DMAA Consensus Outcomes Evaluation Guidelines
Frequently Asked Questions

What is DMAA's goal for this project?

To develop a broadly accepted and evolving set of uniform evaluation guidelines for the disease management community to use for outcomes reporting purposes.

Why is DMAA spearheading this effort?

DMAA, true to its mission of "standardizing definitions and outcome measures" for disease management and care coordination, launched its project in response to ongoing concern about numerous competing evaluation methodologies in the marketplace. The absence of a consistent approach to measuring disease management's financial and clinical outcomes created doubts about the value of disease management programs, even as the industry enjoyed robust annual growth rates in recent years.

To overcome skepticism among academics, policymakers and others, and to reaffirm disease management's important role in the care continuum for chronic conditions, the DMAA Board, Quality and Research Committee and the Outcomes Steering Committee concluded that DMAA, as the only association effectively representing all stakeholders in disease management, must establish consensus guidelines for program evaluation—something akin to generally accepted accounting principles.

What has DMAA done to lay the groundwork for this project?

Since its inception in 1999, DMAA has contributed to and initiated discussion within the industry about the need to bring consistency to disease management program evaluation and to develop metrics for multiple aspects of program performance. National and international conferences—in particular, DMAA's annual Disease Management Leadership Forum—provided the setting for and helped advance discussion and industry guidance on program evaluation.

In 2004, DMAA published the "Disease Management Program Evaluation Guide" to provide disease management organizations, health plans, employers and others with suggested approaches for disease management program evaluation. The publication reviewed current disease management program evaluation studies to develop a set of guiding principles for future evaluation of often complex programs. The guide also identified methodological pitfalls that commonly undermine evaluation estimates, and developed analytic tools for evaluating and comparing disease management program effectiveness.

How can uniform guidelines benefit providers and purchasers of disease management and care coordination programs?

Development of a broadly accepted approach to program evaluation, using key statistical and actuarial practices, will permit health plans, employers, state and municipal governments, and other purchasers to more clearly understand the clinical and financial value of disease management and make better-informed purchasing decisions. DMAA further envisions use of the guidelines as an aid in developing contractual terms for assessing disease management programs in both private- and public-sector settings.

How did DMAA develop its outcomes guidelines?

Although DMAA officially launched its Outcomes Project in January 2006, the Outcomes Steering Committee began its work in 2005 with development of a survey that would serve as the primary data collection tool for the project. DMAA distributed the survey in January to its entire membership, which includes health plans, disease management organizations, pharmaceutical companies, pharmacy benefit managers, large employers and numerous other stakeholders.

DMAA received about 50 completed survey responses, which the University of Chicago's National Opinion Research Center (NORC) collected, reviewed and analyzed. NORC summarized the survey responses to identify emerging best practices, as well as areas of commonality and divergence of opinions and methods. The Outcomes Steering Committee then undertook a rigorous process, using work groups, to resolve divergence in several areas, including methods; clinical, financial and additional metrics; and productivity and wellness.

DMAA then reached out to a greatly expanded base of stakeholders—members and non-members alike. In collaboration with the Agency for Healthcare Research and Quality and the Joint Commission on the Accreditation of Healthcare Organizations, DMAA convened a roundtable Sept. 11, 2006, at AHRQ headquarters, to solicit comment from prominent quality and accreditation interests, businesses, actuarial organizations and others. Key external stakeholders that participated in the roundtable and throughout the guidelines development process included the Case Management Society of America, the National Committee for Quality Assurance (NCQA), URAC and the Society of Actuaries. Each of these organizations committed to support the outcomes project's goals.

In final steps, DMAA again engaged its membership with an all-member audio conference and Webcast to present the guidelines draft and solicit comment, and prepared a final draft for consideration by the DMAA Board of Directors. The Board approved the final guidelines unanimously Nov. 9.

Who responded to the outcomes survey?

Survey respondents included integrated delivery systems, 4 percent; disease management organizations, 46 percent; health plans, 27 percent; consultant/third-party administrators, 16 percent; and pharmaceutical manufacturers and pharmacy benefit managers, 7 percent.

What did respondents identify as the most important goals of disease management programs?

Survey respondents overwhelmingly agreed that improving quality (97 percent), reducing health care costs (94 percent), optimizing care (82 percent), and providing return on investment (70 percent) were the most important strategic requirements of disease management programs.

Isn't DMAA concerned the industry might resist an overly prescriptive approach to outcomes evaluation?

The DMAA guidelines are neither prescriptive nor intended as an ideal method for all populations under all circumstances. The guidelines are a result of a consensus effort to create a standardized method, based on best practices, for determining disease management outcomes that meets suitability and acceptability requirements across a wide variety of populations and circumstances. DMAA views its guidelines as an intermediate step in evolving practical and reliable methods to compare program performance. Also important to note: The project's goal was not to select the best method for delivery of disease management programs. Rather, DMAA sought to work closely and collaboratively with recognized industry experts and allied organizations to identify and promote guidelines by which to evaluate program results.

Where does the DMAA Outcomes Project go from here?

DMAA does not consider its outcomes guidelines to be the last word in evolving standardized methods for comparing inter-program and intra-program performance. The Outcomes Steering Committee will begin a second phase of the Outcomes Project in 2007, with developing priorities to include:

• collaboration with one or several organizations to develop additional clinical, quality, productivity, process and utilization measures, and disease-specific population selection criteria;
• refinement of the evaluation design recommendation to include a list of biases and ways to reduce the impact on evaluation results;
• consideration of an economic model to calculate Trend;
• development of clear and practical recommendations around statistical analysis for program evaluation; and
• collaboration to "test-drive" methodologies.