Health Dialog, Foundation for Informed Medical Decision Making, CIGNA's Revolving Door and Why Your Health Care is Now One Word, Part I

(Originally posted October 26, 2009)

Once, sometime in the not-too-distant past, health care was spelled with two words. Then along came some shiny suited corporate marketer, fresh from B-School, full of some ideals, who blended those two words into one, and thereby cemented the hold on health and care in our nation into the hands of The Corporation.  

Trademarked and proprietary, thank you very much.

Health care used to be about you and your doctor trying to keep you healthy with your regular check-ups or trying to figure out how to heal what was wrong with you. Remember that quaint notion? Remember when pharmaceuticals weren't allowed to advertise on TV?  Oh, the day.  Now, I'm all for dissemination of information, but seriously, we've become one hell of a pandered-to nation.  The Ambien ad makes me laugh every single time I see it. "Sleepwalking, and eating or driving while not fully awake, with memory loss for the event, as well as abnormal behaviors such as being more outgoing or aggressive than normal, confusion, agitation, and hallucinations may occur."

Our health care has been so grossly intruded upon by so many people trying to get their fair-share, piece of the American health care pie, that we are left with a mockery of what health care is supposed to be about.  Your doctor is just one small step up from you on this ladder--and you and I, the sick person, the consumer, we're on the bottom rung.

It's such a wasteful system that it spawns all sort of ways for companies to figure out how to make money from all that waste--a way to grab a piece of that pie.  How big a piece?  Let's look at one company making a play for the pie, Health Dialog.

Here's an excerpt of an interview at HealthCareEuropa.com with Chris Coloian (formerly of CIGNA) now of Health Dialog. And CIGNA is now a Health Dialog customer! Works out nicely, doesn't it? Full interview here.

We talk to Chris Coloian, Senior Vice President Health Services at Health Dialog, a US population health and health improvement company owned by UK healthcare insurer BUPA. Chris is the former vice president of health advocacy at CIGNA Healthcare, where he provided strategic, product, and marketing direction for the company’s portfolio of care management and health coaching programs.

HCE: How do you see the European market for chronic disease management programmes growing over the next few years?

CC: Very fast, maybe doubling in the next few years. I see no reason why in 2-3 years it shouldn’t be 20-25% of the US market, which today is around $2.5bn and growing at 10-15% a year.

HCE: Why this very fast growth?

CC: I think European policymakers, like our own president, really 'get it'.

HCE: Hmm, I hear mixed reports. In the USA, where people stay with insurers for 4-5 years, I’ve heard that chronic disease management programmes make sense, as they effectively reduce the acute care that an individual will need over that limited time period.
But people in Europe tell me that it is different for healthcare payors like UK primary care trusts, who will be paying out until the person dies. In those circumstances, do these programmes really deliver savings?

CC: To understand the full impact on society, one has to look past medical costs and consider productivity and contributions, such as increased tax revenue. You may extend someone’s life by, say, 2-5 years, but you will also have a much more healthy individual, who will be able to contribute more.
The studies I have seen show that this productivity bonus far outweighs any extra costs. And the cost of the extra few years is not very great anyhow, as most of the costs for any individual are incurred in the last six months of life. I think European policymakers and politicians understand this.

Where to begin.  Let's start with the fact that Chris is talking about growth in the European market--growth off which his company can feed in the chronic disease management arena because European policymakers "get it."  What do they get?  That integrated care is the future.  I did not know our President "got that" because we can't even get a Public Option let alone a National Plan.  So, who's going to pay for this integrated care of the future? You and I will via our premiums--so that we can help our insurance companies cut costs.  Make sense?  Think bottom rung.

From the International Journal of Integrated Care.

One big difference exists between the USA and Europe. There, disease related integrated care is provided by independent, mostly commercial disease management programs. They do their work instead of regular primary health care and regular hospitals. In Philedelphia, this approach was at the centre of the congress. Not all speakers agreed with this outcarved, independent approach. Medicare's health care innovator, Linda Mango, preferred to embed DMPs within the regular structures, because persons with one chronic condition (still?) do need all types of services. In contrast, Wallstreet broker Brooks O'Neil has lost all trust in carers as usual, in regular primary care and hospitals, and wants to invest as much as he can in commercial DMPs. He sees DMPs as a tool for a revolution to replace ordinary fragmented working doctors and hospitals.

Yes, yet another way to grab a piece of the Health Care Pie--commercial Disease Management Programs like what Health Dialog peddles, you know, Health Coaching and the like. Go to their website, it's a prime example of some really awful corporate writing. 

Our predictive models deliver individual-level information that predicts (don't predictive models already predict?) financial risk and provides insights into the impactibility or readiness of each individual to become engaged in the healthcare process. By incorporating this concept of impactibility we identify those who can most benefit from Health Coaching or other care management programs within a specific time frame, and then match intervention to need. 

Psst, Health Dialog, impactibility isn't a word.

And the interviewer asks why the European market should grow like the U.S because here, we use the predominant employer-based insurance system and on average, we change jobs every 4-5 years, thus change insurance. So the programs here reduce acute care costs over that limited time period--but for who?  Insurance companies and our employers who have to pay into our insurance.

While I am all for reducing the need for acute care, what is the price for reducing this need? Because as you know, we don't have a great track record here in the U.S for taking care of our sick people--even the ones with insurance.  30% of all claims were denied in the state of California just within the first 6 months of 2009.  30%!  That reduces acute care all right.

And don't you just love being thought of as a contributor to "tax revenue?"  Thanks, Chris.  Really puts the human in your humane thought.

And the only reason I stumbled upon Health Dialog and companies of their ilk was due to my research and personal interest into Ms. Abigail Johnson of Fidelity Investments.  I was trying to figure out where she stood on health and care in our country.  What I found besides Ms. Johnson's campaign contributions, was her husband, Mr. Chris McKown.  He's one of the founders of Health Dialog. From the Health Dialog website:

Health Dialog is a leading provider of care management and analytic services and is a wholly-owned subsidiary of Bupa, a global provider of healthcare services.

Health Dialog Services Corporation (Health Dialog) was founded by George Bennett and Chris McKown in 1997. The company was built in collaboration with the not-for-profit Foundation for Informed Medical Decision Making (FIMDM) to directly address unwarranted variation in healthcare. The firm provides sophisticated analytics that drive actionable and measurable solutions for your population, including care management programs and provider measurement services.

"To directly address unwarranted variation in healthcare" (one word).  What's all that mean? Part 2 tomorrow.