Lessons from German Disease Management Programs

Health care recently has been chock full of ideas to improve quality and reduce costs, but many of these programs have limited evidence of achievement of their noble ends.  One such initiative is disease management, which has slipped into slight disregard in the United States due to a perception, perhaps unfair, that it has achieved neither significant savings nor improvement in outcomes.  McKinsey Quarterly carried an article describing disease management program experience in other countries, particularly Germany, and summarizing factors which appear to lead to success.   (McKinsey Article)

Germany’s disease management programs are run by its sickness funds, which provide health coverage.  The programs have 6 million people enrolled in them, although some are enrolled in more than one.  The programs must have clear, evidence-based care guidelines, a single provider who coordinates care, guidelines controlling referrals to specialists and they must be offered nationwide.  The diabetes program is the oldest and has shown good results to date, including fewer complications such as foot ulcers, increased patient satisfaction, and 13% lower costs, primarily through reduction of inpatient utilization.

The five success factors which McKinsey extrapolates from the German and other DM experience are:  size, which allows cost spreading and resource sharing, produces more data for process refinement and makes it easier to get providers attention; simplicity–broad eligibility, simple care pathways and clear responsibilities; patient focus–interventions that apply to most patients, a single provider that the patient looks to for oversight and targeted patient incentives; information transparency, including clear metrics, third party data analysis, and open dissemination of results; and incentives for all parties–patients, providers and payers.