In a faltering economy, employers may heighten their desire to see demonstrative metrics on their disease management programs. Tough times might even call for more physician engagement in the programs, assert some DM analysts.

DM programs have been around for a long time, which means employers are looking for a proven return on investment, says Barry Hall, a principal in the health and welfare practice at Buck Consultants." A weak economy just accelerates that mandate."

As layoffs continue, companies need the workers they have to be productive and present. DM and wellness programs serve as a way to control indirect health care costs associated with lack of productivity and presenteeism.

"Given the economic environment we're in, disease management is more important than ever. There is now an opportunity for the firms that do disease management, and do it well, to really distinguish themselves by virtue of creating a value statement that includes an impact on medical costs and productivity," says Dr. Lonny Reisman, the chairman of the New York-based firm ActiveHealth Management.

Precise measurements

Employers see DM programs as a way to rein in escalating health care costs by making sure workers with chronic conditions stay on top on monitoring their illnesses.

Yet the economic quagmire doesn't mean more employers are scaling back on their DM offerings. It's quite the contrary. They are moving forward with their DM strategies, but in a tight economy they are going to make sure they are spending money on programs that have added value to their corporate performance, Hall observers.

New market research by DMAA, a Washington, D.C.-based disease management trade association, shows steady support for DM programs. The 2008 data offer a snapshot into the disease and wellness management programs from the perspectives of 114 employers (20%), health plans (31%) and vendors (49%) who cover 166 million to 197 million participants.

For instance, 92% percent of health plans and employers offer one or more DM programs; within the next 12 months, 95% will have an investment in disease management. According to the research, by 2010, 97% of health plans and employers plan to offer one or more programs for disease management.

In addition, nearly 80% of service providers offer one or more DM programs, with an additional 16% providing DM support technology, software or devices.

Programs that focus on diabetes, coronary artery diseases and asthma achieve the greatest number of enrollments, measured as a percentage of eligible program members, the study finds.

"Any time you interrupt continuity of care, particularly for chronic disease, you risk sliding backward in health status and creating higher costs when conditions worsen for lack of regular care," says DMAA President Tracey Moorhead. "Retreating now from these important programs might generate savings in the short term. Ultimately, though, it will cost all Americans much more in health status and health care dollars."

Yet as the economy worsens, employers will expect DM programs to produce results. "Whatever the employer has already bought, they will want that program to be as robust as possible. Especially in this slow economy, employers are going to take a hard look at ROI," says Dr. Elaine Mischler, co-chair of the DMAA Market Analysis Workgroup.

Mischler explains that employers are going to want to see ROI in a much broader sense, focusing more on the cost trend of health care expenditures. DM vendors will have to be precise in explaining how their programs have made a change in the company's cost trend.

"It's not so much what's the ROI of an individual part of the program such a health risk assessment, but what has the program done for the company's total trend," she explains."We may also see less purchasing of new programs."

M.D. engagement

The DMAA research also reveals that nearly 70% of DM service providers believe that physicians view DM programs as intrusive. As a result, 41% of DM vendors say doctors are unlikely to encourage patients to engage in DM programs.

"M.D. engagement is critical. It's a three-legged stool involving the member, the physician and the payor," Mischler says. DM service providers must work to help physicians see DM programs as an extender of their time in working with a patient.

"We have to overcome that attitude that theses programs are 'playing in the physician's sandbox,'" she adds.

"As a physician, it saves me so much time when the patient comes in and knows what their health issues are and knows the type of questions I am about to ask. That kind of help is invaluable."

Mischler further explains that the industry will win over physicians by being clear that DM and health and wellness programs are a strong plus when done in partnership. The programs are not an attempt to practice medicine by getting into the physician space.

"Patients are never told medically what to do, but are educated about their diseases. That's what these programs are about, educating the member to manage their condition along with the physician," she adds.

Economic uncertainty may see the medical home concept grow in popularity in the DM space. It's a concept in which the primary physician or family doctor commits to performing many of the functions carried out by the DM vendor.

Proponents of a medical home approach contend that a DM program with heavy physician engagement will have a greater impact. "Let your doctor do the disease management functions, but motivate him or her to do it by offering incentives. Until all the pieces are in place, DM vendors have an important role to play," Reisman adds.

The most commonly offered DM programs by employers

Disease Management Programs Currently Supported

Diabetes (pediatric & adult; types 1 & 2) 82%

Asthma 68%

Coronary artery disease 68%

Heart failure 59%

Chronic obstructive pulmonary disease 55%

Hypertension 55%

Depression/mental health 50%

Low back pain (chronic) 45%

High-risk maternity 32%

Oncology 27%

Osteoporosis 23%

Arthritis 18%

Atrial fibrillation 18%

Kidney disease management 18%

Low back pain (acute) 18%

Fibromyalgia 14%

Inflammatory bowel disease (IBD) 14%

Irritable bowel syndrome (IBS) 9%

Urinary incontinence 9%

Headache 5%

HIV/AIDS 5%

Source: DMAA