Monday, October 25, 2010

The Real Reason Why Health Care Is Going Home

Hospital-like care at home. Home health agencies doing disease management. Home visits by technology-equipped physicians. Monitoring devices, telephony and self care all guessed it, home. If it looks like all of these approaches share a theme, you're right. That theme is the topic of a New England Journal "Perspectives" article titled "Why Health Care Is Going Home" by Steven Landers of the Cleveland Clinic.

Regular Disease Management Care Blog readers won't find much new news here. They'll agree however, that more than a decade after the disease management industry began, the denizens of the academosphere are still struggling to recognize a key value proposition of disease management. Hopefully they'll start reading this blog, says the DMCB.

According to Dr. Landers, home-based care has a lot going for it because 1) there won't be enough hospital beds to meet future demand, 2) it turns out being in a hospital bed is dangerous, 3) exiting a home for health care can involve stairs, narrow hallways and other threats to safety, 4) acute illness = hospital care, chronic illness ≠ hospital care, 5) home care is promoted by the Chronic Care Model, 6) modern monitoring and treatment technology is becoming extremely compact and reliable, 7) hospice has an attractive track record, 8) consumerism prefers the convenience of home care and, last but not least, 9) it's a lot cheaper than the alternative.

Dr. Landers is right on all of the above but fails to give credit where credit is due. Consumer goods are increasingly being linked to service contracts to the point where the experience of ownership is more important than the initial purchase. While health care is not necessarily a consumer good, our patients are coming to expect high-end support services. Disease management has known that for over a decade. Examples include home monitoring devices that are tethered to 24/7 nurse support, the willingness of vendors to staff their line for evening home telephone calls and the rise of community-based care management nurses who will not only see the patient at the clinic but in their place of residence.

Disease management's outcomes have shown home care can be cheaper and safer than being in or having to go to the hospital. It capitalized on the emerging need for alternative approaches to chronic illness. It was explicitly adopted by medical device manufacturers. It is also remains the quintessential answer to consumerism.

In short, disease management is a principal reason Why Health Care Is Going Home. Too bad the Journal's editors didn't work with the author to make sure that point was made in the manuscript.

The DMCB will download a copy of this article to its hard drive so that it can use the reference in the opening paragraph of some future manuscript or early on in a PowerPoint presentation. It may be of use to other DMCB readers that are looking for useful marketing "collateral."

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