You Could Win A DMAA Leadership Award. Here's Why.

The Disease Management Care Blog feels your pain.

Your demanding customers bear an uncanny resemblance the skeptical and frugal DMCB spouse. Her attitude about the DMCB's obviously valuable blogging is undoubtedly similar to the tough mindset you're encountering about the veracity of your decreased emergency room utilization and hospital admissions data. Unfortunately, unlike the DMCB, pretending you didn't hear won't work, so you need another way to quell the criticism and gain a competitive advantage.

The DMAA, the Care Continuum Alliance to your rescue with its nationally recognized and highly covered Leadership Awards. Once again, the competition has been opened for organizations just like yours.

Should you go for it? The DMCB says yes, but to help you answer the question for yourself, the DMCB is happy to offer this exclusive for readers only self-assessment questionaire:

Has your company:

1) partnered with a community health program, causing an insurer's claims expense to drop lower than a D.C. incumbent's approval rating, or

2) changed its branding, emphasizing how it does really the same stuff but now calls it "empowering consumer-based self care to drive optimal outcomes," (or is it branding health consumerism by optimizing outcomes based driving...? - whatever)... or

3) developed an app that cures diabetes when you hold the iPhone against a person's forehead?

Have any of your overpaid consultants pointed out that....

1) you miraculously got a special insurance rider past the actuaries and finance people upstairs and, if others knew about it, it would make health insurance a lot better for persons with chronic illness, or

2) you need to counter those big boy competitors that are hogging all the limelight by cluttering the internet with press releases, e-mails, tweets, white papers and discussion-board chatter, or

3) no health care professional's life is complete without regularly checking out the Disease Management Care Blog?

Do any of the following pertain to you?

1) your evidence-based approach has been used by a government Medicaid program and the State Medical Director is very happy, or

2) you have outcomes results that have been validated using a contemporaneous propensity-matched and quasi-experimental design using age, gender and the number of Lady Gaga tunes on a person's iPod as variables, or

3) you have data that shows liberal use of a chrome-plated handgun to noisily fire some plugs into the ceiling is an effective means of engaging providers?

Alternatively, have you discovered that.....

1) your enrollees' use of terms such as 'like,' 'good' and 'want' speaks louder than anything published in the New England Journal of Medicine, or

2) you have a physician leader in your organization that is truly rare because he or she is only occasionally an insufferably obnoxious know-it-all, or

3) your marketing employees'/consultants'/partners' use of terms like 'robust,' 'groundbreaking,' 'evidence-based,' 'unparalleled' and 'unique' is an embarrassment to the industry?

Do you....

1) agree that an awards venue for you to showcase these and other talents at a national meeting that is attended by important policy makers, potential customers and widely read bloggers is a good thing, and

2) know that the DMAA awards committees make their choices regardless of a company's size or market penetration and

3) realize that those crystal trophy baubles would sure look good in a your reception area when potential customers come-a-calling?

That's why the DMCB is happy to let you know that if any of the above is true, you should compete for a DMAA Leadership Award.

Seriously, the awards are a great way to showcase you or your company's accomplishments in the increasingly crowded of population-based health care. While the application process is rigorous, your company is worth it. While you think about applying, you should also ponder the luster of an extra added bonus: if you win, it's highly likely that you or your company will be mentioned in a certain widely admired blog that has thousands of readers and would be a leading candidate for the Best Disease Management Blog Award if only the DMAA would see fit to offer it.

A good start is to check out the DMAA Leadership Awards' web site. The deadline is June 11, so you have plenty of time to familiarize yourself with the various categories and the nifty on-line submission process.

Important Webinar Alert

Are you flummoxed by the methodology utilized to evaluate disease management outcomes? Do you wonder why the experts utilize the word "methodology" instead of "method?" Do you wish they'd stop with the "utilize" stuff and just use the word "use?"

You're in luck because the DMAA is hosting a pair of Webinars that will help you better understand its important (and free, by the way) guide, the 'Outcomes Guidelines Report, Volume 4.' The March 4 kick-off includes faculty who really know what they are talking about: Soeren Matke of Rand and David Veroff of Health Dialog. Compared to other webinars, the pricing is quite modest, especially if you're a DMAA member.

Weak Ties, Professional Development and Implications for Companies and Trade Associations

In it's last tour of the Population Health Management Journal, the Disease Management Care Blog neglected to mention the editorial by Paul Terry of StayWell Health Management.

