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    Leaders take DM from concept to reality: Part 1


    Managed Healthcare Executive presents the first ever comprehensive list of top leaders in disease management. They appear alphabetically rather than by ranking because the candidates’ contributions to the field of DM are so extensive, it is difficult to rate them. The December issue of Managed Healthcare Executive will present another installment of influential leaders.

    Although it is difficult to avoid injecting an element of subjective editorial judgment into any listing and ranking of influence, the compilation of Managed Healthcare Executive’s Top Disease Management Leaders is based on objective measures.

    For disease management companies and health plans, we used a two-step process: selecting the organizations and then looking at people within those organizations that should be recognized.

    For disease management companies, clearly corporate revenues are key. After revenues, being innovative, creating first-of-their kind programs and building a sizeable customer list are highly weighed. Recognition from others, such as the Disease Management Association of America (DMAA), the Blue Cross and Blue Shield Assn. or the Health Industries Research Companies (HIRC), is worthy of consideration, especially as a validation tool. Finally, we used accreditation as a measure but as a threshold.

    In measuring the “influence” of health plans and various governmental entities, we analyzed their commitment to disease management in terms of size, scope and longevity of programs. Other factors, such as securing patents on disease management tools; winning awards from DMAA, HIRC or other organizations; and being certified for savings measurement by the Disease Management Purchasing Consortium (DMPC), were also taken into account, but once again, more as validation tools.

    One can’t really compare the influence of health plans with disease management companies since both have different roles. It could be argued that without the former’s commitment, the latter wouldn’t exist or vice-versa, so the list simply includes roughly comparable number of representatives from both healthcare sectors, while considering the leading “built” programs as well.

    Once the organizations were selected, we evaluated one or two people affiliated with each, based on the person’s position within the organization and tenure in the field, as well as on a variety of influence factors.

    Measures of overall influence include how often an individual is cited as a source of disease management information, presentations, publications and innovations specifically in the field of disease management. While a simple Google search helped shorten this process by simply counting how many times one has been published or mentioned, the type of publications was weighed. The small number of pure promotional press releases appearing on Google, however, was taken with a grain of salt. These influence factors also were applied to the number of academicians and consultants on the list.

    For everybody, their roles in DMAA, contributions to the growth of public programs and influence on legislation related to disease management also were taken into account.

    All of these intermediate factors were then further distilled to answer the question: In what direction and to what degree is the disease management field as a whole shaped, as a result of this person’s being actively involved in it? One final note: Our selection of specific individuals within health plans is not to detract from their co-workers, and in no way reflects them trying to “take credit,” in a public forum. Rather in each case where a health plan deserved inclusion on the merits, a judgment call had to be made about whose name is most closely associated with it. This is also true for vendors, but to a lesser degree.

    We expect that not everyone will wholeheartedly agree with the list and its rankings. For example, some might question why no one from the Centers for Medicare & Medicaid Services (CMS) is listed. It is not because the agency is unimportant. Instead, as important as CMS is to the future of disease management, recent turnover means that those with the greatest influence today lack tenure in their new positions and those with tenure have left. A list compiled a year from now might very well include at least one person from CMS.

    That’s just one example. We as editors welcome varying reactions to the list and ways to improve our measurement tools.

    Michael W. Cox
    CEO, President and Founder, QMed Inc.
    Eatontown, N.J.

    Cox has been the visionary behind QMed, the only technology company to successfully transition into disease management (DM). QMed is the most physician-centric of the disease management companies, the one that has pioneered physician compensation, chart extraction and collection of primary cardiac data directly through cardiac monitoring. It was the first company to offer coronary artery disease (CAD) disease management and ranks as the only “best-of-breed” company remaining in that category; however, it has diversified into other diseases.

    Cox was instrumental in designing the framework for QMed’s innovative DM program, which combines a comprehensive database of lab, pharmacy and medical claims, patient chart information extracted through an electronic medical record and formulary information; algorithms designed by specialists and based on national guidelines; decision support tools for physicians; predictive modeling; and patient education. QMed prides itself on fully engaging physicians in the DM process and compensating them based on a quality performance formula.

