Tuesday, January 24, 2006

Making a Buck Off of Disease Management Programs

There may be big money to be made keeping patients well. Kaiser Permanente is taking a new approach to the health maintenance business.

Apparently their management sees a revenue source in their Disease Management Programs (DMP's) and has spun off a subsidiary called Kaiser Permanente Healthy Solutions to generate those revenues. Their business plan is to leverage their institution's experience and data regarding such programs and their efficacy and in effect sell it to large corporations that otherwise do no business with Kaiser.

DMP's have been around for quite some time and involve specific systems for keeping patients with certain diagnoses healthy and out of the emergency room or hospital. Some diseases proven amenable to such solutions are diabetes, asthma, coronary artery disease, congestive heart failure (CHF) and others.

For example, a congestive heart failure program may target patients who are so-called "frequent fliers" to ER's and hospitals. Such patients utilize a disproportionate amount of healthcare resources and often for simple, easily resolved issues. If CHF'ers miss taking even a few doses of their medications or engage in occasional "dietary indiscretion" such as eating one too many salty potato chips, they can develop a life-threatening CHF exacerbation that can send them to the ER. This obviously involves significant risk to them (and heavy costs to their employers or insurers).

It has been shown that simple interventions such as weighing oneself daily (to quickly determine if excessive fluid is being retained can prevent such potentially catastrophic exacerbations hence the evolution of such programs. Unfortunately these are exactly the sorts of low-tech solutions that physicians and other providers are typically unable to efficiently implement on their own.

Once frequent fliers are identified, they can be enrolled in a health plan's CHF program. Nurse practitioners or physician assistants will call them up or bring them into clinic on a regular basis to assess how effectively they are taking they are taking care of their health.

They may check to see that they're taking their medicines (which can include even making sure they're even filling their prescriptions) or that they're tolerating them well. CHF is a complicated disease which can involve many pills often with potential drug-drug interactions or side-effects. Sometimes a simple call from a nurse can determine that a patient has stopped taking one or more pills because of such side-effects. Patients are often otherwise reluctant to confess such mild sins to their doctors. Once the "transgression" is known, the physician can then be notified and a suitable alternative can be prescribed possibly preventing another trip to the ER.

The nurse may uncover evidence that the patient's therapy is starting to fail and may require modification such as a subtle weight gain, worsening shortness of breath or reduced ability to walk or perform activities of daily living (ADL's) that could be harbingers of impending acute decompensation. Often such early warnings can trigger therapy changes that can prevent full-blown failure or possibly a simple return visit to the patients primary care provider.

The nurses may also be involved in promoting other health maintenance techniques as well for their patients such as risk factor modifications e.g. smoking cessation.

What is fascinating to me is that Kaiser has recognized or at least believes that instituting such plans for large businesses on behalf of their employees might be profitable for them. (Kaiser itself is a nonprofit organization and it isn't clear from this article I've linked how such new revenues can or will be channeled back into the institution.) It will be interesting to see how many businesses will hire Kaiser to evaluate their healthcare utilization data and determine which types of programs will be effective for their unique employee bases.

It will also be interesting to see just what kind of economic benefits can be realized from such programs (e.g. lower healthcare costs or reduced sick days or even employee retension).

It is truly a new age when Kaiser's expertise in such programs can actually be used to both save other companies money, improve quality of life among their employees and make a buck on the side! If they are successful, they can be guaranteed heavy competition from other for-profit businesses, even startups, for these dollars.

Aren't free markets great?

3 Comments:

Anonymous Anonymous said...

Whatever the outcome is, they have great commercials. I've really been impressed with the creativity.

Back to the subject at hand, however, having recently been the lucky recipient of a phone call offering to help me manage my health risks that were in response to answers given on a 'confidential' questionaire at open enrollment, I'm pissed about my information being handed off to a third-party for the purpose of helping me 'manage' my health risks. The real joke is that of the four of us covered, my costs are the lowest. But the rest of my family didn't get the helpful phone call.

feh. :(

January 24, 2006 12:57 PM  
Anonymous mchebert said...

Maybe I am not understanding this clearly enough, but why does Keiser own this data? Can I pool data on my own patients and sell it? What if a bunch of us docs get together in our small town and pool all kinds of local data and start leasing it to whoever wants it? Small as our city is, a dozen docs or so could have a virtual monopoly for any company that want to try to market medical products in town.

How about this: if we have a rise in CAD disease documented in our cath labs, could we sell the data to Outback steakhouse as proof that our town loves high fat meals?

I'm not sure that patients want to know that their personal data is being used for marketing and profit. There is not just a privacy issue here. Perhaps ther is a sacred dignity to patient data such that, even anonymous, it should not be used without express consent of the patient.

January 24, 2006 2:20 PM  
Blogger The Medicine Man said...

Mchebert,

Kaiser is relying on their own data (i.e. experience) to develop models that can be used to crunch other companies' utilization data to see if these other companies will benefit from DMP's and if so which ones.

You couldn't sell your patients' data to third parties but you could certainly use it to develop models on effectiveness of DMP's.

I never meant to imply that Kaiser will "own" these other companies' data.

I don't see any HIPAA violations here especially if these calculations involve only aggregate data.

John

January 24, 2006 5:00 PM  

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