Titled ''The Strength of Weak Ties' Revisited: Achieving True Integration of Disease Management and Lifestyle Management,' Dr. Terry reaches into a backwater of social theory and argues that the cozy, 'tight' and insular ties that characterize like-minded professional relationships paradoxically impair collaboration and stymie social change. What is needed, he argues, are more of the 'weak ties' of loose acquaintances that allow otherwise separate expert networks to access each other's insights and knowledge. He suggests close ties within the disease management and lifestyle management communities are getting in the way of fashioning true comprehensive solutions across the population continuum. His proposed solutions include 1) fostering true multidisciplinary teaming, 2) putting the needs of the population first and 3) transparently sharing all research findings.

The DMCB likes the concept and wonders if this could be taken even further by readers both personally and organizationally.

At the personal level, we're all on the lookout for professional career paths that are likely to lead to fame and fortune. Individuals who can create the weak ties across multiple professional camps will have a leg up in the competition for those future coveted healthcare VP jobs. By networking outside your field of study, you'll be able to gain access to otherwise unavailable insights and use them to you and your organization's advantage. While you risk becoming a jack of all trades and a master of none, if would seem that there is a need for individuals that can crosswalk between disease and lifestyle management, public health, medicine, actuarial sciences, nursing and pharmacy.

Organizationally, it seems to the DMCB that fostering weak ties between the various work units, departments and divisions could contribute to a competitive advantage. This concept should be useful to corporate leaders, who may be otherwise tempted to promote close ties in their workforce.

In addition, there are forums where companies themselves can network, such as trade associations and purchasing groups. Assuming no company can be a member of every organization out there, this social theory would suggest that it makes sense to choose one that offers a high level of diversity. One example that comes to mind is the DMAA, which convenes a broad swath of traditional disease management and lifestyle management organizations, along with a host of other stakeholders. Which brings up another point: business associations that are not insular and instead strive to have a broad membership with weak times are probably the ones that are doing their members the greatest service.

Random Observations On the Disease Management Industry Thanks to the DMAA Forum 09

The Disease Management Care Blog used the DMAA’s Forum ’09 exhibit booths as a window looking into the state of the industry. It came away with several impressions.

The first is that while the salespersons are infected with ebullient enthusiasm, there was a lot of optimism in that exhibit hall over the future of the disease management/population health industry. The DMCB discerned two reasons:

1) Tally ho! The exhibit hall denizens said there has been no decline in the overall number of commercial sector RFP’s. Despite the dour skepticism of the inside-the-beltway CBO and their academic friends, the customers still like what the industry is offering, and

2) Blue Ocean. Whatever shape health reform takes, it will include dumptrucks of money for wellness, prevention and chronic condition management. That means new customers and new markets with new opportunities.

Over and beyond the industry’s derring-do, the DMCB detected a considerable willingness to engage in modular multi-party partnerships that involve two or more companies plus whatever components that are kept in-house by their customers. Thus, while individual companies are offering a broadening suite of health information support, telephonic care management, wellness interventions, surveys, analytics and the like, they are paradoxically more than happy to offer their wares cafeteria style. What’s more, being able to share data, integrate work flows and play nice with other companies is emerging as a competitive advantage. The DMCB thinks this has implications for the advocates of the Patient Centered Medical Home, who will need to figure out how it can flexibly plug into evolving spectrum of care management services.

The DMCB is also disappointed to report that the excess of superlatives continues to infect the science of disease management more stubbornly than a MRSA outbreak at a humid fitness center. Examples include 'robust!,' 'unmatched!,' 'outstanding!,' 'rigorous!,' 'award-winning!,' 'innovative!,' 'proprietary!,' 'unique!,' 'cost-saving!,' 'proven!,' 'exceptional!' and on and on and on. The DMCB lessened its pain by increasing its bar-based beverage intake. Duly fortified, it then soldiered on through the silliness, wondering when these industry mouseketeers will stop being so tone deaf to the difference between evidence and proof. Now that policy makers, scientists, physicians and masters-prepared Congressional staffers are just as much an audience as all those naïve human resource directors, the DMCB suggests it’s time to reign in the vendoring run amok. The marketing may taste great, but it’s perpetuating the industry’s lightweight less-filling branding.

Outside of the Display hall atmospherics, the DMCB never expects to be so famous and busy that it will have to send a video of itself in lieu of speaking in person at a national conference. In the case of Dr. Clancy, the miracle of this substitutive technology ended up making her look almost alive.

Thanks to a DMAA Forum session, the DMCB is now aware of one more instance in which a State Medicaid Medical Director, along with some friendly jawboning from other State departments, has gotten multiple commercial insurers within the borders to cooperate in population-based care programs, including data sharing and pooling support for primary care. Perhaps the Medical Directors’ job descriptions need to be broadened to include words like convener, trusted intermediary, networking, and innovator. The States’ impressive work in this area seems largely under-recognized in the health care reform debate, and it’s only just been recognized by CMS. As usual, Medicare is late to the party.

