About us / Mission / Approach / Challenges & Solutions

The Value of Disease Management?

Employers, health plans, States, DHHS/CMS and other health care purchasers face a growing dilemma over sponsoring population health interventions (e.g. Care / Disease Management 'DM' programs) which on the one hand promise to provide substantial benefits to beneficiaries, while on the other hand, actual savings from such programs have come under question by the Congressional Budget Office (Oct. 13, 2004) citing peer-reviewed papers reported that: "while DM programs are worthwhile for patients, there is insufficient evidence to conclude that DM programs can reduce Medicare health spending".

At least three non-profit organizations have issued positions relative to this report:

• Disease Management Association of America. www.dmaa.org
• American Health Insurance Plans. www.ahip.org
• Institute for Health and Productivity Management/Health Management Strategic Advisory Council. www.ihpm.org

The first two take issue with the CBO's conclusion, the latter provides qualified agreement with it. .

These conflicting conclusions lead to an important question:

What should purchases do to optimize value - for their beneficiaries, taxpayers and/or shareholders - when DM shows such great promise to improve health and decrease costs, but when the delivery and economic impact of that promise remains uncertain?

The answer to this question is exacerbated by the fact that there is no generally accepted methodology to determine the clinical and economic effectiveness of pro-active health interventions. The methods used in clinical experiments -- the double-blind randomized control trial of individual patients—is seen as an impractical solution to measuring impact by the DM industryand other expert observers for population-based programs implemented outside of a controlled academic or research environment.

The PHI Institute Solution

The Population Health Impact Institute was founded to help address the central scientific issues of error and bias in measuring the impact of defined population health interventions.

PHII's novel processes are designed to deal with these real world and persistent problems. Solving these problems should help all stakeholders (providers, government agencies, employers, taxpayers and patient) have greater faith in the clinical and economic value of new and often costly, proactive health interventions.

The PHI Institute is actively engaged in evaluation and process demonstration projects with employer organizations and state Medicaid systems. We believe that the Institute's novel solutions are more likely to help purchasers effectively managing the design, procurement, implementation, evaluation, and reconciliation of population health programs than current alternative approaches. These strategies are based upon: establishing objective baseline datasets for disease-specific and co-morbid populations, planning tools and processes that will improve the assessment of current and long term health interventions, whether for internally built programs or programs outsourced to contract vendors.

Benefits of the PHI Institute Process

With a successful implementation of the PHI Institute process, commercial organizations, government purchasers and others will be better able to:

1. Make evidence-based population health program procurement decisions.
2. More effectively monitor current and future population health programs.
3. Identify which interventions contribute the most to (optimize) both clinical and cost impacts.
4. Access PHI Institute's Benchmarking Data Sets to compare results of different methodolgies. different defined population health patterns, and different defined population health programs. 
5. Optimize procurement decision making.