CEO SUMMARY: Predictions are that 30% of large corporations will offer disease management programs for their employees by the end of next year. Disease management seems to be the next form of managed care, where prevention and early detection are the primary goals. Laboratories should be alert for opportunities to add value to these programs.
IF THE 1990S WAS the “managed care” decade, then the 2000s may turn out to be the “disease management” decade.
The use of disease management programs is growing steadily among both employers and payers. Early efforts report worthwhile gains in healthcare outcomes, particularly when measured against the cost of the disease management program.
Hewitt Associates, a human resource consulting firm, reports that the number of large corporations offering disease management programs doubled since 1997, increasing from 9.5% in 1997 to over 19% in 2002. It predicts that as many as 30% of large corporations will have disease management programs in place by the end of next year.
“Growth of these programs has been exponential in the last two years,” observed Bruce Kelly, Senior Consultant of Watson Wyatt Worldwide, another large human resource consulting firm. All the major health insurers are ramping up disease programs in response to interest by employers. One disease management company, Cor-Solutions Medical, Inc. of Buffalo Grove, Illinois, reports that, this year, programs it manages for large insurers have 300,000 patients enrolled. This is up from only 12,000 enrolled patients five years ago.
Use of disease management programs on a wide scale is a recent development, so most providers, including local laboratories, have felt little impact. THE DARK REPORT predicts that disease management programs represent a significant opportunity for clinical laboratories. Because these programs heavily emphasize preventive medicine, diagnostic testing usually plays an integral role as physicians use lab tests for screening, diagnosis, and patient-monitoring.
Expect the widespread use of disease management programs to create a new class of customer for clinical laboratories. The needs of this new lab customer will be different. On one hand, physicians and program managers will require more comprehensive access to lab test data for patients enrolled in a disease management program.
On the other hand, patients—the primary customer—will be actively involved in their personal healthcare and will expect laboratories to provide them not just with lab test results, but also relevant information about lab testing that helps them better manage their health care. For many disease states, this will include patient self-testing.
Regardless of whether individual lab tests were done in a central lab, the physicians’ office, or as a patient self-test, the disease management program will want that lab data integrated
into a single patient record.
A properly run disease management program will require a seamless flow of information between physician, payer, employer, and patient. Because laboratory test data is the major component of the typical patient health file, there will be a strong demand for laboratories to have the informatics capability to serve the needs of these users in new ways.
More specifically, the goal of having all laboratory test data end up in the patient’s primary medical record will require the integration of lab test data. Regardless of whether individual lab tests were done in a central lab, the physicians’ office, or as a patient self-test, the disease management program will want that lab data integrated into a single patient record.
Within the lab industry, there will be innovative laboratories that recognize this need and invest the money necessary to develop a laboratory information system that provides these enhanced capabilities. By their design and goals, disease management programs should see clinical laboratories as natural allies. That’s because lab testing is the most cost-effective way to detect most common diseases.
Benefits In Health And Cost
One existing disease management pro- gram demonstrates the benefits that can accrue. The city of Ashville, North Carolina, is enrolling employees with diabetes into a management program. Besides reducing the number (and cost) of frequent visits to physicians, patients in the program cost the city an average of $4,651 per year, versus $6,127 per year before this program was launched.
Results like these demonstrate that disease management programs can be an effective vehicle for improving the quality of care in a cost-effective manner. It should be no surprise that employers have begun to deploy these programs on a fast track. The return of double-digit increases in annual healthcare costs provides employers plenty of motivation and incentive to offer their employees and dependents a full menu of disease management programs.
Labs As Essential Partners
The trend toward implementation of disease management programs appears to be in full swing. Laboratories and pathology group practices should develop strategies for serving this new type of healthcare provider. The ability of laboratory medicine to offer preventive and predictive guidance to clinicians and their patients should position laboratories to be an essential partner in the care continuum.