Finally, a Harvard researcher provided an interesting plenary session on the topic of bias-free and evidence-based patient education that harnesses the patient’s ability to decide on whether or not to have a test or a treatment. The DMCB has been aware of the supporting peer review literature for quite some time, which convincingly shows that when patients receive this kind of state-of-the-art education, they are better able to discuss the risks, benefits and alternatives with their physicians. What's more, many, compared with usual care, will elect to not undergo preference-sensitive and unnecessary procedures. As a result, patients may appropriately elect to avoid controversial prostate cancer screening, decline an invasive heart procedure and refuse inappropriately extensive breast surgery. The DMCB asked what this means for a HEDIS measures, where patients may also elect to not have a mammogram or a flu shot. Maybe the denominators need to be changed.

HAPHIE

The best part of today's DMAA Forum '09 meeting was the plenary session address by the Chair of its Board of Directors, Gordon Norman, MD. He tackled the important issue of how to combine the various interventions that are being promoted by the various stakeholder groups, including the patient centered medical home, patient monitoring technology, the electronic medical record, data exchange, physician payment reform, classic disease management, wellness, prevention and consumerism.

The Disease Management Care Blog agrees with Dr. Norman: it's no longer a matter of measuring the return on investment or the impact on quality for the still evolving iterations of each of these individual interventions, it's now a matter of figuring out how to fit these all together into a integrated whole.

He called the concept 'High quality, Affordable, Personal Health Improvement for Everyone' a.k.a. HAPHIE. His point was that we already have all the tools and all the information and all the science we need to provide mass customization for individual health care consumers. There is already plenty of money in the system to provide personalized care on a population-based scale. The challenge is to fit all the pieces together in an overlapping, mutually self-supportive and synergistic whole.

The DMAA Forum '09: Volume IV Recommendation on Assessment of Disease Management Outcomes Is Out

If you have been struggling with the topic of how to evaluate your latest population health program, things got a little bit easier today. The Disease Management Care Blog sat in on a DMAA Forum '09 session on the release of Volume IV Recommendations for Measurement of Outcomes. It builds on all the prior Volumes but (and here's the good news) this latest edition will contain all the previous published recommendations and be available without charge for download from the DMAA website.

The DMAA deserves a LOT of credit for making this available gratis. The DMCB thinks the recommendations are not only valuable for assessing disease management, but could be of use for stakeholders interested in the evaluation of other population-based programs, including the patient centered medical home. Sure: a randomized clinical trial is the gold standard for any program evaluation, the fact is that it's not always feasible to do that. Volume IV offers a way out.

The latest release has some other important additions, including:

How to measure and report medication adherence (for example, a minimum to two claims for a specific drug class must be incurred to include a member).

Which baseline to use for long term programs (i.e., those that have been underway for 3 or more years: do you use the first year or the last year?).

A consensus definition of 'Population Health Management' (and a diagram to go with it): 'strives to address health care needs at all points along the continuum of health and well being through the participation of, engagement with, and targeted interventions for the population.'

How to assess the impact of wellness programs (it depends).

The report at the time of this writing is not available on the DMAA web site. The DMCB will keep an eye out for it.

Other noteworthy happenings at the DMAA Forum:

The frightfully bright Mark McClellan MD PhD, former administrator of CMS, gave the day's keynote speech and noted that the considerable consensus over the need for insurance reform means a bill will pass one way or another. He stated that care management - even though it's not viewed favorably by the Congressional Budget Office - has wide bipartisan support. He was very optimistic about the disease management industry's prospects in the coming legislation.

Tracey Moorhead, the President and CEO of DMAA pointed out in her short speech that peer review studies of disease management and its outcomes are critically important going forward. All eyes are on care management, and policy makers as well as legislators will continue to be very interested in knowing more about it. The DMCB agrees: performing rigorous assessments of outcomes and reporting them in the public domain under the scrutiny of peer revew is becoming a cost of doing business for health care in general including disease management organizations including 'carve-ins.' It is our duty and it's good business to understand what works and how much it costs.

Also of note: attendance at the Forum seems high enough to fill meeting rooms, cause crowded escalators and lead to queues at the reception bars. It appears the number of paying attendees is about the same as previous years' meetings but there are also fewer numbers of people manning the display booths.

News About the DMAA Meeting: Save Money by Registering Early and Why Not Apply for an Award?

Psst! Want to save some serious coin and learn about the latest real world advances in care management, prevention and wellness? You may want to invest in your or your company's intellectual capital by going to what is, hands down, the premier national educational meeting on care management, 'bending' the insurance trend and reconciling clinical outcomes with reductions in claims expense. You'll get to see the industry's leaders in action, make new friendships, renew old acquaintances and obtain critical policy and competitive insights.

