Al Lewis

He is president of the Wellesley, Mass.-based Disease Management Purchasing Consortium and is an editorial advisor for MHE.

Reported outcomes from medical homes must be able to discern between true and preceived cost savings, and North Carolina is an example of what can go wrong

While it is true that actuarial calculations of medical savings from disease management have been controversial, there is enough underlying value to DM that it will not only sustain itself, but also continue to grow as the true value of the concept emerges.

How is it that well-informed people can look at the same data and come up with dramatically different conclusions and action implications? It turns on whether the analysis is done by biostatisticians looking at utilization data in an academically rigorous way, or by actuaries and benefits consultants looking at overall financial trends in a pre-post manner.

Probably never before in the history of managed care have health plans tolerated a bigger gap between actual and potential reimbursement than in Hierarchical Condition Coding (HCC) for Medicare Advantage (MA).

Disease management as we now define it may be on its last legs, though no one knows it yet. The Disease Management Purchasing Consortium has noticed that the savings in all but a few diseases doesn't offset the costs, and nowhere does it generate the level of return on investment (ROI) that some people think they are getting.