Monday, September 15, 2008

P4P, Disease Management, the Medical Home, Electronic Records and Consumer Directed Plans: The Unified Field Theory of Population Health

The Disease Management Care Blog checked out a publication from the Journal of Medical Practice Management authored by Charles Peck MD, the Chief Medical Officer of LifeMasters. He argues that usual pay-for-performance programs (P4P) are more trouble than they are worth to busy physicians because of burdensome data collection. Enter disease management organizations (DMOs). Dr Peck argues they’re ready to be “partners” and help busy physicians get ahead of the curve. DMOs can not only achieve outcomes, they can help get them documented. Unfortunately this particular article is light on specifics. It doesn’t describe how LifeMasters does/would do it and offers no examples.

Interested in more detail on how this might work? One example is what McKesson is doing in the DMCB's home state. It is contracted to provide disease management services for fee-for-service Medicaid enrollees in Pennsylvania. According to this press release, a Mercer audit confirmed there was a net savings of $35.9 million over the course of one year. While this press release doesn’t mention it, the McKesson program not only deploys the usual distance telephonic patient coaching, but also compensates physicians with a version of P4P for the work of referrals, recruitment and follow-up.

The DMCB wishes, however, that the methods and results from this program be detailed in a peer-reviewed forum. No disrespect to the folks from Mercer, but let's face it: it’s hard to know what’s going on here. Without kicking the scientific rigor and transparency up a notch, the DM industry will continue to be disdained as black-box voodoo by policy makers. While we're thinking about that, here's another option to think about.

Never mind that, though. Think disease management combined with the medical home.... Medical home sycophants have suggested it can be supported with P4P..... Both disease management and the medical home rely on information technology, registries, decision support and electronic record keeping..... Now we see disease management and P4P.
See a pattern?

The Disease Management Care Blog does also. It continues to be interested in a unified field theory of population management. This view suggests disease management, the medical home, pay for performance, the electronic medical record and even variations of consumer directed health plans can be not only integrated into mutually supportive programs, but combined in a single approach to care. Doing so will make up for the weaknesses of the other. Is this another opportunity for the DMO community to show some leadership?

Sounds good conceptually, but writing it up, keeping it less to 5000 works and getting it published somewhere has turned out to be a daunting challenge. The DMCB continues to work on the manuscript. We’ll see.

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