Thursday, March 4, 2010

More Monitors, More Waste

"A decade ago General Electric experimented with a promising approach to employee health care known as disease management. ... 'It seemed too good to be true,' says Dr. Robert S. Galvin, GE's chief medical officer. And he adds, it was. ... Disease management [DM]--depite a series of studies finding that it doesn't deliver what it promises--has caught on throughout the business world (BW-Feb. 1 & 8). ... Companies marketing [DM] counter that in-house research shows such services sharply reduce costs. ... But outside analysts say the case for [DM]--and the data its marketers emphasize--typically rely on exaggeration and ignore the cost of the service itself. ... In August 2009, Rand [Corp.] issued a report for the state of Massachuetts concluding that [DM] Could increase employer and government spending in the state by $6.7 billion over 10 years with little overall benefit. ... One reason: A lot of preventive attention ends up directed at relatively healthy people who wouldn't require hospitalization anyway. ... The vast discrepancy between the contentions of [DM] companies and those of critics stem from different attitudes toward projections. .. About three-quarters of large companies offer some form of [DM] services, as do most state Medicaid programs for the poor. ... In Washington there is bipartisan support for allowing employers to grant bigger incentives to employees who participate in [DM]. ... Healthways ... was one of the eigt that participated in the 3-year Medicare pilot that ended in 2008. Medicare paid the [DM] providers about $360 million in fees, but outside consultants found no evidence of improved outcomes. ... At GE, [DM] didn't work on a broad scale, according to Galvin, who was a primary-care physician for 10 years before joining the company. ... The program failed, Galvin says. GE struggled to get enough enrollment to justify the cost, and those who did enroll rarely responded to the nurses. For much of the past year, the providers have been promoting their wares in Washington. Healthways officials say they've lobbied fiscally conservative democrats who are swing votes on health reform legislation. Their claim that prevention programs could save Medicare $652 billion over 10 years reflects industry assumptions that [DM] would dramatically increase the percentage of healthy seniors entering Medicare at 65 and keep them fit for yeas to come", Chad Terhune and Arlene Weintraub at Businessweek, 15 February 2010, link:

DM looks like another boondoggle. Like say the PCAOB, or much of CPA firm auditing which doesn't pay for itself. Or "portfolio monitoring services".


Anonymous said...

Clearly a triumph of marketing.

Here is what would improve health outcomes...

Smokers and obese people should pay insurance and Medicare premiums which reflect the dangers of their health choices.

The idea of pooling for catastrophic illness or disease has become pooling for the gigantic costs of diabetic, obese smokers...

All the rest is marketing.

Thai said...


Next time "they" come buy selling you this snake oil, watch your wallet.

Indeed, if we can't agree on disease management for the most public person on the planet who has one of the most non-controversial medical conditions in all of medicine, imagine how easy it will be for us to "manage" your problems.

... Of course my wife has been pressuring me to put a screened in summer deck on the back of our house to permit mosquito free outdoor evenings. So if you do decide to sip in a little of this cool aid, let me just dispense the "thanks" in advance. ;-)