While not immediately germane, check out this article from today’s Wall Street Journal. This has to do with the pharmacy benefit managers’ eternal battle to promote generics, but there are lessons to be learned from Express Scripts’ multiple interdependent interventions based on insights gleaned from understanding the story behind the story in multiple market segments. The disease management industry may require a similar effort.
Of course, one alternative approach is to mimic the posture of many managed care organizations. This strategy – despite shocked, SHOCKED public protestations to the contrary - means privately calculating that a cozy relationship with the providers is unattainable. Why not? They’re not the source of the revenue and there will always be a tension between the payers on one side and the physicians on the other. Accordingly, being in that ‘space’ means having to take sides and sometimes getting beat-up.
The DMCB disagrees. Absent a really good physician survey that helps us understand just what is going on, the DMCB is going to continue in the tradition of many health care bloggers and express an informed, if unsubstantiated, opinion. It believes there is much that can be done.
Despite the apparent anger out there, many disease management organizations have documented that there is good will in many segments of the provider community. That’s a start. Other segments can be constructively engaged if there is a multidimensional effort that includes, but is not limited to:
A better understanding of the physician ‘market’ segments and their unique perspectives. Who is angry? Where? Why? What can be done? In the opinion of the DMCB, they are evolving into a whole new genus and species compared to their other medical brethren. It’s time to understand that dynamic and what it means to building alliances within the industry’s existing and future business models.
Not waiting for more information on the crisis among primary care providers. If the disease management industry is as allied with these physicians as they say they are, they should know that they are struggling. They could use widespread, repeated, visible and credible support now.
Getting into the “Pay4” arena – big time - with meaningful reimbursement. Cash is always a sweetener, but it’s time to monetize physician participation and program referrals. Note that ‘meaningful’ will need to be defined by the physicians. It will cost, but if patient engagement rates increase, it will be well worth the investment.
Explicit support for the 'Advanced Medical Home' and/or the 'Chronic Care Model.' This will build alliances in policy circles. What’s more, it’s in the interest of disease management organizations to have this resource available to them in their networks. Why not outsource complex care management for appropriate patients that have access to a medical home? By the way, the cash will help generate good will and get patients the right care at the right time.
If anyone has other ideas, please share.
By the way, the DMCB is reminded that many persons in the industry are inveterate party animals. Yet, their travels often result in their becoming victims of the dreaded syndrome of mid-sized city-induced road warrior ennui. As another service to the loyal readers trapped in hotels everywhere, the DMCB has found a solution: fire up that built-in cam in your lap top, don some dark sunglasses and get virtually down!