    QMed has achieved improvements in physician risk factor management more than double the national average and has demonstrated cost savings and population-based reductions in events, such as heart attacks and readmission for congestive heart failure (CHF), The company earned the Disease Management Association of America’s (DMAA) “Best DM Program in America” in 2002 and a DMAA honor for its HeartPartners Medicare project the following year. Its programs for CAD, CHF and stroke are accredited by the National Committee for Quality Assurance (NCQA) for both physician and patient management.

    Donald E. Fetterolf, MD
    Vice President/ Chief Medical Officer, Highmark Inc.
    Pittsburgh, Pa.

    The first Blue Cross plan to embrace large-scale disease management, back in 1998, was Highmark. With more Medicare Risk (as it was called back then) lives than any other Blue and with perhaps the largest regional market share of any Blue, it made great sense to try to improve the health of the community. One of the early pioneers in that effort is Don Fetterolf, MD, who today is the chief medical officer for Highmark.

    While Highmark focuses on many of the more common chronic diseases, it is in the process of moving depression and obesity treatment to more intensive chronic condition management. The health plan also emphasizes wellness and preventive medicine efforts as part of its DM programs, combining educational, motivational and behavioral change.

    Under his direction, Highmark created data mining and predictive modeling approaches to selecting key patients for medical management intervention. Through the use of algorithms and information system strategies, Highmark can identify patients, stratify them by risk and design appropriate interventions. Highmark’s SMART program, a grid developed to assist primary care physicians in assuring the delivery of medical care at the individual level, was not only ahead of its time, but has also produced improvements in most Health Plan Employer Data and Information Set (HEDIS) scores.

    Dr. Fetterolf played a major role in influencing the Centers for Medicare & Medicaid Services development of several requests for proposal for DM pilot projects. He has been a member of the DMAA board of directors since 2001, was recently appointed to DMAA’s executive committee and active on the National Managed Health Care Congress’ (NMHCC) ROI Workgroup. Highmark has developed a method for estimating return on investment.

    Highmark received the BlueWorks Quarterly Award, “The Performance-Based Incentive Program: A Model for Quality Improvement and Cost Efficiency in a Large Primary Care Group” in 2004, and its “Dean Ornish Program Reversing Heart Disease” won Best of Blues in 2003.

    The Highmark DM programs have achieved “excellent” accreditation from NCQA, as well as accreditation from URAC.

    Ronald D. Geraty, MD

    Chief Executive Officer, Alere Medical Inc.
    Reno, Nev.

    Ronald Geraty, MD, has turned around Alere Medical to position it as the premier stand-alone CHF monitoring company. Key to its belated success is being the first of the CHF monitoring companies to offer a nurse call center as a complement to the monitoring program. Its extensive client list, including PacifiCare, Health Net and Humana; partnerships with other vendors to win contracts; and willingness to take risk have distinguished it from other independent monitoring companies.

    Alere’s DM programs focus on heart failure patients, emphasizing intensive patient education in print and via Internet, along with a series of guides called “The Smart Living for Your Heart,” to empower patients to take control of managing their illness and leading healthier lives.

    Alere takes advantage of a home monitoring program featuring its proprietary DayLink monitor placed in patients’ homes to collect biometric and symptomatic information. The information is transmitted electronically 24/7 to a database managed by cardiac-trained nurses, who can analyze patients’ conditions, determine who may be at risk and relay the information to treating physicians. The program won DMAA’s award for “Best Enabling Tool for DM” in 2003.

    After 12 months of enrollment in Alere’s Heart Failure DM Program designed for PacifiCare’s Secure Horizons (>65) and its commercial population, hospital days for the condition decreased 53% and 62% respectively, compared with baseline metrics, and per member per month costs fell by 50% and 60% for the two populations, respectively. The program has received patient-oriented, full accreditation from NCQA.

