For the latest on how disease management is an important option in the formation of "Accountable Care Organizations," check out this (regrettably ad cluttered) HealthLeaders article describing how the 4-hospital-17-clinic Essentia Health System's positive experience with their nurse-led disease management program is giving them a leg-up on keeping patients out of the emergency room and the hospital. Its success has led the way in making Essentia's confident that it can be a successful ACO.
Any why not? Even the U.S. Agency for Healthcare Research and Quality says there is pretty good ("moderate") evidence that Essentia's heart failure program was a home run. As the DMCB understands it, patients either self referred or were referred by doctors, especially after an admission for heart failure. A mix of nurse practitioners and registered nurses conducted series of one-on-one or group visits to educate patients as well as start or adjust medications under an established protocol. In-bound calling was also available and selected patients were given home telemonitoring weight scales.
Minnesota Blue Cross Blue Shield analyzed the program's results for its participating insureds and determined the readmission rate dropped, length of stay decreased, medication use increased and cardiologists were freed up to care for high priority patients. Based on a subpopulation of "29 patients," they estimated there were $1.25 million in savings.
Essentia points out that "disease management" is not a physician skill set. The DMCB wholeheartedly agrees and also thinks that its physician colleagues don't really mind that characterization, especially since this is a team sport. After all, the nurses in the program are performing many of the rote duties of clinical management while simultaneously deferring to the docs when needed. Some friction is inevitable, but the advantages and the outcomes outweigh the disadvantages. This program speaks for itself.
While the DMCB has been leery of the proposed ACO regulations as now written, if anyone can succeed at this, it seems Essentia can.