Cultivating a disease management partnership: a value-chain model.
Disease management (DM) is one of the health care industry's more innovative value-chain models, whereby multiple relationships are created to bring complex and time-sensitive services to market. The very nature of comprehensive, seamless DM provided through an outsourced arrangement necessitates a level of cooperation, trust, and synergy that may be lacking from more traditional vendor-customer relationships. This discussion highlights the experience of one health plan and its vendor partner and their approach to the development and delivery of an outsourced heart failure (HF) DM program. The program design and rollout are discussed within principles adapted from the theoretical framework of a value-chain model. Within the value-chain model, added value is created by the convergence and synergistic integration of the partners' discrete strengths. Although each partner brings unique attributes to the relationship, those attributes are significantly enhanced by the value-chain model, thus allowing each party to bring the added value of the relationship to their respective customers. This partnership increases innovation, leverages critical capabilities, and improves market responsiveness. Implementing a comprehensive, outsourced DM program is no small task. DM programs incorporate a broad array of services affecting nearly every department in a health plan's organization. When true seamless integration between multiple organizations with multiple stakeholders is the objective, implementation and ongoing operations can become even more complex. To effectively address the complexities presented by an HF DM program, the parties in this case moved beyond a typical purchaser-vendor relationship to one that is more closely akin to a strategic partnership. This discussion highlights the development of this partnership from the perspective of both organizations, as revealed through contracting and implementation activities. It is intended to provide insight into the program development and rollout processes that one health plan and its partner have adopted to advance a DM model that integrates appropriately within the local environment. This discussion also highlights how an organizational culture can shift from an emphasis on cost, growth, and control to an emphasis on quality, innovation, and service within a value-chain model.
Murray
Carolyn F
CF
Blue Cross Blue Shield of Massachusetts, Mail Stio 12/09, 25 Newport Avenue Extension, Quincy, MA 02171, USA. carolyn.murray@bcbsma.com
Monroe
Wendy
W
Stalder
Sharon A
SA
D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000458:organization & administration*; D019468:Disease Management; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D008404:Massachusetts; D020416:Outsourced Services / Q000458:organization & administration*; D016730:Program Development