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New Paper Reveals Reasons for Payer Discontent with Disease Management

A thought provoking manuscript addressing key challenges facing the industry.

Nashville, TN (PRWEB) September 8, 2008 -- From pioneering research and profound insight into the inner workings of disease management (DM) comes a thought provoking manuscript addressing key challenges facing the industry. The article is published this month in The Journal of Managed Care Pharmacy. [Why 2008 May Be The Tipping Point for Disease Management], by disease management research expert Brenda Motheral, BPharm, MBA, PhD, presents a compelling view on why 2008 has been a year of discontent in the disease management industry but could actually pave the way for new business models and competitors.

In the paper, Dr. Motheral explains: "While once the darling of employers and benefit consultants, disease management is now the object of considerable dissatisfaction and growing distrust. Based on industry observation, there seem to be multiple reasons for this disaffection, five of which include lack of: 1) alignment of vendor and client interests, 2) transparency in business arrangements; 3) plausibility in reports of financial and clinical outcomes; 4) rigorous evaluation methodology; and 5) convincing evidence of outcomes improvement."

The goal of this candid commentary is to draw attention to the DM industry's deficiencies while clearly stating that there are short- and long-term solutions to be considered. Here are a few examples outlined in the paper:

  • If still using an opt-out model with limited transparency, plan sponsors can move to an engagement revenue model and require greater detail on engagement and interventions, including call recording.
  • Expand outcome assessments beyond methodologically-weak financial ROIs to include more frequent reporting of key leading clinical indicators that are less susceptible to exaggeration, such as medical compliance.

According to Dr. Motheral: "In today's economy, plan sponsors can no longer afford to purchase disease management services on faith, and without greater evidence of value. To be successful, the new generation of disease management vendors must be much more methodical in determining which individuals to target, how much intervention is really warranted and how to provide customized solutions to address the most important needs of each plan sponsor," .

About CareScientific
Led by Dr. Brenda Motheral, CareScientific is a trusted consulting resource developed to improve the efficiency and effectiveness of disease management, health, wellness and pharmaceutical care programs. To learn more, please visit

Kate Leach
Marketing Communications Consultant
The Agency
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