As you are reading this, you have only four days to not only save $400 by registering early for The Forum 09, the 11th annual meeting of the DMAA: The Care Continuum Alliance, but there is an additional $50 discount here if you do it on-line. Now THAT's a return on investment.

The Forum 09 will feature expert keynotes on health policy and trends, including Mark D. McClellan, MD, former Medicare and FDA administrator and director, Engelberg Center for Health Care Reform; Michael J. Barry, MD, director, Health Services Research Program and chief of the General Medicine Unit at the Massachusetts General Hospital and medical director, John D. Stoeckle Center for Primary Care Innovation; and David K. Nace, MD, vice president, clinical development, McKesson Health Solutions and co-chair, Patient Centered Primary Care Collaborative Center for e-Health Information Adoption and Exchange. DMAA also offers a terrific selection of educational sessions, including a new Pacesetters Policy Issues series and tracks on physicians and collaborative models, outcomes measurement, obesity and other timely topics. Last but not least, you'll get the walk up and actually meet the Disease Management Care Blog.

What's more, you have eleven days to throw you or your company's hat into the ring for a coveted DMAA annual award. You may think you can't compete against the big boys, but the DMAA has seen plenty of examples of smaller novel initiatives capture the attention of the awards committee.

DMAA will accept nominations for its annual industry awards through 8 p.m. Eastern Time, July 10, through its online nomination system here. DMAA this year expands its new Quality Awards program to three categories: Most Innovative Program Design or Delivery, Greatest Impact on Health and Greatest Impact on Satisfaction. Combined with the association's annual Leadership Awards, you have 10 awards categories from which to choose. Not only will you be featured at the Forum but the DMCB may describe your winning entry in a future post. Right after the one where it describes how the DMAA should create an 11th award category for 'best blog.'

The Interview with Tracey Moorhead. Insights About the State of Disease Management

Tracey Moorhead, President and CEO of DMAA was interviewed by none other than the Health Care Blog’s, Matthew Holt. Is the Disease Management Care Blog jealous? Even if it was, it wouldn’t mention it here, but it and the DMCB spouse do look forward to the day when it achieves the HCB’s level of sophistication, gravitas, readership and ad revenue. But it digresses…..

The podcast is well worth a listen, if for no other reason than to hear the repartee between the skeptical Mr. Holt and the optimistic and confident Ms. Moorehead. Realizing that not everyone has 34 minutes to spare (and may not be willing to put up with the periodic buzzing in the recording), here is a brief summary of the better learning points. The DMCB will keep these in its intellectual tool box and keep handy to thwart doubters, stymie naysayers and verbally smote nattering nabobs. You can also, because you read it here:

Remember that CBO report that said disease management doesn’t save money? Mr. Holt sure did, but Ms. Moorhead coolly responded by pointing out that much of the research used in that report was outdated. In response, the DMAA has opened and maintained a regular dialogue with CBO that includes a regular feed of up-to-date literature along with face-to-face meetings. As a result, CBO is better able to stay current with the rapidly changing science of population management, which may have, in turn, helped them craft this later report. The DMCB summarized it here.

And how about that Medicare Health Support? Out of date also, rejoined Ms. Moorhead. Those one-size-fits-all mass recruiting call center programs have gone the way of pneumoencephalogram and doctors' awareness of Pott’s Disease quicker than you can say ‘Tom Daschle’s history.’ In contrast, other successful public sector programs have not been hampered by MHS-style delays or an inability to update their clinical operations, which should tell you something. In addition, a gauge of MHS’ success is not just savings, it’s satisfaction and clinical outcomes, both of which have shown improvements. Keep in mind that the original law that launched MHS did not intend for it to achieve savings, only be budget neutral. Last but not least, stay tuned. A final report has yet to be issued and additional analyses may show that some subpopulations did benefit from reduced claims expense.

What about the future? Well, Ms. Moorhead says it is so bright, she’s gotta wear shades. Medicare was originally designed for an acute care model and everyone, and she means everyone, understands it needs to be changed to support a long term care model. She is optimistic that there will be a convergence of other care models such as the medical home. She is also very confident that the DMAA’s members are committed to the centrality of the physician and believe disease management is one resource that can help them. In fact, some vendors are already partnering and successfuly collaborating with some physician practices.

Finally, said Ms. Moorhead, there is a growing body of evidence that shows population-based care coordination works, especially if the emphasis is about quality of health care, not the return on investment savings. And don’t just listen to her say that, because there are champions of disease management on the Hill and in the Administration.

