Laboratory News

Fast Growth in Disease-Management Programs Triggers National Standards

Since 1997, disease-management services have grown at a 40% compound annual growth rate! Disease management is now a $1.2 billion industry.  To bring order to this chaotic growth, the Disease Management Association of America  (DMAA) in 2006 released an initial set of consensus guidelines designed to help standardize the way disease-management programs measure and report their outcomes. Now, a second phase of this project will be launched later this year.

By the end of 2008, DMAA plans to refine its guidelines and supplement them with a set of disease-specific clinical metrics.  The National Committee for Quality Assurance  (NCQA) hopes to fold these metrics into its own accreditation program by late 2008.

DMAA solicited input for these guidelines from association members, as well as external stakeholders, including employers, benefits consultants, academics, actuaries, government agencies, and accrediting bodies.  The effort to create national guidelines was a response to a report released in October 2004 by the Congressional Budget Office (CBO), which concluded that there was “insufficient evidence” to prove that disease-management programs actually save money.  Furthermore, as employers and health plans spend more money on disease management programs, they are demanding greater proof that their money spent on chronic disease management programs is being put to good use.

Suggestions in the DMAA guidelines include a recommendation that disease-management vendors calculate their outcomes in terms of total-dollar savings rather than return on investment (ROI).  This is a response to critics, who observe that ROI creates a more fluid ratio that can muddy financial comparisons.  The DMAA chose to endorse two competing approaches to identifying patients for the purpose of program evaluation, “annual qualification” and “prospective qualification.”  Unfortunately, the two methods differ in the way they define a population to be measured.

Another criticism of voluntary industry guidelines is that not all disease management companies may chose to follow them. It is pointed out that small and start-up disease-management vendors are likely to ignore guidelines unless they become part of federal health regulations.  Proponents of the guidelines argue that they are an extremely important first step in regulation an industry running out-of-control with exaggerated results.  Dennis White, a senior vice president of value-based purchasing for the National Business Coalition on Health, says that employers will have to play a bigger role in driving industry change.  “I think it will take the purchaser community and (other outside) organizations to step up and start using these guidelines and to demand their use.”

Some corporations, like Cigna , have embraced the DMAA guidelines because the guidelines are complementary to what the company is already doing to validate the quality and performance of its disease management programs.  Other companies, like Kaiser Permanente , have no plans to adopt the guidelines because they feel their existing, internal guidelines are superior. One wild card in this situation is the NCQA. As the NCQA accepts and incorporates the metrics from the updated DMAA guidelines into its accreditation program later this year, disease management vendors are likely to take these guidelines more seriously.

Most laboratory executives and pathologists are unfamiliar with these efforts in the disease management community. However, regular laboratory testing is an important component of chronic disease management. Thus, there is a need for the disease management community to establish quality standards and effectiveness metrics that also include guidelines for specific standards to track whether the patient, and his or her physician, is getting the right lab tests at the right time and whether the lab test results are followed up in an appropriate and timely fashion.

Related Articles: 

• Numbers that count:  Disease-management industry is taking steps to deliver more reliability, consistency in data on program outcomes 
• DMAA, NCQA Collaborate on Disease Management Clinical Measures
• DMAA Releases Consensus Guidelines on Measuring Outcomes 
• DMAA Consensus Outcomes Evaluation Guidelines
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