Is Disease Management a Good Investment? We May Finally Have an Answer

This doesn’t focus on recovery management, but a new study supports the argument that disease management saves money.

In 2003, Pepsi started an employee health program that included risk assessments, on-site wellness events, lifestyle management, disease management, complex care management, telephone nurse advice lines, and maternity management. By 2011, there were 5 telephonic lifestyle programs (weight management, nutrition management, fitness, stress management and tobacco cessation) and 10 telephonic chronic disease management programs (asthma, coronary artery disease, atrial fibrillation, congestive heart failure, stroke, hyperlipidemia, hypertension, diabetes, low back pain, and chronic obstructive pulmonary disease).

Of the greater than 67,000 Pepsi employee participants, 2,610, 17,432 and 2,162 persons with an average 6.4 years of participation in disease management, lifestyle management and both, respectively, were matched, using propensity scoring, to Pepsi non-participants. The two groups’ insurance claims expense and absenteeism were compared.

Overall, all the participants had an average of $360 per member per year (PMPY) less cost compared to the non-participants. The participants’ vs. the non participants’ cost curves diverged and became statistically significant after 3 years

However, it turned out that the savings was confined to the disease management population, which had a lower cost of $1632 PMPY.  Participants in the lifestyle management had negligible savings.  Disease management had a return on investment of $3.78

Participants in both disease management and lifestyle programs had a savings of $1,920 per year.

via Disease Management Care Blog: Is $1 Billion a Good Investment for Disease Management? We May Finally Have an Answer.

Recovery vs. Disease Management

hopeThe Hopeworks Community blog has an outstanding post contrasting recovery and disease management.

His focus is on mental illness, but the parallels are clear. One can’t help but reflect on the fact that the addiction recovery movement rose in response to the failure of the mental health system to help addicts recover.

There’s a lot there. It’s worth reading the entire post. Here are a few of my favorite points.

  • Recovery believes that individuals matter.  No degree of impairment or difficulty makes them matter less.
  • Disease management believes that the disease or diagnostic label is the most important thing about anybody.

On recovery vs. symptom management:

  • Recovery  believes the primary thing the  individual recovers is  control over his own life through the acquistion of knowledge, the development of tools that enables him with the support and encouragement of others to begin building the type of life that enables him to be the best and most version of himself possible.  It believes that recovery involves success in activities, connection with other people, in the contetxt of a life of meaning and purpose.at is important to that individual is important: his thoughts, feelings, goals, aspirations, and interests.  No degree of impairment makes those things matter least.
  • Disease management believes  that symptom management is the best things can be.  And for the most part it believes that those symptoms will be chronic, always in danger of reoccuring.  It largely believes that medication will be a life time need.

On hope:

  • Recovery assumes that hope is a real thing.  Life can and should be a movement towards better things.  The steps may be slow and require much in the way of patience, but no matter how slow or small they are they are real and should be valued and treasured.
  •  Disease managment believes that hope is limited to symptom management.  It assumes that people will need continual treatment and that life will always tend to be disrupted by the “course of the disease.”  Life never really gets better, the hope is that it get less worse.

On the humanity of people with mental illness:

  • Recovery assumes that mental illness does not cause you to lose anything essential to being a human being.  Mental illness may block you.  It may disrupt you.  It may damage you.  It may detour you.  It does not diminish what it means for you to be a human being.
  • Disease management believes that the much of what you do, much of what you think, much of  what you feel, and even much of what you believe is either a symptom of your disease or a reaction to a symptom of your disease.

Personal responsibility:

  • Recovery assumes personal responsibility.  It is not something done to you.  It is not something you are given as much as it is something you get.
  •  Disease management identifies responsibility as following directions given to you by medical personal.

On helping that helps the helper:

  • Recovery assumes that you can support and help others, that often, the greatest help you get is in the help you give.
  •  Disease management believes that your capacity to give to others is not as great as people who are not “mentally ill.”  They do not believe you can be near as helpful as a medical person.

Non-medical treatments are essential

 


Love First linked to this article on the role of non-medical interventions in treating addiction.

I’m more and more convinced that the key to managing costs and improving outcomes for all chronic diseases are behavioral or lifestyle strategies. We’ve got a lot to learn about helping people make important changes in their lives that will help prevent relapses in cardiac care, joint replacements, weight loss, respiratory care, depression, etc. We’ve got even more to learn about helping people maintain these changes for decades.

Addiction treatment is ahead of the curve on a lot of this. We have a lot to offer the rest of medicine and I’m certain we’ll have a lot of opportunities to learn from their research and innovations.

 

CarePartners

The University of Michigan is trying a new program to improve depression care by involving a friend or family member in their care.

Patients who enroll in the CarePartner program enlist a trusted individual in their life to check-in on them and help manage depressive symptoms.

The program entails the patient completing an automated telephone assessment each week. The patient would receive immediate feedback on their condition. If they reported something that needed immediate attention, like thoughts of suicide or self-harm, or adverse side effects to medication, the system would connect them to an appropriate medical or professional resource.

Following each weekly call, the partner in care would receive an e-mail update on the patient’s condition, along with advice on how to help their friend or loved one stay the course when it comes to treatment. It also encourages the patient and care partner to set up a time for a weekly phone check-in.

This seems like a great idea and it would seem that addiction care could learn and borrow a lot from an approach like this. At the same time, this affirms a lot of what we already do–sponsors, family programming, etc.