Call for Abstracts!! Do You Have a Good Story to Tell About the Care of Populations?

If so, you should strongly consider submitting an abstract for the DMAA Forum '09 Meeting. You or your colleagues may be put off by the prospect of assembling a presentation and having to present it in a mini-lecture format, but keep in mind that its a heluva lot easier than you may suspect. The abstract reviewers from DMAA are not only interested in a sufficient degree of methodologic rigor but they are more interested in new and meaningful approaches to employee, insured, uninsured or community-level populations. Folks in the audience are supportive and enthusiastic. They'll be counting on the same level of support from you when they make their presentation.

How does the Disease Management Care Blog know this? Because it has served as an abstract reviewer. It likes new program descriptions from newcomers. That's where all the innovation is.

Ask yourself:

Thanks to your novel program, did people lose weight or exercise more often? Stop using tobacco? Have better control of their chronic illness?

After your unique intervention, did enrollees see their primary care physicians more frequently? Stay away from emergency rooms? Have lower claims expense?

Once you were done, did persons express greater confidence in dealing with their chronic illness? Did they like their relationship with your health coaches?

While your excellent initiative was being launched, did the physicians change their approach? Were they willing to participate? What feedback did you get?

And let's not forget the Patient Centered Medical Homes. This is a perfect setting to share preliminary results about the many pilots underway and share notes with others at the Forum who are undoubtedly going to be talking about the same topic.

There are many reasons to submit. It's not only a reason to go to sunny San Diego, it's a chance to gauge the reactions of other experts in the field and solicit their input. It may help you spot changes that could be made to further improve your program going forward. You may be approached by the media for a quote. Various peer review journals representatives may ask you to submit a manuscript for possible publication. You may get an award for best presentation. You'll be labeled an expert. You can put this on your CV. Once you break the ice, you'll be even better at submitting for Forum '10. DMAA is a good place to trial run your abstract prior to submitting it to another meeting. This is a good way to not have to think about the prospect of how badly healthcare reform will be messed up in D.C. The DMAA 'Faculty' name badge makes a great fashion accessory and memento to show your relatives. Finally, you'll also get to meet the most excellent DMAA staff and their indefatigable leader, Tracey Moorhead.

Face it: when you and your colleagues launch a population-based care program, you probably have a pretty good idea of what the baseline is like and you probably have at least a good idea of what you'd like to see happen. By performing at least partially complete measurements and having an adequate comparison group, you have the ingredients necessary to submit your abstract along with all the big boys.

Go ahead.... the Disease Management Care Blog dares ya. You have until 8 PM EST Feb. 20 to pull it together. Mark your calendar, close down your web browser and hammer out a preliminary Word document. You thought about it last year, this year is your chance to actually do it.

Disease Management and the Medical Home Podcast

The Disease Management Care Blog is in a podcast? That DMCB first is thanks to the DMAA posting the audio from a November 25 keynote panel held at the Hollywood Florida Forum 08 Meeting. The topic was a DMCB favorite: the patient centered medical home and disease management. Hundreds listened in on the presentation and this is your chance to share in the knowledge.

The link to the audio is here. In it, you'll hear the real stars of the show, Lisa Latts MD of WellPoint, Paul Wallace MD of Kaiser Permanente and Ricardo Guggenheim MD of McKesson. These experts know of which they speak. So, if you must eat your lunch at your desk, the DMCB suggests listening to this will make your left-over turkey, lettuce n' mayo sandwich that much tastier.

A summary prepared by the DMAA eNews is below in case you don't have the time to listen right now.

'The panelists generally expressed optimism about the medical home model, but cautioned that questions remain about the fundamental design, payment mechanisms and patient engagement strategies. Dr. Wallace suggested that the patient-centered medical home might be better positioned as one component of a more complex "medical neighborhood" with a diversity of providers and a care delivery infrastructure supported, in part, by population health improvement. He also argued for greater patient involvement in health care decision making as the best path to a successful medical home. "Patient-centeredness is something we can do," he said of physicians. But "'personalized' is something that we can only do together with the patient. I think we have to trust the patient to help us find that spot." Dr. Guggenheim noted the need to include hospitals in the "medical neighborhood" concept. Success, he stated, will depend on the ability of the population health improvement industry to provide actionable, real-time data; IT tools to facilitate the care management process; and consumer-focused service.

Dr. Latts noted the challenge of providing additional payment to primary care physicians for medical home services with a limited pot of money that also must fund specialty care. She emphasized that, to succeed, the medical home must be simple to administer for primary care practices, with a coordinated approach to working with multiple vendors, including those providing population health improvement services. Dr. Guggenheim also spoke about the challenge of finding an acceptable payment model for the medical home, calling it "the biggest hurdle" to change. "I think the biggest problem that you have with changes in payment structure is that everyone wants them but nobody's that eager to sign up for them," he said.

