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.
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