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DMAA releases outcomes guidelines


DENVER--The Disease Management Assn. of America has issued its long-awaited blueprint for measuring outcomes in disease management programs.

Employers have increasingly been seeking proof that disease management, one of the most popular methods for addressing chronic medical conditions, is living up to vendors' claims that it curbs runaway health care costs (BI, April 17).

The guidelines, which have been in development for more than a year, will bring the health care industry and employers at least one step closer to measuring the effectiveness of the programs, according to Tracey Moorhead, executive director of Washington-based DMAA, who announced the guidelines on Monday at the DMAA's eighth annual Disease Management Leadership Forum in Denver. The guidelines were approved unanimously by the DMAA board of directors Nov. 9.

Among other things, the DMAA's new guidelines recommend use of a "pre-post" study design that incorporates an equivalent concurrent comparison or control group; using health care cost outcomes such as medical and pharmacy claims to calculate the financial impact of the programs; and using a nonchronic population as a comparison for calculating health care cost trend rates.

The DMAA guidelines also suggest that before any measurement process starts that parties first agree on a mutually acceptable risk-adjustment method, which would take into account participants' pre-existing health status so outcomes are not affected.

Although the new guidelines do provide a framework for measuring disease management program effectiveness, they are not designed to compare vendors' programs, Ms. Moorhead said. However, the DMAA envisions that the guidelines could be helpful for employers when developing contractual terms with vendors for assessing disease management programs, she said.

"These are starting-point guidelines" for evaluating the effectiveness of disease management programs that target "the top five chronic conditions"--namely diabetes, asthma, chronic obstructive pulmonary disease, coronary artery disease and heart failure--Ms. Moorhead said.

The DMAA's outcomes project was officially launched in January 2006 after the organization's outcomes steering committee surveyed its membership on the measurement methods currently in use. The committee also sought input from the Agency for Healthcare Research and Quality and the Joint Commission on the Accreditation of Healthcare Organizations, the Case Management Society of America, the National Committee on Quality Assurance, URAC and the Society of Actuaries.

The Outcomes Steering Committee will begin a second phase of its outcomes project in 2007 to develop additional clinical, quality, productivity, process and utilization measures, as well as selection criteria for disease management program participants. Other objectives of the second phase of the project include: refinement of the evaluation design recommendations to include a list of biases and ways to reduce the impact on evaluation results; consideration of an economic model for evaluating trend; development of statistical analyses for program evaluation; and ways to test methodologies.

A summary of the recommendations is available on the DMAA Web site, For a copy of the full report, contact DMAA at 202-737-5980 or via e-mail at