The market for disease management services holds tremendous opportunities, yet there are significant issues that disease management (DM) companies must address.

The issue of return on investment (ROI) is a frequent topic, and although ROI is typically not the only decision point for purchasers, it is a significant topic. While much of disease management industry wrestles with the best ROI measurement methodologies, actual measurement methodologies must balance the theoretic with the pragmatic while providing timely and understandable responses to clients.

Tillit Consulting can assist disease management companies with a variety of pragmatic issues:

• Work with DM staff to develop standard data requests and data verification methodologies,
• Review DM ROI methodologies for reasonability and soundness,
• Peer review the presentation of DM outcomes/reports,
• Work with plan sponsors to understand changes in benefit programs including benefit plan changes, contribution requirements, provider network changes, and other changes that can have a material impact on measuring DM impacts,
• Obtain financial information from plan sponsors for reconciliation work,
• Work with health plans or TPAs to understand changes in provider reimbursements during DM study periods,
• Facilitate the request, transfer, reconciliation, and development of summary reports from detailed claim and enrollment files.