Dr. Wallace said that payment reform is achievable, but must include "some accountability in the process for what patients care about." Patients, he said, "care about cost, they care about service and they also care about health. And I think that that's really the dilemma about how we align that incentive. I think that's where managed care and we came up short in the '90s." He also said the medical home must encourage the primary care provider to serve as a gateway to appropriate specialty care rather than as a gatekeeper to limit access to specialists.

Dr. Wallace sounded a positive note for population health, saying that the industry's expertise in reaching out to patients will underscore its value in a care delivery model centered on patients' needs. "I think that's why I'm hopeful for this industry, because this industry has survived only because it has figured out how to connect with patients," he said. "The challenge here is how do we take that connection with patients and align it with the rest of the delivery system?"'

Coda: Next year's meeting Forum '09 Sept 20-23 in San Diego. Mark your calendar.

Insights on the Prospects for Healthcare Reform from the DMAA

Today the Disease Management Care Blog heard former U.S. Senator Breaux of Louisiana and former HCFA Administrator Gail Wilensky talk about the prognosis for health care reform.

Senator Breaux belongs to the ‘too much other stuff to do this year and fundamental health care reform is too complicated camp.’ He predicted Congress will go for the low hanging fruit with funding for SCHIP, information technology, comparative effectiveness and physician payment reform. He thinks Obama-esque reform will take two years - at least.

Dr. Wilensky belongs to the ‘I was unable to sleep and had an 'aha!' moment 2 weeks ago’ camp. Her insight was that the public is concerned about one thing and one thing only: health care affordability. In the meantime, policy makers, politicians and wonks are worried about quality, safety, economic sustainability and entitlements. While they correctly note these issues ultimately drive affordability, Dr. Wilensky predicts the public will have little patience for these high falutin concepts and look for understandable solutions that directly lead to lower costs for insurance and/or health care. This mind-set may be the secret weapon for those opposed to health care reform: Harry and Louise aren’t going to fret over loss of choice, but over rising of cost.

While Dr. Wlensky also agreed that quick reform was unlikely, she pointed out that care coordination and disease management were areas that are benefitting from strong bipartisan support. She felt the future was bright for DM industry.

And before the DMCB had a chance to ask her about it during th Q&A, the topic of bundled payments came up. She likes the idea, because 'ala carte,' fragmented fee-for-service Medicare is one of the biggest drivers of increased utilization. Bundling, in her economist point of view, is a good fix.

Last but not least, the topic of an independent national health board came up. As noted in prior DMCB posts, this may be the most controversial feature of the Democratic reform package. Senator Breaux said the idea has legs not because the U.S. Congress enjoys giving up power, but because there is an emerging consensus among his former colleagues that the Congress can no long micromanage the increasingly complicated details of Medicare and Medicaid.

Tomorrow: a plenary session in which leaders from the health insurance industry, disease management and an integrated delivery system will talk about the prospect of closer coordination between the medical home and disease management. Your intrepid DMCB reporter will be there.

Reasons to go the DMAA Forum 08

The Annual DMAA confab is less than a week away. In addition to hearing the latest in population management, seeing old friends and making new ones and enhancing your professional development, here's another reason to go, straight from the DMAA eNews:

'There will be a keynote panel Nov. 25 at featuring four thought leaders for an informative discussion of approaches to integrating population health improvement into the patient-centered medical home. This special presentation will feature representatives of organizations delivering solutions in collaboration with primary care practices. Panelists will explore the successful fit of population-based strategies in the medical home from the perspectives of health plans, Medicaid programs, disease management organizations and integrated delivery systems.

Panelists for the morning presentation include:

* Ricardo Guggenheim, MD, McKesson Health Solutions
* Lisa M. Latts, MD, MSPH, MBA, FACP, WellPoint Inc.
* Paul J. Wallace, MD, Kaiser Permanente

Former DMAA Board member and population health expert Jaan Sidorov, MD, will moderate the discussion. Dr. Sidorov writes the popular Disease Management Care Blog and speaks nationally and internationally on health services research, disease management and managed care insurance.

"This is without question a must-attend presentation," DMAA President and CEO Tracey Moorhead said. "These are exceptional speakers who will provide Forum attendees invaluable insights into the synergy between the medical home and population health."'

The self promoting DMCB does not disagree with Ms. Moorhead. The overlap between the medical home and disease management is a critically important topic and Dr. Sidorov intends to squeeze each of the panelists for every insight they can muster.

