The Future of Disease Management

MARCH 01, 2006
James C. McAllister III, MS, FASHP

I was stunned by an article entitled "Disease Management Strikes Out," in the January 23, 2006, issue of Modern Healthcare. Laura Benko described a recent decision by PacifiCare Health Systems to terminate a Medicare demonstration project for heart failure care a year early. The demonstration project has been running for more than 2 years and has been plagued by extremely low enrollment and, according to PacifiCare, "has not generated Medicare savings as anticipated." The author suggests that the early termination of the demonstration project casts further doubt on the ability of disease management to reduce medical costs, especially for the Medicare population.

I have not reviewed any of the data regarding the program's design or the results to date, but I have many questions. I would first determine the role of pharmacies in this project, then review interventions, drugs used, educational efforts, and costs incurred. I also question the decision to suspend the project. Given the virtual indictment of disease state management (DSM) that project cessation implies and the impact that it may have on successful DSM programs, PacifiCare has a responsibility to strive for success for the duration of the demonstration grant period.

Pharmacists can cost-effectively impact patient outcomes through DSM programs. The Asheville Project is the first such initiative to come to mind, but I am aware of many other successful disease management programs nationally. The sponsors of the Asheville Project were so pleased with the preliminary results that the program was made permanent well before the pilot was to be completed. The literature is replete with descriptions of other DSM initiatives that have been successful.

I am anxious about PacifiCare's decision to stop the demonstration project early for several reasons. Most importantly, I believe that DSM will become an increasingly important service that pharmacists provide in ambulatory care as we evolve from a product focus (dispensing) to a patient focus. The timing is certainly poor in that the Medicare Part D program was just launched, and not only are disease management services covered, but pharmacists are eligible for payment for medication management services. The cessation of the demonstration project flies in the face of what we, as a profession, aspire to do in our future, and it may discourage plan administrators and legislators from supporting such initiatives in the future.

We as pharmacists must do all we can to actively participate in DSM initiatives and to demonstrate the value of the programs themselves and the pharmacists' role in them. Our commitment to optimizing patient outcomes and contributing to the success of DSM initiatives is critically important as our profession evolves. Be an outspoken advocate of disease management programs, and help debunk the implications of what appears to be a bad decision by PacifiCare.

Mr. McAllister is director of pharmacy at University of North Carolina (UNC) Hospitals and Clinics and associate dean for clinical affairs at UNC School of Pharmacy, Chapel Hill.