    William Gold, MD
    Vice President/ Chief Medical Officer, Health Management Division
    Blue Cross and Blue Shield of Minnesota
    St. Paul, Minn.

    Blue Cross and Blue Shield of Minnesota (BCBSMN), as measured by total dollars spent per capita, is the strongest believer in DM among Blues plans, and among the strongest believers anywhere. The health plan reports $6 billion in total revenue. William Gold, MD, vice president/chief medical officer of BCBSMN, was one of the visionaries behind this achievement and, as the effort has evolved, continues to rank as perhaps one of the strongest advocates for DM among payer executives. He also has made presentations and written prolifically on outcomes studies, which have tracked large numbers of eligible members against those who have the diseases but are not eligible—a study design not widely seen among published reports. He also was instrumental in assisting U.S. Rep. Nancy Johnson (R-Conn.) in making recommendations for the Medicare Modernization Act (MMA) of 2003.

    BCBSMN addresses a wide scope of chronic diseases in addition to the most common conditions, including Parkinson’s, multiple sclerosis, rheumatoid arthritis, hemophilia, scleroderma and urinary incontinence. In addition, all members are screened for depression. To address the problem, the health plan will launch a depression management program early next year. Key to its programs’ success are an ongoing trusting relationship between the member and the nurse care manager at the Minnesota-based call center, along with home-based biometric monitoring, disease-based health literature, communication with providers and a group of nurses who meet regularly with providers throughout the state.

    Two year ago, the health plan, with the help of American Healthways, designed a DM program called BluePrint for Health care support, which hopes to engage 13% of members. The outcomes-based program focuses on five dimensions: adherence to evidence-based guidelines, population health measures, member and provider satisfaction and cost–all of which have been demonstrated in the plus column.

    BCBSMN won the AstraZeneca-National Managed Health Care Congress Partnership Award for its BluePrint for Health program, which has been accredited by NCQA, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and URAC.

    U.S. Representative Nancy Johnson (R-Conn.)
    Washington, D.C.

    Like many people, not excluding legislators, Rep. Nancy Johnson had never heard of disease management seven years ago. But like most good legislators, she was interested in understanding and fostering new employment opportunities in her district in any emerging industry. A routine tour of a start-up company, Cardium, a disease and health management company, in her district six years ago—scheduled as a result of her interest in her district, not in disease management—provided the epiphany which Rep. Johnson needed to become Congress’ strongest advocate of DM in the public sector.

    Following unsuccessful attempts to attach DM to other legislation, which nonetheless provided education for other legislators and built a base for future support, she spearheaded the successful effort to add prescription drug benefits, preventive care and DM programs to the Medicare Modernization Act of 2003. As a ceaseless advocator of DM on Capitol Hill, she received the DMAA’s Alfred B. Lewis Presidents Award in 2003, and was honored by the Coalition for Medicare Choices this year.

    Rep. Johnson currently serves as chairwoman of the House Ways and Means Subcommittee and was the only woman to serve on the Medicare Conference Committee, which completed work on MMA.

    Joan Kennedy
    Vice President, Health Services, Empire BlueCross BlueShield
    New York, N.Y.

    The largest healthcare market is Greater New York and the leader in that market—as measured by total dollar commitment to disease management—is Empire BlueCross BlueShield. That commitment is largely the initiative of Joan Kennedy, vice president for health services. Kennedy forged well-negotiated alliances with leading outsource vendors and has enjoyed clear success in marketing those programs to ASO employers. She has been active in DMAA while she and her colleagues have presented more broadly on DM than any other health plan except possibly Blue Cross and Blue Shield of Minnesota and Highmark.

    Relying on both DM companies and its own internal resources, Empire addresses CHF, diabetes, cancer, end-stage renal disease (ESRD), asthma, and cardiovascular disease by employing a variety of techniques—nurse call centers and onsite case managers, patient education, predictive modeling, pharmaceutical and population management, technology, evidence-based guidelines and outcomes measurement.