By the way, there are plenty of other reasons to go, according to the latest issue of the Population Health Management Journal, including:

Hearing about transparency from the very famous Elizabeth McGlynn PhD and David Wennberg MD. Reminder: Dr. McGlynn wrote that article in the New England Journal of Medicine on how the health care system fails to deliver basic quality. The DMCB thinks that if she talks, it should listen.

Learning from Elain Mischler MD about the DMAA's market survey on what the real wold thinks about disease management and wellness.

The role of pay for performance in Medicaid disease management, thanks to James Bush MD of Wyoming and David Kelley MD of Pennsylvania.

The juicy details behind LifeMasters' program for dual eligibles in Florida, straight from Linda Mango of CMS and Christobel Selecky, former DMAA Prez.

Health promotion and disease prevention guru Vic Stretcher MD will be talking about the return on investment of an interesting program in Hawaii. Vic's methodology is worth learning about because it has widespread credibility.

The ever actuarial Ian Duncan will discuss the more sublime aspects of wellness program evalution using risk factor change. Have things gotten to the point where there is no room for amateurs? This is your chance to find out.

Sue Jennings PhD will update us about the latest update in the DMAA outcomes methodology. This is worth the price of admission because that's the process that you can use to tell your CFO whether your program saved any money. Ignore this at your own peril.

Jefferson's Neil Goldfarb MD will update us on what the medical literature tells us, and doesn't tell us, about obesity management. When you return home, you'll be able to quote from this session and amaze your friends and silence your naysayers.

David Brumley MD and partner in crime Sarah Sampsel will tell us what a major New England insurer is doing to improve obesity assessment and treatment. Dr. Brumley has a two-fer, because he'll also be talking about the real world support of the Medical Home.

The very strategic Vince Kuraitis will challenge us about being leaders or laggards in the march toward data interoperability. This is the IT glue that will bind disease management to the rest of the world.

There will be plenty of other excellent sessions that are too numerous to mention here.

Obesity: The Emerging Role of Disease Management and An Important Opinion Piece in JAMA

Good news. The DMAA has established an Obesity Resource Center. There are links to useful consumer information, links to a literature search engine preloaded with the term obesity, links to information that employers would find useful and other goodies.

There is also a link to the newly released DMAA Obesity Toolkit. The Disease Management Care Blog would like to immodestly point out that it was involved in its formulation. In it's humble opinion, the .xls spreadsheet that allows insurers to load assumptions into an actuarially sound calculator is a neat tool. Depending on what is covered, how it's paid for and what utilization patterns are likely, users can price the insurance cost of covering obesity-related services in a benefit rider. Very cool.

And while we're on the weighty topic of obesity, the Oct 15 issue of JAMA has come out with a provocative article on the food industry's inability to curb its insatiable appetite for profits. The authors, Drs. David Ludwig and Marion Nestle, describe a glutinous pattern of underhanded public relations that is designed to deflect criticism over the avarcious marketing aimed at getting consumers to eat more high profit-margin, calorie-dense, processed and waist expanding food.

The authors note that cars are responsible for a certain frequency of injury and premature death, yet we don't expect car manufacturers to regulate their own industry. Instead, the government uses a blend of regulations, taxes, mandates, incentives and the threat of being hauled up before a Committee of Congress to shape the industry. The FTC, U.S. Department of Agriculture, and the FDA have the means to deliver many of these readily available tools. Given the conflict of interest between maximizing shareholder value versus the public health burden of obesity, the authors call for these government organs plus academia and public health advocates to rigorously apply the appropriate checks and balances.

While the DMCB wishes the authors had mentioned the role of disease management organizations along with academia and public health, it will forgive them. It is also generally suspicious of government's ability to intelligently regulate, but it recognizes that the authors make a good point.

The DMCB thinks it would be neat if this article were posted on the DMAA Obesity Resource Center. It's.... good food for thought.

Is This Any Way to Run a Meeting?

Alas, the Disease Management Care Blog is not posting this 'live' from a meeting site at the DMAA Forum '08. As many readers know, a potential Category 4 bully by the name of Ike presented an unacceptable risk. Even if many of us had been able to get to the meeting, who knows when we would have been able to get out?

In the meantime KUDOs to the DMAA Staff. The DMCB received several 'stay posted' emails in the days leading up to the travel day, a request to update contact information 'just in case we can't get a hold of you,' a very timely cancellation notice and then, on top of it all, a personal phone call just to make sure I wasn't on my way to the airport. I talked to the staffer and she relayed that everyone being called was very supportive. And why not? That's what happens when you exceed the memberships' expectations.

