Managed Healthcare Executive - October 2008 - (Page 22)

Industry 2009 State of the DISEASE MANAGEMENT Linden Consulting Group. “However, it must be an e ective program,” he says. “That means it should identify potential participants using data from a health risk assessment process, as well as from claims. In addition, DM programs should incorporate motivational interviews and address barriers to enrollment, such as the member’s readiness to change.” He recommends frequent contacts with high-risk members through remote telemonitoring, and systematic approaches to increase physician involvement. Linden suggests that chronic obstructive pulmonary disease (COPD) is another candidate for high ROI, since these patients often have a high number of admissions. However, only 3.7% of respondents said COPD had the highest ROI. The largest percentage of respondents ranked diabetes as the condition with the highest return. Diabetes is tricky to manage because when diabetics are admitted to the hospital, it’s generally for related conditions, such as hypertension or a coronary event. “A disease management program that focuses just on diabetes and excludes these other components is obviously missing the boat,” Linden says. Almost 10% of survey respondents found that asthma had the highest return on their disease management investment, while 16.4% found it have the lowest return. Sauer nds that in her own experience, asthma has been the most di cult condition to see a signi cant ROI, because there are issues that make asthma costs hard to control. “ER visits are going up, and there are many di erences across physician practices in how they prescribe medications for asthmatics,” she says. “In addition, I think we’re seeing an increase in asthma nationally due to of environmental issues.” MHE VALUATING THE return on an investment in disease management can be quite complicated, and survey results are suggestive rather than conclusive. For example, disease management’s return on investment often uctuates from year to year, says Paula Sauer, vice president for care management at Medical Mutual of Ohio (MMOH) and an MHE editorial advisor. “You may see a high return on investment initially in disease management, but then over time it often decreases,” she says. Another signi cant factor is that some plans have high turnover in membership, and they might see a higher return on their DM investment for the newly enrolled, compared to longerterm members. Survey respondents also noted a typical return on investment in a DM program, with 36.1% saying they achieve between 1-to-1 and 1.5-to-1 in returns; and 24.5% said they achieve between 1.5-to-1 and 2-to-1 in returns. However, a similar percentage (23.3%) said they achieve less than 1-to-1. HIGHEST RETURN While 10.3% of respondents said that congestive heart failure showed the highest return on their disease management investment, 8.4% found it had the lowest return. According to Sauer, MMOH tends to see the greatest return on investment from congestive heart failure programs. “These patients frequently go to the emergency room, and they frequently get admitted,” she says. “Your admissions costs o er your greatest potential reductions, which drives your ROI. Admission costs are actually a much more signi cant factor than ER visits.” Peer-reviewed literature supports congestive heart failure as a good candidate for high ROI, according to Ariel Linden, DrPH, MS, president of the 22 OCTOBER 2008 E Disease Management and ROI Offer Program Program Earns Highest ROI Program Earns Lowest ROI Diabetes Asthma Congestive Heart Failure COPD Coronary Artery Disease 69.1% 48.4% 46.3% 39.8% 37.8% 43% 9.9% 10.3% 3.7% 4.5% 8.8% 16.4% 8.4% 13.9% 10.1% N/A responses were as follows: Offer Program, 23.6%; Program Earns Highest ROI, 28.5%; Program Earns Lowest ROI, 42.4% Source: Managed Healthcare Executive Reader Survey, 2008

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Managed Healthcare Executive - October 2008 For Your Benefit Editorial Advisors Contents News Analysis State Report Politics &�Policy Healthcare Reform Trends in 2009 Cost Control Strategies Predicted Premium Increase Top Challenges in 2009 IT System Integration Technology Innovation Disease Management Health Management Pharmacy Best Practices Technology Desktop Resource Ad/Edit Index Managed Care Outlook Statement of Ownership

Managed Healthcare Executive - October 2008

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