors that save money
  • Improving collaboration – where it matters
  • Rigorous evaluation
  • Determine savings plausability
• There are 3 concentric circles of focus.  At the middle is cost savings then cost-effective and then clinically appropriate.  Most programs are clinically appropriate, but only 20% show cost savings.