One of the highlights of the Forum would have been a presentation by Bruce Bagley MD, a leader in the American Academy of Family Physicians, and Paul Grundy MD, director of healthcare transformation for IBM and chair of the Patient-Centered Primary Care Collaborative on the medical home and synergy between it and population health improvement interventions. The good news is that the presentation will still go on via web cast today at 10 AM. It should be very informative.

Ten Good Reasons To Go To The Annual DMAA Confab

Other than this simply being a great learning experience for anyone interested in populaion-based health improvement, here are ten other reasons to click here:

1. Hear about successful market-based real world advances in population based health outcomes that you’ll never see in most peer reviewed academically dominated print journals.

2. Watch individuals and organizations get a DMAA Awards and say to yourself, “Hey, I’ve done more than that. Next year I’m nominating myself/organization for that award.”

3. You’ll meet the growing number of medical school faculty that ‘get it.’

4. Hear and meet the unsinkable Tracey Moorhead.

5. Endless intrigue: Will Gordon Norman sport facial hair when he becomes Chair? Will DMAA change its name again? Will the Kaiser Family Foundation site mention any policy findings from this meeting? Can you get to the wine without stopping at a booth?

6. Meet and Greet the DMO CEOs COOs CMOs and countless other Cs. Find out for yourself that they really spend a lot of time worrying about quality and cost.

7. Watch the DMAA staff swarm into customer expectation-exceeding action.

8. Toast the Greenie’s doom and gloom predictions of hurricanes along the Florida coast with an umbrella’d drink poolside at the sunny host hotel.

9. You may get mentioned in the Disease Management Care Blog.

10. Hear Drs. Bagley and Grundy talk about the Medical Home.

You Really Should Go To the DMAA Annual Meeting

The Disease Management Care Blog would like to point out that the DMAA: The Care Continuum Alliance will reach an important milestone in just a little more than three weeks from now. That's right, this is the 10th annual meeting, which will be held in Hollywood, Fla.

DMAA has evolved along with its members over the past decade, addressing the full continuum of chronic disease care and the changing approaches to health care delivery. At the upcoming meeting, a new track will examine the Patient-Centered Medical Home and population health improvement's contributions to this model of care. A featured keynote underscores this: medical home proponents Bruce Bagley, MD, of the American Academy of Family Physicians; and Patient-Centered Primary Care Collaborative Chair Paul Grundy, MD. Yours truly will be very interested in what they have to say and will resist populationating.

The DMCB will also be presenting in the Pacesetters International sessions on a successful offshore, web-based disease management program. More on this is a later post.

Readers should visit the The Forum site to learn more, wonder if your picture will ever be posted along with these other white male illuminati and to register for this most excellent program. Also note that members of DMAA and several partner organizations, including CMSA and NACDD, can attend at a significant discount.

See you there.

Do You Deserve an Award for Disease Management? Here's Your Chance

Do you work hard on behalf of populations afflicted with chronic illness? Would you and your co-workers appreciate some recognition for once? Have your company's ideas gone unnoticed by too many for too long? Is there a professional colleague that deserves better ?

Or alternatively, do you have a boss that could use some serious sucking up?

Here's your chance. You can nominate yourself or a coworker or your boss or your company for one of eleven awards from the the Organization Formerly Known As D.M.A.A., now simply DMAA the Care Continuum Alliance. You don't even have to be a DMAA member (though, let's face it, you ought to be if you aren't) to be considered. Note that submitting more than one application is not only verboten, but in poor taste.

The Disease Management Care Blog has participated in past evaluations of nominees. While there have been some rather fabulous, famous, expert and star-studded winners, the Committee has always carefully considered all the merits of each nominee and has not been prone to being swayed by the usual rock stars. The small, meek and the mild with meaningful track records of success have actually won some important recognition.

Think the awards don't have much gravitas? Think again. The DMCB has participated in site visits and program evaluations for payers and purchasers where the DMAA trophy has been prominently displayed (we're talking in the middle of the table with a small spotlight) and mentioned on the first page of the response to an RFP. The reason they do that is to take business away from you.

Deadline is June 13, 8 PM EST. Time to get crackin' - this is less than two weeks away.

The DMCB's advice for next year: Create a 12th Award: Best Blog.

Humbly speaking of which, the DMCB's position in the blogmos has now reached being in the top 500 blogs in the Healthcare100 ranking (there are a cornucopia of health care blogs out there and many are big business) and two hundred and something in the Wikio Health Blog ranking. Impressed? Well the spouse isn't. The DMCB wonders if a recent conversation on the difference between the outcomes and process of using a vacuum cleaner is playing any role. Husbands, be forewarned, this is not an area you want to tread in.