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Smart Moves? E-patient Systems Rise Amid Skepticism

Andrew D. Smith
Published: Thursday, Jun 16, 2011

Smart PhoneDuring the past 20 years, disease management (DM) systems have mushroomed in medicine, expanding from call centers staffed by nurses to electronic devices that collect streams of data to pump into doctors’ offices. Heart patients are strapping on wristband monitors, and diabetics are checking their glucose meters; there’s even an “intelligence toilet” system that tracks several health indicators.

Now, as many cancers evolve into chronic diseases, momentum is building for DM systems in oncology that, among other things, remind patients to get diagnostic tests, help them manage adverse events, and talk them through their bouts with depression. One trade group estimates that nearly a fifth of cancer patients already use some form of DM and, collectively, spend $250 million a year on it.

Amid the growth, though, questions persist about whether DM can deliver on its goals: better quality of life and treatment outcomes for patients, more efficient systems for busy physician practices, and cost efficiencies for healthcare payers. Indeed, studies conducted thus far have concluded that DM does nothing to cut medical bills and little to improve health outcomes in chronic illnesses far less complex than cancer.

"As much as the studies show questionable benefits, the alternative of having people hung out to dry is not acceptable to most health plans and employers. That’s why you have this growth."
—Al Lewis
Al Lewis

—Al Lewis, president of the Disease Management Purchasing Consortium International
Such disappointments have spurred efforts to design better DM tools, but they have hardly dampened overall enthusiasm. The idea that you can keep patients healthier with better communication and smart tools makes so much intuitive sense that the DM market keeps booming.

Annual revenues for independent DM vendors have jumped from $78 million in 1997 to $1.2 billion in 2006 and to $2.8 billion today, according to the Disease Management Purchasing Consortium. Add in the money that insurance companies spend on their own systems and it’s a $5 billion industry, the group says.

Looking forward, analysts expect DM to grow 10% a year. Oncology DM is growing faster still—even without experimental technology that would boost growth higher and software systems that would allow oncology practices to make sense of the data collected.

“As much as the studies show questionable benefits, the alternative of having people hung out to dry is not acceptable to most health plans and employers,” said Al Lewis, president of the consortium. “That’s why you have this growth.”

Human Touch Is Part of Electronic Advantage

The concept of DM began 2 decades ago with cardiology patients. Several small trials identified patients who came to major academic hospitals with heart failure. After these patients were sent home, the teams they’d worked with at the hospital followed up regularly, both over the phone and face to face, asking what patients had done over the past few days and reminding them of what they needed to do over the next few days.

Repeat hospital visits fell. Patients developed healthier habits. Medical costs dropped. And a movement was born. DM began to boom—not because doctors embraced it, but because employers and insurance companies thought it might cut costs by keeping chronically ill patients out of the hospital.

Rather than using the hospital staff for the follow-up work, the larger programs created by insurers or DM vendors—those that are being increasingly employed in oncology—find it far more efficient to use teams of nurses who work in call centers and do all of their work over the phone.

But such changes, DM skeptics say, eliminated benefits that came with initial trials, where doctors and nurses tapped their relationships with patients and knowledge of their needs.

“After a decade of market experimentation with limited success, new thinking is called for in the design of DM programs,” argued Brenda R. Motheral, PhD, in a review of telephone-based models in The American Journal of Managed Care (2011;17(1):e10-e16).

“Targeting of specific patients and activity combinations based on risk, actionability, and treatment and program effectiveness has the potential to deliver a cost-saving DM program if combined with an outreach model that brings the care manager much closer to the patient and physician,” she said.


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