|Greek for "working together"|
The authors use a different terminology (as well as acronyms) to arrive at a health care construct remarkably similar to one repeatedly described in this blog: there is no single approach that solves the twin quality and cost challenges of chronic illness. Instead, multiple overlapping and synergistic interventions are required. The good news for the disease and care management service providers is that Dr. Moskowitz's publication appears in the prestigious Journal of General Internal Medicine, is thoroughly referenced and specifically includes "self management support" as one of the key ingredients for success.
In multiple writings, the DMCB has identified health information technology, disease management, the medical home, payment reform, wellness and insurance benefit designs as the mix of interventions that can transform health care. This article identifies "evidence based medicine" (or EBM) plus self management support (or SMS, where patients fit EBM to their personal circumstances) plus "community health" (or CH, where the physical and social environment can be modified to support SMS) as the key ingredients to achieve greater value. Primary care that successfully incorporates all this can be dubbed "health homes" instead of "medical homes."
The article then goes on to describe - with the back up of lots of peer reviewed literature references - the role of turbocharged SMS in the care of diabetes, obesity, asthma and tobacco abuse. Non-surprisingly, numerous studies and meta-analyses have shown SMS works.
The article closes with a melancholy call for changes in non-physician job descriptions and competencies, changes in how physicians achieve certification, cultivation of community-based networks, broadening of the NCQA's accreditation criteria and greater involvement of primary care in the fabric of the community. The DMCB uses the term "melancholy" because, at the end, the author implies that significant barriers stand in the way of this new vision of EBH.
From time to time, the DMCB recommends that certain publications be included in a "resource library," filed away as "business intelligence," quoted in collaterals, inserted in a PowerPoint presentation or mentioned at a staff meeting. This may be one of those articles because it's a brief and well written piece in favor of self management support written by a credentialed academic.
The disease and care management providers can also take comfort in knowing that they're part of the solution. They've been in the business of overcoming barriers for years, know how become integrated with other parts of the system, can provide the trained non-physicians, refer to community resources and help fulfill accreditation criteria.
Drs. Moskowitz and Bodenheimer say "EBH = EBM + SMS + CH."
The DMCB wonders if it's more like EBH = (EBM + SMS + CH) x (i.e. times) PHM. And that ain't melancholy at all.