DMAA Leader Responds To RAND Disease Management Literature Review

Main Category: Public Health
Article Date: 16 Jan 2008 - 2:00 PDT

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Even though few large-scale studies have assessed its outcomes, disease management represents a wise investment, the chairman-elect of DMAA: The Care Continuum Alliance says in a letter published in The American Journal of Managed Care.

The letter from DMAA Chairman-Elect Gordon K. Norman, MD, published exclusively online in the journal's January issue, responds to a RAND-supported literature review published in December. The review concluded disease management's clinical and economic value remains questionable given a shortage of large-scale, randomized controlled trials (RCTs) on its outcomes.

"There are sound reasons why DM [disease management] outcomes satisfy buyers today, even if academics remain unconvinced," writes Dr. Norman, executive vice president and chief science officer for Alere Medical Inc. "Taking all the data and circumstances as a whole, it is reasonable and responsible to conclude that we are wise to continue investments in DM, while accumulating more and better evidence about the total population effects."

Most purchasers of population-based programs, such as disease management, are so convinced of the programs' value that they are unwilling to exclude a portion of their population to form an RCT control group, Dr. Norman writes. Further, he says, purchasers are "not in the business of proving new science," but in managing a health plan population or workforce.

"They base daily decisions on business intuition and common sense, appreciating also that DM outcomes evaluation is an evolving discipline," Dr. Norman says. "More credible evidence for the economic effect of DM is accumulating over time, thanks in large part to efforts by DMAA: The Care Continuum Alliance to standardize evaluation methods for DM programs when RCTs are not feasible."

Purchasers also understand that large-scale trials might not reflect the results of their small-scale programs and, instead, rely on internal data -- data that often makes a compelling case to continue population-based strategies, Dr. Norman says.

"Are those adopting DM programs guilty of making leaps of faith in the absence of indisputable scientific support for DM?" he asks. "The answer is yes only if a leap of faith is defined as any decision made in the absence of compelling RCT evidence, which does not exist for most of what physicians do in everyday practice."

Dr. Norman suggests that even absent studies conclusively showing cost savings from disease management, population-based care might still prove to be cost-effective, given its success improving health outcomes. "Health and DM programs have been in rapid evolution during the past decade, and -- with the continued convergence of the electronic health record, the personal health record, and pay for performance, as well as the anticipated emergence of the patient-centered home -- there are exciting opportunities ahead for further refinement of best practices in chronic care management for yet improved outcomes," he writes.

Dr. Norman's letter may be viewed here.

About DMAA: The Care Continuum Alliance

DMAA: The Care Continuum Alliance convenes all stakeholders providing services along the care continuum toward the goal of population health improvement. These care continuum services include strategies such as health and wellness promotion, disease management, and care coordination. DMAA: The Care Continuum Alliance promotes the role of population health improvement in raising the quality of care, improving health outcomes and reducing preventable health care costs for individuals with chronic conditions and those at risk for developing chronic conditions. DMAA's activities in support of these efforts include advocacy, research and the promotion of best practices in care management.

DMAA: The Care Continuum Alliance represents more than 200 corporate and individual stakeholders--including wellness, disease and care management organizations, pharmaceutical manufacturers and benefits managers, health information technology innovators, biotechnology innovators, employers, physicians, nurses and other health care professionals, and researchers and academicians. Visit DMAA on the Web at http://www.dmaa.org.