    Empire’s DM program has been cited by the HIRC 2004, as being “unique for having, as measured by the number of programs and the number of people in them, the greatest commitment to high-quality disease management—and measuring it correctly and negotiating it well—of any health plan in the tri-state area.” In addition, the program utilizes a customized set of interventions that have been integrated with real-time case management activities.

    Empire was one of the first managed care plans to be awarded certification by the Disease Management Purchasing Consortium’s (DMPC) new Savings Measurement Certification Program that indicates a health plan’s success in validating savings methodologies, and a 2002 “Best of Blues” award for program communications for its asthma program.

    Kennedy is a founding member of DMAA and has spent countless hours promoting DMAA’s position on HIPAA regulations and the benefits of DM for Medicare beneficiaries.

    All three of Empire’s DM vendors—American Healthways, RMS and Accordant—are accredited by NCQA.

    Ben Leedle
    President and CEO, American Healthways
    Nashville, Tenn.

    You may never have heard of Ben Leedle, but you've certainly heard of the company he runs as CEO, a “small start-up” called American Healthways. While perhaps others in the company are more visible and even more influential in the DM field, Leedle's time is focused on continuing the company’s run as perhaps the single best-performing. publicly traded stock over the last six years—a run which if sustained paves the way for other DM companies to go public. Not coincidentally, he also guides the company's highly successful strategy—developing more strategic avenues with which to partner—that has already led to long-term contracts with major health plans, such as CIGNA, BCBSMN and HMSA.

    American Healthways has leveraged its many tools, from long-term behavior modification, outcomes measurement, telephonic outreach to prevention strategies, standards of care and evidence-based medicine and onsite case nurse managers to address 17 chronic diseases, including osteoporosis, fibromyalgia, urinary incontinence, irritable bowel disease and Hepatitis C.

    Two years ago, the company initiated a 10-year partnership with BCBSMN for all 17 disease states and demonstrated $35 million to $50 million in savings during the first year—significant enough to bend the overall healthcare cost trend by 200 to 300 basis points. The population-based program touches nearly 20% of BCBSMN’s members and correlates with the health plan’s strategic initiatives—promoting wider, more economical and timely availability of health services for the people of Minnesota and maintaining consistent interactions with members, including BCBSMN's tobacco reduction program, behavioral health services and integrated employee assessment/coaching program. The program earned American Healthways the 2004 AstraZeneca NMHCC Partnership Award for innovation in healthcare.

    American Healthways is the first DM management organization to earn accreditation from NCQA, JCAHO and URAC.

    Alice Lind
    Manager, Care Coordination Section, Medical Assistance Administration,
    Washington State Department of Social and Health Services
    Olympia, Wash.

    Along with Florida, Washington has been the pioneer in outsourcing Medicaid disease management, and Alice Lind RN, has led that effort. Washington’s efforts, though not as visible as Florida's, for better or worse, have been emulated by many other states around the country. Lind has accepted additional responsibility—even though government employees cannot accept compensation for this effort—to spread the word on DM outsourcing to other states via many presentations and articles.

    The Medical Assistance Administration, under the auspices of the Washington State Department of Social and Health Services, was the first Medicaid agency to contract for traditional DM in a fee-for-service environment. Other states have adopted their requests for proposals, contracts and federal approval documents from Washington’s model. The program merited DMAA’s “Best DM Program for Medicaid” award in 2003. The administration serves 20,000 DM enrollees with two contractors.

    Lind has been successful in driving Washington State’s authorization for its DM program, and for promoting CMS’s support of DM programs addressing Medicaid populations.

    She has presented her program at meetings nationwide and has contributed articles to a variety of publications, including Managed Healthcare Executive.

    David Nash, MD
    Dr. Raymond C. and Doris N. Grandon Professor and Chairman of the Department of Public Policy, Jefferson Medical College of Thomas Jefferson University
    Philadelphia, Pa.

