The Collaborative Forum

I have recently returned from the DMAA: The Care Continuum Alliance’s annual trade association meeting in San Diego and have had time to reflect on what I saw and learned. By way of background for those not familiar with the Care Continuum Alliance’s Annual Forum, this meeting assembles arguably the best and most established companies and thought leaders in the field of chronic disease and wellness. No, not necessarily policy wonks, nor highly published academic researchers. But rather the folks who over the past decade have built a multi-billion dollar industry from scratch while improving the lives of countless individuals and the profitability of their customers.

As a newly appointed member of The Care Continuum Alliance’s board, I am humbled by the great minds working together to solve our healthcare crisis. In years past, I have witnessed many call-outs of the problem and seen many potential solutions arise. Notably, one major element has been missing from the solution — collaboration. This year is different. I walked away with the sense that our industry is finally in agreement that change is needed – that what has been is not sustainable in the future – and that collaboration is the key to that change. I also walked away with the keen sense that the DMAA: The Care Continuum Alliance is a catalyst to help us move in that direction.

I am excited for the work ahead of me and The Care Continuum Alliance’s board as we help guide this movement.There were three other key themes that marked this year’s meeting, which I’d like to explore. These themes, to an outside observer, might seem unrelated in many ways. But my sense is that taken together, they represent an important milestone in the healthcare industry, perhaps even a pattern – one that appears to represent nothing short of a seismic shift.

THEME ONE: Collaboration
One of the best attended sessions at the Forum was actually not on the conference schedule. It was an ad hoc meeting after the conclusion of the Forum of a naisant group calling itself the “Clinical Groupware Collaborative”. This group is made up mostly of information technology vendors, some new to the meeting, some not, who collectively see the axis of power shifting to the provider-patient axis, and from large EMR vendors with large, expensive client server systems to technology platforms that rely on software delivered as a service and the Internet. This model leverages important trends both inside and outside of healthcare, including the demand for healthcare data integration, new physician incentive dollars as part of the ARRA stimulus bill, and concepts like “Platforms”, “Applets”, Software as a Service and Cloud Computing. This group seeks to support a new model of healthcare, where collaboration BETWEEN stakeholders is ENABLED by technologies that are intentionally designed to communicate and interoperate.

THEME TWO: A Shifting Tide
I am pleased to say that I now see an industry reinventing itself. The tide is shifting. The traditional outsourced disease management model is no longer the topic of conversation. We have learned over the years and adapted our model to ones that are more collaborative, such as the patient centered medical home and accountable care organizations, where care delivery is centered around the physician and patient and technology runs the engine. A wise friend recently couched it as moving from “islands of technology to communities that communicate.”

THEME THREE: A Change in Payer Focus
Payers realize how important population health management is to the health of their organization and members. So much so that they are bringing it in house, allocating more resources to it and expanding programs for more control and efficiencies. While some companies in our industry may not survive this shift, many more will emerge as true “enabling” partners to help embrace a new culture of health improvement and technology.

THEME FOUR: Exploration of New Payment and Delivery Models
Dr. Mark McClellan, former head of CMS, and now director of the Engelberg Center for Healthcare Reform and the Brookings Institution, is perhaps the strongest voice of reason about where and how healthcare delivery can be transformed to a more efficient, higher value healthcare system. His keynote at the Forum was a tip of the hat to the level of insight and leadership that the disease management industry has brought to healthcare and at the same time marked the fact that healthcare policy makers are now set on creating incentives and models for PROVIDERS to better manage chronic care and provide wellness services. Many talks were given about an emerging trend in one such provider-directed chronic care model, the Advanced (or Patient Centric) Medical Home. Several others were discussed that take this same theme into other provider centered models, such as the Accountable Care Organization (ACO), provider Care Transitions programs following hospitalization, bundling of payments to incent models of delivery that reduce readmissions following a hospitalization, and even a new benefit design for preventative counseling and services. One message was clear – these models incent physicians, hospitals and community health centers, while leaving DM and Wellness companies wondering if and how they might have a seat at the table.

These four themes seem to come together to redefine population health management. The pattern represents a shift FROM payer centric (and vendor outsourced) traditional call-center staffed wellness and disease management services, where the customer is the insurer or self-insured employer, TO a provider-patient centric, technology enabled, and payer incented model of chronic care collaboration, where the provider team is the customer. From Quadrant 1 to the Value Quadrant: provider coordinated, technology enabled chronic care delivery. Read the position paper on the right for more information about the Value Quadrant.

The question remains, “Who will survive this seismic shift?” I argue that those who cling to the remnants of their traditional world view will not. That those who follow our heritage of innovation and leadership as Dr. McClellan so aptly put it, will be the ones to succeed and drive the next generation of chronic care management.