Disease Management: Future Research Agenda Neil Goldfarb Director of Research Research Assistant Professor Department of Health Policy Jefferson Medical College Philadelphia, PA

2006 DM Colloquium Future Research Roundtable – How are we doing?  Consensus methodology for evaluating financial impact of DM programs. Tracey Moorhead  Relationship with physicians - Demonstrating the support and assistance that DM can provide to physician-led healthcare team. Tracey Moorhead  Broader health and productivity metrics. Dr. Loeppke  Technological limitations for standardization and transfer of appropriate data for measurement. Dr. Loeppke  Finding ways to hold consumers (as opposed to just physicians) more accountable for their wellness. Dr. McCall  Measuring health and improvement in the older, chronically ill. What is realistic? Dr. McCall

Why ROI? From customer perspective DM is viewed as an investment But, from a research perspective, should ROI be translated into Cost-effectiveness or Cost-utility If ROI is expressed in CE terms, how will DM compare with other health interventions?

Wellness vs. DM If Wellness programs “succeed” does the structure, process or outcome of DM change? How can wellness and DM programs best be integrated? Are smoking (tobacco addiction), obesity, and cardiometabolic risk “diseases?”

What’s in the DM Black Box? Need to move beyond blanket definition of DM Which components of DM programs work, why do they work, and how can they be replicated? What are the criteria for judging the rigor of a DM intervention?

Dissatisfaction with Satisfaction Does “one size fit all” – can a standardized questionnaire be developed? Does satisfaction correlate with quality? Does satisfaction lead to improved self- management and outcomes? Do client and provider satisfaction correlate and is there a synergistic effect?

Compliance and Adherence How can C&A be measured? What is the relationship between program content, C&A, and outcome? How does benefit structure influence C&A? Does pharmaceutical C&A correlate with other self-management activities?

Impact of Changes in Insurance Consumer directed and high deductible health plans Medicare and Medicaid DM programs Growing population of uninsured and under-insured Pay for Performance programs

Which Diseases to Manage? Which diseases benefit most from DM? Why are certain diseases not yet being addressed by DM vendors, payors and purchasers? What is the dividing line between case and disease management? How well do DM programs address the population with co-morbidities?

Does Size Matter? How important is a local presence to DM program success? The Goldilocks Dilemma: Is there such a thing as being “too big” or “too small?” What’s just right?

How can DM meet the challenges and opportunities of a changing healthcare marketplace? Primary care physician shortages Nurse-managed primary care Convenient care centers Changing role of pharmacists

Which populations respond (best) to DM? Readiness to change Improved models of risk stratification Addressing disparities To what extent can DM interventions be customized and still be considered DM?

Other Considerations for Employers (How) can productivity measurement become routine? Is there a case for ROI in a high turnover population?

Nagging Methodologic Issues Understanding regression to the mean “Intent to treat” analysis and selection bias Dose-response analysis

Making the Case for Publication