    The unique achievement of David Nash, MD, is to be named to this list despite spending only a small fraction of his professional time spent in disease management. Such are the achievements of Dr. Nash that were we to develop a “Top 25” for pharmacoeconomics or quality measurement, he would likely appear on those lists as well.

    Dr. Nash, co-director of the masters program in public health at Jefferson Medical College, is recognized for his work in outcomes management, medical staff development and quality-of-care improvement. A board-certified internist, he founded the original Office of Health Policy in 1990.

    He serves on the national advisory committee for the Robert Wood Johnson Foundation Partnerships in Quality Education program, bringing together managed care organizations and leading academic medical centers, and on the board of trustees of Catholic Healthcare Partners in Cincinnati, chairing its committee on quality.

    Dr. Nash is a consultant to organizations in both the private and public sectors, including the Technical Advisory Group of the Pennsylvania Health Care Cost Containment Council.

    Gordon Norman, M.D.
    Vice President, Disease Management, PacifiCare
    Cypress, Calif.

    As measured purely by the number of awards its DM programs have received, PacifiCare is No. 1. Its programs have been cited by the DMAA (Best Medicare DM, 2003), HIRC (one of country’s top DM programs, 2004), America’s Health Insurance Plans (AHIP) (Exemplary Practice Award, 2004) and the NCQA for multiple Quality Profile awards (2001-2003). It was also granted a Chronic Care Demonstration project by CMS in 2003. All of this is a tribute to the vision of Gordon Norman, MD.

    The field’s greatest advocate of the “best-of-breed” contracting approach, Dr. Norman has created a series of very focused programs which include more in-person contact and a greater use of monitoring technologies than any others.

    Under Dr. Norman’s direction, PacifiCare developed a Third Generation DM model that combines best-of-breed specialty vendors with the plan’s internal resources to create a hybrid DM program that will deliver one-stop shopping, cost savings and population- and case-based services, and facilitate patient/physician communication. PacifiCare’s DM programs have increased appropriate medications for CHF by 26% and improved blood sugar and cholesterol control by 25% to 29%. After 12 months’ enrollment in DM for CHF, COPD, ESRD, cancer and CAD, PacifiCare realized $121 million in savings.

    PacifiCare is one of eight health plans that has received DMPC’s certification in its new Savings Measurement Certification Program that applauds health plans which have successfully validated savings methodologies.

    Norman has been active in lobbying on the state and federal levels on behalf of Medicare+Choice plans and in supporting DMAA’s efforts to influence MMA legislation in favor of DM. He serves on the DMAA board of directors.

    Pete Petit
    Founder, Chairman and CEO, Matria Healthcare Inc.
    Marietta, Ga.

    Matria is one of the two largest publicly traded companies with a DM focus. Like American Healthways, Matria—headed by Pete Petit—made a transition into disease management from its base business—fetal monitoring. With QMed, Matria is one of only two companies to successfully turn a technology into disease and condition management. Matria ranks among the leaders in direct-to-employer disease management programs, and is among the few that run a virtually paperless call center. Petit serves as a DMAA board member.

    Petit has been an innovative leader in introducing technology to DM, creating a paperless system managing large populations, integrating large databases and managing a complex set of clinical rules across multiple diseases and conditions. Matria addresses 10 chronic diseases, including depression, obesity, high-risk pregnancy COPD through a wide range of effective tools—monitoring treatment plan compliance and appropriate medication usage; counseling, guidance and lifestyle management support; and outcomes measurement and reporting. He is a member of the DMAA board of directors.

    Matria’s TRAX system handles every step of the DM process, from risk identification through the integration of medical and pharmacy claims and lab data, followed by an automated enrollment system and customized care plans based on national clinical guidelines. The technology provides real-time data, making it possible to move a patient from DM to case management or to identify a patient in need of DM services. In addition, the technology creates a care-centric approach focusing on managing the individual rather than just the disease through individualized care plans.

