CURRENT ISSUES

'Consumer-centric' disease management - the way forward

-Amanda Cameron-

M any people argue that there is still no definitive proof that disease management (DM) works. One reason for the largely suboptimal performance of DM programmes is a lack

of integration in health management. Speaking at the third annual Disease Management Congress [Washington, DC, US; September 1998], Dr Deleys Brandman of Andersen Consulting described an innovative approach to DM that attempts to integrate care at the patient level.

Multiple forces are shifting the focus of healthcare towards self-care and self-help networks, and away from the traditional patient-physician relationship.

Taking healthcare out of the office and into the community could look like a cheap cost-cutting exercise, if it were not for evidence suggesting that only a slim proportion of healthcare resource use is medically necessary.

Furthennore, physicians themselves think that much of the care they provide could be delivered by nonphysicians in alternative settings (such as at home or over the telephone).

One integrated solution needed Healthcare organisations are racing to meet

consumer and employer demand for OM programmes that are oriented towards the patient - so-called 'consumer-centric' OM. Meanwhile, the healthcare industry is becoming increasingly confused as the various stakeholders move outside their traditional roles and begin providing similar sorts of services.

This confusion points to a need for one integrated solution so that healthcare consumers, suppliers, providers and purchasers can begin to communicate effectively, said Or Brandman.

Various organisations are developing health management tools and services, such as advice lines or infonnation centres, but no one has yet integrated all of these capabilities.

To maximise the potential value of OM programmes, OM organisations need to build integrated solutions which recognise what motivates consumers to use the plethora of healthcare resources now available, said Dr Brandman.

What makes the patient tick? The retail industry identified a long time ago the

key decision drivers that motivate consumers when they buy a product. But up until recently, the healthcare industry had not even begun to understand the kind of factors that influence consumers' use of healthcare resources.

This is all about to change. In fact, according to Dr Brandman, several OM programmes have already begun to improve their perfonnance by giving infonnal consideration to the different types of consumers that make up the population that they serve.

In the first fonnal 'patient segmentation' analysis of its kind, Andersen Consulting partnered with one of its health plans to find out why its members were using the OM programmes inappropriately.

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Six types of consumer A random survey of 2000-3000 individuals who

had been plan members for ~ 1 year, together with claims data for this population, revealed 6 main types of healthcare consumer based on their psychosocial and behavioural profiles: • the 'actively healthy', who are proactive about

staying healthy

• the 'worried well' • 'ready repeaters', who agree with whatever the

physician says and like to return for repeat visits • 'impatient controllers', who want a fast answer

from the appropriate level of physician • 'silver bullet searchers', who go from specialist to

specialist looking for an easy solution • the 'family reliant' , who need input from

~ 1 family member to make a decision about healthcare or to be compliant with a health plan

• the 'resigned', who get depressed about healthcare problems instead of seeking help

• 'passive destructibles', who have real disease and significant comorbidities but who do not actively seek healthcare. These findings spoke very clearly about how various

'segments' of the member population would have to be approached very differently to maximise the potential value of any OM programme.

For example, active outreach is required to get the 'resigned' and the 'passive destructibles' to join a OM programme, whereas a simple mailout announcing a new OM programme is enough to get the 'actively healthy' onboard. It was also found that 'silver bullet searchers' are less inclined to go specialist-hopping if they have ongoing access to up-to-date medical infonnation via a nurse-operated telephone service.

The patient - a 'segment of one' This example demonstrates how a healthcare

consumer population can be divided into conceptual 'segments' based on certain demographic, geographic, psychographic or behaviouraVattitudinai infonnation.

The implementation of concurrent multiple segmen­tation strategies provides an even deeper understan­ding of the consumer population. enabling healthcare organisations to 'proactively engage and manage individual healthcare consumers and leverage information technology to achieve optimum demand, satisfaction and outcomes' , said Or Brandman.

The ultimate goal of integrated 'consumer-centric' OM is to build a specific plan for a 'segment of one' -

PhannacoEconomics & Outcomes News 17 Oct 1998 No. 184

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4 CURRENT ISSUES

'Consumer-centric' DM - cont'd

the patient. That is, a OM organisation can build a OM programme for each of the segments in a certain population, but these OM programmes must intersect at the patient level to take into account comorbidities and other patient factors.

For example, an elderly woman with diabetes mellitus would need a plan built using aspects of the 'diabetes' as well as the 'frail elderly' programmes. Furthermore, the patient's health-risk level and healthcare consumer behaviour would determine the content and approach of the healthcare intervention.

A new health management model Tailoring healthcare solutions to individual consu­

mers entails the provision of: • customised information to enable 'smart'

healthcare service use and access choices • an appropriate 'context' (e.g. physician office,

telephone, internet or mail) when communicating with healthcare consumers

• incentives (not necessarily monetary) to encourage appropriate healthcare service use. Population segmentation is at the core of a new

health management model that provides the framework for 'consumer-centric' OM.

The new model assumes that healthcare solutions will be provided by a 'multi-channel' practice network. That is, patients will have access to alternative care delivery channels, such as call centres, on-line care, video clinics and health kiosks, as well as the more traditional primary-care centres, specialist services, hospital services, and additional health services.

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