Disease Management as a Sales Tool for Drug Companies.

One of the ways the government is investigating to reduce Medicaid
expenses is Disease Management Programs. Patients with chronic
diseases are instructed in self-management techniques, and are
frequently monitored in visits to disease management specialists.
Programs like these for diabetes and hypertension can be quite
successful.  On the other hand, as the article below shows, Disease
Management Programs can also be fronts for drug companies like Pfizer,
Bristol-Myers Squibb, GlaxoSmithKline, and AstraZeneca to get patients
onto their patented products.



California Healthline, 10/16/2003

House Subcommittee Debates Private Disease Management Programs in
Medicaid

Members of the House Energy and Commerce Health Subcommittee on
Wednesday discussed the impact on costs and quality of care in the
Medicaid program of implementing disease management plans and debated
whether private companies should be involved in such programs,
CongressDaily reports (Rovner, CongressDaily, 10/15). Nationwide, 24
states have implemented disease management programs in which Medicaid
beneficiaries' chronic diseases are monitored, and officials from
those states told the committee that beneficiaries who participate in
the programs are hospitalized less often, reducing costs for emergency
room visits and hospital stays. For example, a Florida disease
management program for patients with congestive heart failure
decreased spending by more than 16% over two years, Christobel
Selecky, chief executive of LifeMasters Supported SelfCare, which
administered the program, testified. About 25% of Medicaid
beneficiaries have chronic illnesses, but treatments for chronic
illnesses account for about 75% of Medicaid spending, according to
subcommittee Chair Michael Biliarikis (R-Fla.) (Sherman, AP/Las Vegas
Sun, 10/15).

Private Companies' Involvement

Although Democrats on the panel approved of more closely monitoring
and counseling beneficiaries with chronic illnesses, they questioned
whether private companies should be contracted to provide such
services. They said that states might save more money if they operated
such programs themselves instead of delegating responsibility to
private companies, which take a portion of the savings as profits.
Rep. Sherrod Brown (D-Ohio) said that state-run efforts might provide
a higher quality of care. "Effective disease management, like
effective health care, hinges on continuity. HMOs undoubtedly do some
things well, but providing continuity of care is not one of them,"
Brown said. Indiana Medicaid official Melanie Bella said that her
state had considered contracting with private companies for a disease
management program but decided against it because a state-operated
program could provide "permanent, long-term structural change"
(CongressDaily, 10/15).


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Las Vegas Sun, October 15, 2003
http://www.lasvegassun.com/sunbin/stories/thrive/2003/oct/15/101502961
.html


States Looking to Manage Medicaid Costs

By MARK SHERMAN
ASSOCIATED PRESS

WASHINGTON (AP) - Medicaid recipients with chronic diseases are
hospitalized less often and states save money under programs to
monitor patient health closely, state officials told lawmakers
Wednesday.

Two dozen states are now utilizing so-called disease management
programs to cut their Medicaid costs at a time when budget deficits
are forcing them to limit spending on the program or restrict
eligibility for it.

Medicaid is the joint state-federal health insurance program for the
poor and disabled. Chronic illnesses afflict roughly a quarter of
Medicaid recipients but account for nearly three-quarters of Medicaid
spending, Rep. Michael Bilirakis, R-Fla., chairman of a House health
subcommittee, said at a hearing.

In disease management programs, chronically ill Medicaid recipients
are frequently monitored, with the goal of reducing expensive
emergency room visits and hospital stays.

In one Florida program for patients with congestive heart failure,
spending dropped by more than 16 percent over two years, according to
Christobel E. Selecky, chief executive of LifeMasters Supported
SelfCare, the private company that ran the program.

Other programs in Florida, a testing ground for disease management
programs, are run by four drug companies. Last month, Gov. Jeb Bush
announced that Pfizer Inc. had extended its program until 2005 and
said it would save the state $45 million.

The three other companies - Bristol-Myers Squibb Co., GlaxoSmithKline
PLC and AstraZeneca PLC - have either renewed their contracts or are
in negotiations to do so.

Democrats questioned whether private companies should play so
prominent a role in disease management.

"Disease management programs should not be a code word for privately
run systems that reduce patient care in order to increase profit,"
said Rep. John Dingell, D-Mich.

Melanie Bella, a Medicaid official in Indiana, said her state opted
not to contract with a private company because negotiators spent "too
much time talking about fees," rather than the substance of the
program.