    Matria earned NCQA’s full patient and practitioner accreditation for six diseases; its cancer program holds full utilization management accreditation from URAC.

    Susan Riley
    CEO, AirLogix Inc.
    Dallas, Texas

    Minted as CEO five years ago, Susan Riley turned around AirLogix Inc., in revenues, profits and reputation. AirLogix is not just the only respiratory-focused DM company left standing, but is it actually growing steadily due to its reputation for achieving savings in COPD. It is the only DM company which routinely sends staff to a member's home to facilitate breathing strategies for COPD, and trigger identification and self-monitoring for asthma. She serves on the DMAA board of directors.

    AirLogix’s Chronic Respiratory Health Management Program, established in 1996, has served more than 400,000 members with asthma and COPD. The company thinks of itself as an extension of a physician’s practice by reinforcing the member’s individual care plan, thus, reducing barriers to full compliance. It claims review process prioritizes members by risk and their need for care management and coordination services through telephone-based assessment, which evaluates symptom severity and functional status. Using proprietary algorithms, patients are slated for one of three initial interventions–education and research, telephone intervention or a home visit conducted by a respiratory care practitioner, who assesses medical and lifestyle status, reviews medication regimens, enforces self-management plans and measures pulmonary function. Physicians receive a written report summarizing the initial visit; members receive follow-up intervention and care coordination and management as needed.

    The program has resulted in both net savings and improved clinical outcomes: For 6,428 members with COPD who have been in the program for at least 90 days, the number who reported that breathing interferes with their normal activities more than slightly decreased from 62% to 48%; those reporting awakening during the night with shortness of breath more than occasionally dropped from 25% to 14%.

    AlrLogix has earned the National Health Information Awards in Member Education Information since 1998 for its COPD self-management guide and workbook. The company received member and practitioner-oriented full accreditation by NCQA for its asthma and COPD programs, and is the first company to receive NCQA/JCAHO Privacy Certification for Business Associates.

    John B. Sory
    Vice President, Pfizer Health Solutions (PHS)
    New York City, N.Y.

    As vice president of Pfizer Health Solutions (PHS), John Sory oversees the largest, most visible and most successful of the disease management entities connected with pharmaceutical firms. PHS, partly because of its parentage (though it operates quasi-independently), the aforementioned visibility and the size and drama of its largest programs—along with American Healthways—serves as a barometer of the health of the disease management field to Wall Street. As such, the performance of PHS has a “ripple effect” throughout the industry.

    PHS has partnered with the State of Florida in a ground-breaking public/private collaboration called Florida: A Healthy State, which features a community-based health network of hospitals, civic organizations and patient advocacy groups, and education, triage and advice provided by registered nurses. Addressing the needs of 145,000 high-risk Medicaid beneficiaries in Florida, the program cut the state’s medical costs by $43.8 million during a 27-month period ending in September 2003.

    Other outcomes include 50% of patients with diabetes lowered their HbA1c after 18 months; the percentage of those with asthma who measure peak air flow at home doubled to 64%, while the number of severe asthmatics dropped by 18%; and emergency room visits and hospitalizations for those with heart failure decreased by 19% and 7%, respectively.

    Florida: A Healthy State, along with another PHS program called Amigos en Salud, earned the 2004 Mary Eliza Mahoney Award in recognition of PHS’s outstanding contributions for promoting access to healthcare in minority communities. The company has been accredited by NCQA in systems and program design for asthma, diabetes, cardiovascular disease and healthy lifestyle.

    Sandeep Wadhwa, MD, MBA
    Vice President, Government Programs, McKesson Health Solutions
    Newton, Mass.

    Just as American Healthways has the greatest disease management presence in the private sector, McKesson Health Solutions takes that honor in the public sector. Its Medicaid public sector market share is even higher than American Healthways' position in the private sector. Sandeep Wadhwa, MD, is the “voice” of McKesson, an enduring presence on the DMAA board of directors, where he has served since 2002, and on the government affairs committee.

