For more than a decade, the disease-management industrys approach to evaluating and reporting outcomes has been about as comprehensible as baseball legend Casey Stengel famously directing a group of rookie players to line up alphabetically according to height.
Since the industrys inception in the mid-90s, disease-management vendors have assessed their clinical and financial outcomes using a hodgepodge of competing and often flawed methods, yielding results that even the staunchest advocates admit have strained plausibility and defied comparison across programs.
But now the Disease Management Association of America is trying to get everyone on the same page. In December 2006, the Washington-based trade group released an initial set of consensus guidelines designed to help standardize the way disease-management programs measure and report their outcomes. And this yearin what it calls Phase 2 of its outcomes projectthe DMAA plans to refine those guidelines and supplement them with a set of disease-specific clinical metrics, which could be incorporated into a formalized accreditation program down the road.
It became clear not only to our membership, but also to the purchasers of disease-management services that there needed be some recognized, standardized set of guidelines to alleviate the significant amount of confusion that had arisen around the true impact of these programs as a direct result of the numerous methodologies that were out there, says Tracey Moorhead, the DMAAs president and chief executive officer.
The guidelines are the result of a yearlong effort by the DMAA that incorporated recommendations from association members, as well as a broad array of external stakeholders, including employers, benefits consultants, academics, actuaries, government agencies and accrediting bodies.
The effort comes in response to the fallout of a damaging report released in October 2004 by the Congressional Budget Office, which concluded that there was insufficient evidence to prove that disease-management programs actually save money. Since then, disease-management vendors have been scrambling to build a better business case for their services, largely at the urging of employers and health plans that have begun demanding greater proof that the millions of dollars they are investing in chronic-care programs are being put to good use (Aug. 8, 2005, p. 26).
But to what extent the guidelines will actually solve the industrys credibility problem remains to be seen. Some observers question whether the voluntary nature of the guidelines will pack enough punch to prompt vendors to change their established way of doing things. Others point out that the guidelines equivocate on a number of key issues, preventing true standardization even if they were adopted industrywide.
If the goal is to have everyone speaking the same language I think there are several controversial areas that will need to be revisited, says Michael Mustille, associate executive director of external relations for the Permanente Group, the physician arm of Kaiser Permanente.