Sunday, January 9, 2011

Disease Management: More Than Proprietary Clinical Pathways, It's The Nurse Coaches!

In the course of reading a considerable number of disease management company manuscripts, marketing materials, proposals, PowerPoints and corporate web site content over several years, the Disease Management Care Blog has repeatedly run into claims of industry “proprietary” information technology and decision support. They contend that thanks to their unique on-screen pathways, guidelines and prompts, their health coaches can access a supremely organized network of evidence-based knowledge that can change any patient, prompt any physician, produce any outcome and reduce any cost.

Don’t believe it. The secret sauce of the good disease management companies is more than just technology, it’s the touch. Its not just the protocols but their people.

The DMCB has come to that conclusion because it has personally witnessed both good and bad nurse-coaches in a variety of settings accessing these top secret protocols in the course of their phone calls. When it works, the magic of patient engagement with behavior change has less to do with what is on the monitor and more to do with its human application thanks, in turn, to the nurses' clinical “wisdom” and professionalism.

As a result, the DMCB recommends that purchasers of disease management services not only ask about the clinical support tools and the vendors' in-house training programs but inquire about the nurse-coaches themselves. For starters, ask about the number with previous career experience in outpatient clinical settings and how many were meaningfully involved in the care of persons with chronic conditions. While that may be an imperfect gauge of the depth of the vendors' human capital, having a high number of experienced nurses could explain why some disease management companies consistently deliver results, while others have a more spotty record.

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