Evaluating disease management results.

59 IN A RECENT ISSUE OF this journal (Dis Manage. 2007;10:185-188), Scott MacStravic, Ph.D., asserted that disease management (DM) programs are likely to show lower savings in the first year and greater savings in subsequent years of intervention provided participants persist in programs. Persistence is often out of the hands of the DM vendor, and self-insured employers may not kick and scream when costly health care members drop coverage or even employment. But the original premise bears consideration, too. DM vendors often identify high-cost members for intervention knowing only too well that roughly 60% of them will not be high-cost again the next year (ie, regression to the mean). If these same individuals persist in programs then, in all likelihood, their savings potential diminishes rapidly. Hence, assuming stable intervention costs per participant as well as participant persistence, return on investment (ROI) should be maximal in Year 1 and minimal or nonexistent in subsequent years. DM vendors, therefore, maximize their purported ROI benefit because of new patient identification each year. Gordian Health Solutions’ reported results, on the other hand, tell a different story. Gordian is not a traditional DM vendor as Dr. MacStravic states. Rather, Gordian engages as much of the population with health risks as possible to encourage healthier lifestyle habits such as better diet and exercise and smoking cessation. As such, Gordian is in the disease prevention business rather than the DM business. Often, employers working with Gordian have a DM vendor in place as well. The highest cost members are typically “claimed” by the DM vendor, leaving Gordian the rest of the at-risk and healthy population. Naturally, these lower risk and lower cost members also have lower savings opportunity in the short term. Yet, when these wellness behaviors are promoted over a longer period of time, the health and cost benefits to the population increase.