The Future of Disease Management

I was stunned by an article entitled"Disease Management Strikes Out,"in the January 23, 2006, issue ofModern Healthcare. Laura Benkodescribed a recent decision byPacifiCare Health Systems to terminatea Medicare demonstration project forheart failure care a year early. Thedemonstration project has been runningfor more than 2 years and hasbeen plagued by extremely low enrollmentand, according to PacifiCare, "hasnot generated Medicare savings asanticipated." The author suggests thatthe early termination of the demonstrationproject casts further doubt onthe ability of disease management toreduce medical costs, especially forthe Medicare population.

I have not reviewed any of the dataregarding the program's design or theresults to date, but I have many questions.I would first determine the role ofpharmacies in this project, then reviewinterventions, drugs used, educationalefforts, and costs incurred. I also questionthe decision to suspend the project.Given the virtual indictment of diseasestate management (DSM) that projectcessation implies and the impact that itmay have on successful DSM programs,PacifiCare has a responsibility to strivefor success for the duration of thedemonstration grant period.

Pharmacists can cost-effectivelyimpact patient outcomes through DSMprograms. The Asheville Project isthe first such initiative to come tomind, but I am aware of many othersuccessful disease management programsnationally. The sponsors of theAsheville Project were so pleased withthe preliminary resultsthat the program wasmade permanent wellbefore the pilot was tobe completed. The literatureis replete withdescriptions of otherDSM initiatives thathave been successful.

I am anxious aboutPacifiCare's decision tostop the demonstrationproject early forseveral reasons. Mostimportantly, I believethat DSM will becomean increasingly importantservice that pharmacistsprovide in ambulatorycare as weevolve from a product focus (dispensing)to a patient focus. The timing is certainlypoor in that the Medicare Part D programwas just launched, and not only are diseasemanagement services covered, butpharmacists are eligible for payment formedication management services. Thecessation of the demonstration projectflies in the face of what we, as a profession,aspire to do in our future, and it maydiscourage plan administrators and legislatorsfrom supporting such initiatives inthe future.

We as pharmacists must do all we canto actively participate in DSM initiativesand to demonstrate the value of the programsthemselves and the pharmacists'role in them. Our commitment to optimizingpatient outcomes and contributingto the success of DSM initiatives iscritically important as our professionevolves. Be an outspoken advocate ofdisease management programs, andhelp debunk the implications of whatappears to be a bad decision byPacifiCare.

Mr. McAllister is director of pharmacyat University of North Carolina (UNC)Hospitals and Clinics and associatedean for clinical affairs at UNCSchool of Pharmacy, Chapel Hill.