    McKesson Health Solutions targets a wide range of chronic diseases including pain, hypertension, ESRD, COPD, diabetes and cancer and utilizes a variety of tools–from call centers and patient education to home visits, prevention techniques and technology—to best meet its members’ needs.

    The McKesson Health Solutions’ team serves Medicaid beneficiaries in rural Montana in a program that combines demand and disease management; 24/7 access to nurses; and field and telephone-based patient outreach. Calls to patients help them address symptoms, but also enables nurses to identify patients with chronic illnesses. Started in January, the program already reaches 40% of the Montana Medicaid population.

    The disease management company has won DMAA’s “Best Disease Management” Program for Medicaid in both 2002 and 2003, and as been recognized at one of the top 10 DM management vendors in the United States for the past four years by HIRC.

    Dr. Wadhwa has delivered testimony in Congress and met with congressional and governor staffs to promote DM to the Medicaid and Medicare populations.

    Mary Wieg, RN, MBA
    Nurse Consultant II, Office of Public Policy and Plan Administration,
    California Public Employees’ Retirement System (CalPERS)
    Sacramento, Calif.

    The California Public Employees Retirement System (CalPERS) is the nation’s third largest purchaser of employee health benefits, with 1.2 million enrollees, costing $4 billion annually. Just as the public-sector investment community looks to the CalPERS pension fund to guide them in policy and governance decisions, so too do public sector entities and large employers look to CalPERS for leadership in health insurance policy and benefits. CalPERS, by embracing DM for its self-insured population (and perhaps soon for its fully insured population) has led the way for other public sector entities. If CalPERs is the most visible entity of its genre in DM, Mary Wieg is CalPERS most visible advocate. Though constraints on quasi-government employee activities limit her ability to be vocal, her “leadership by example” has inspired many to undertake DM.

    CalPERS contracts with three HMOs and five PPOs who provide a combination of internal and external DM programs. The large organization has created innovative ways to monitor the performance of its health plans’ DM reporting. It reports HEDIS measures collected by HMOs serving CalPERS members and monitors and reports administrative HEDIS measures for its PPOs related to the effectiveness of cardiovascular and diabetes programs. CalPERS is currently using its data warehouse to calculate and compare the population and DM program performance in each health plan.

    Results of member satisfaction surveys based on Consumer Assessment of Health Plans Survey are reported to members annually through the Quality Report, which Wieg has written for the past three years. The report includes articles on prevention, DM, tips for choosing a provider and outcome measures.

    Thomas Wilson, PhD, DrPH
    Trajectory Healthcare LLC
    Loveland, Ohio

    Thomas Wilson was the first epidemiologist to study DM and educate the industry on measurement of results, and to advocate the possibility of doing random-controlled trial(s). He supports identifying and addressing more confounders than even state-of-the-art measurement uses today. Wilson’s uniquely academic perspective provides a thoughtful counterpoint to the simpler metrics used or advocated by DMPC, Johns Hopkins and others.

    Wilson is principal of his own strategic epidemiological consultancy and founder and board chairman of the Population Heath Impact Institute, which is dedicated to providing unbiased, independent transparent comparisons of different ROI models and defined population health management programs to facilitate optimal decision-making.

    Wilson has developed two key causality principles—equivalence of population and metric comparability—which have been adopted by the NMHCC work group on ROI in DM and by DMAA’s new “Principles” consensus document.

    He is widely published and shares his expertise and ideas on DM measurement at presentations around the country. Wilson has been active in DMAA, currently serving as chairman of the patient safety work group and as a member of the quality and research committee.

    More disease management leaders have qualified for the MHE Leadership list, and they are listed separately with slightly different criteria in a separate article. Please read Part 2 for the second list of leaders.

    Mari Edlin
    Mari Edlin is a frequent contributor to Managed Healthcare Executive. She is based in Sonoma, California.

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