Friday, August 1, 2008

Disease Management's Ace in the Hole

Regular readers of the Disease Management Care Blog know it is looking forward to future - and better - combined versions of both 'disease management' and the 'patient centered medical home.' DM brings remote multi-channel coaching, scalability and an understanding of performance guarantees in an inflationary insurance market. The PCMH leverages the physician-patient relationship, 'high touch' engagement and is one of the ingredients in the resuscitation of primary care. In the opinion of DMCB, each makes up for the weaknesses of the other. Combining both makes a lot of sense.

Yet, even the DMCB admits PCMH is in ascendancy: it's lost track of all the pilots underway, the support of academia and policy makers is deafening and a big Big BIG Medicare demo is in the chute. Feeling confident, PCMH advocates appear to be in little mood for modification of their care model. Who can blame them?

Just wait. The DMCB suspects PCMH's life cycle is about 5 years behind disease management and rapidly reaching the red dotted Peak of Inflated Expectations. After the pilots demonstrate blunted quality improvements and just how difficult it is to reduce claims expense, disillusionment will give way to dialog that is focused on building better approaches to population care.

We're only weeks away from the college football season and its lesson that there is nothing like early season losses to bring players and fans back to the reality of planet earth. My colleagues on the PCMH 'side of the aisle' believe well intentioned doctors and nurses, because they ARE doctors and nurses, can 'educate' patients into doing the right things. The disease management organizations and their nurses moved beyond this years ago. The DMCB predicts once gravity intrudes, we'll be able to focus on new approaches to population-based chronic care that focus on even more effective versions of patient coaching that interlock across the care delivery spectrum.

If you haven't read this fascinating article by Linden and Roberts, you should. Think about taking these approaches and mixing them with the kind of viral consumerism described in books like Buying In and its abundantly clear that we've only begun to scratch at the surface of patient behavior change.

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