Scott MacStravic, Ph.D.
There is a revolution underway--one that promises significant, perhaps dramatic, even “disruptive innovation” kinds of changes to traditional health care and insurance. It involves first a shift of investments in the handling of disease, from reactive diagnosis and treatment of acute and chronic illness, to more proactive management of diseases to minimize their crises, complications, and worsening, once identified. And it also involves a significant shift in the definition of what sorts of things are going to be “managed,” from currently recognized diseases to a host of other conditions, and even unhealthy behaviors.
Disease management has been around for a decade or so, beginning with employer and insurer attempts to manage the care of chronic disease patients in order to save money, and providing a market for vendors who have helped make DM a $300 million/yr market. Payers and vendors have been joined by large numbers of hospitals, physician practices, and integrated delivery/health systems who have entered this market as well.
Originally, DM focused narrowly on selected diseases where the risks of high expenditures among many patients, as well as the probability of reducing such expenditures in a short time (preferably the same year in which DM investments were made) were great. This meant that only tiny minorities of employees or insured populations were targeted for DM interventions, while promoting high ROI ratios for DM investments, though not necessarily high ROI amounts.
