DSM partnership pushes industry standards

Wednesday, April 30, 2003

NASHVILLE, Tenn. — American Healthways, the nation’s largest provider of disease state management services and Johns Hopkins University have teamed up to improve DSM’s credibility.

The duo’s recently released “Standard Outcomes Metrics and Evaluation Methodology for Disease Management Programs” may be a mouthful, but its intention is simple: create common standards, clinical and financial, by which all DSM programs can be measured.

“Our interest is in trying to cut through the hyperbole and rhetoric to really dig down deep and say what actually works,” said Dr. Christopher Forrest, associate professor in health policy and management at Johns Hopkins University. “Because there is no standard approach to assessing the impact of DSM programs, they all look like they are doing a terrific job, and nobody believes that.”

The program provides clinical and financial standards for five disease states: diabetes, heart failure, coronary artery disease, COPD and asthma. The program also asks DSM providers to define their patient populations. For example, does a DSM program’s outcome for people with diabetes apply to everyone with the disease or to a subset of the most high-risk patients? That distinction, combined with clinical and financial outcomes, are critical if a health plan is to make an apples-to-apples comparison between DMS programs, said Bob Stone, executive vp of American Healthways.

Because DSM programs developed individually over the past decade, company by company, sizing one up against another is practically impossible. While JCAHO and other accreditation programs examine infrastructure, staffing and policies and procedures, the Hopkins document, if applied, examines actual outcomes that the infrastructure, staffing and procedures produce, Stone said.

“I think the responsibility now is squarely on the industry to demonstrate that it works,” Stone said. “We as a company are very uncomfortable that people are still skeptical about DSM. We ask the question: If not this, what? If not this document, someone come up with something else.”

For Forrest, there’s no question that DSM works in the short term. Introduce a DSM program to a community that has never had DSM, and it will reduce costs and hospitalizations for the first year or two. But what about after that, Forrest said. Will those outcomes sustain indefinitely?

“When managed care went into a virginal market there were cost savings to be had,” Forest said. “We learned that those cost savings were low lying fruit and were not sustained. I feel we may be seeing the same thing with disease management and we need to prove it one way or another.”

The DSM standards developed by American Healthways and Johns Hopkins are, of course, voluntary. American Healthways has mailed 7,000 copies of the plan to benefit consultants, payers and other healthcare professionals. Over time, Stone said, he hopes the standards become part of how payers evaluate DMS programs.

“This effort is just a beginning,” Forest said. “But until we have some set of entities pulling all of the employers, the health plans and providers around the same table to come up with an agreed upon approach, we’re going to be shooting in the dark in terms of what works and what doesn’t.” HME