Wednesday, October 14, 2009
The Definition of 'Care Management' Courtesy of the New England Journal
The Disease Management Care Blog appreciates it when a useful definition appears in the peer-review literature. It helps everyone in the population-health care business to agree on terms, concepts and principles. The definition of 'care management' has now appeared in an article* by Thomas Bodenheimer and Rachel Berry-Millett in the Sept. 30 New England Journal of Medicine. This quote and the reference can be used by population health warriors everywhere who are dealing with those upcoming responses to RFPs, business plans, presentations, learning sessions, staff meetings, PowerPoints, professional development classes and care initiatives:
Care management is a set of activities designed to assist patients and their support systems in managing medical conditions and related psychosocial problems more effectively, with the aims of improving patients’ functional health status, enhancing the coordination of care, eliminating the duplication of services, and reducing the need for expensive medical services.
There have been other definitions (for example, here and here) and they more or less support the same concepts, but this may turn out to be the oft-cited reference because:
a) let's face it, it's in the New England Journal. It looks good when you quote it.
b) the authors explicitly point out that care management is generally provided by a 'registered nurse.' The DMCB heartily agrees because it is a big fan of nurses and has witnessed repeatedly how their common sense and familiarity with the 'system' are invaluable to docs and patients alike. What's more, the article points out the value of non-specialty trained nurses, which makes sense: this is a role that often calls for generalism and a working knowledge of primary care.
c) the authors also point out that care management should not be applied 'to patients who are too sick to benefit.' While there is no citation for this particular assertion, the DMCB likewise not only agrees with that, but points out that regular DMCB readers are already long-familiar with the supporting peer review literature. The DMCB recalls numerous instances in which its health plan senior leaders insisted that care management nurses 'do something' about the catastrophically ill patients that had had numerous inpatient stays, required many specialty physician visits and used some very expensive medications. Experienced care management leaders already know that care management is best 'aimed' at patients that are in the sweet middle: not too well that their risk of an exacerbation is low, but not too sick that nothing could be done.
Now, in addition to quoting the oft Googled, widely read, sometimes quoted and always useful if humble DMCB about care management, you can also quote Dr. Bodenheimer and the Journal.
Here's the citation for your copying and pasting pleasure:
*Bodenheimer T, Berry-Millett R: Follow the money - Controlling expenditures by improving care for patients needing costly services. New Engl J Med 2009;361(16):1521-1523
And here's the pdf for printing or forwarding to your colleagues.