Monday, September 12, 2011

11 Insights for the Disease Management Community From Dr. Lundberg

The Disease Management Care Blog couldn't have said it better.  It's not often that the DMCB "reflects" web-based content from elsewhere, but this deserves an exception.

Writing for the MedPage web site, former JAMA Editor-in-Chief George Lundberg describes 11 "false assumptions, practice failures, clinical errors and things amiss" in health care today. 

If these defects were corrected, the DMCB guarantees that U.S. medical quality and cost would improve.  The list also speaks to the difficulty of relying on laws, economists, budgets, Rose Garden announcements, regulations, policy-making, hearings, benefit design tweaks and politicians to have any meaningful impact on the real underlying problems in health care today. 

The good news, however, is that disease management offers some solutions to the 11 points.  That's why practically every health insurer in the U.S, with the exception of Medicare, offers some form of population health and care management.

To wit:

1. "Physician persuasion is powerful": in other words, patients need to actively participate in calling the shots.  That's called shared decision making, which is a bedrock principle of the population health management service provider industry.

2.  "Medical tests can lie":  when physicians intuitively disregard "positive" tests, low pre-test odds can make that the right decision.  Smart and experienced care management nurses understand that and can support the physician's decision in care planning.

3. "Disease onset can be gradual" and persons in the earliest stages of chronic illness may not meet the definition of even having a "disease" - yet:  That's why active disease management is best suited for later stage conditions and offers prevention and wellness programs for the rest.

4. "Preventive public health deserves more credit": part of disease management's success lies in its value proposition of applied public health.

5. "There is an overreliance on the indirectly obtained information of labs and imaging" and testing begets more testing as well as avoidable treatments that are the hidden part of health care cost iceberg:  Disease management can help patients understand that they don't need another MRI.

6. "Long term outcomes data for many age/gender groups are lacking": this is why disease management approaches long-term risk contracts cautiously and why the industry can help keep ACOs from jumping off a 3 year cliff.

7. "It's not all in their heads": care management coaching understands the false allure of the mind body dichotomy.

8. "There is what is known and then what is believed": reliance on still evolving evidence-based research that taps a variety of investigative methodologies is not only the best long-term approach, it's becoming the bricks and mortar of disease management.

9. Some conditions cannot be treated: and some patients should be discharged from disease management programs.

10. There is a difference between "biology" and "medicine":  this is why seasoned nurses make the best care managers

11. There is no test that distinguishes the well from the sick: seasoned care management coaches don't necessarily assume their clients are "patients" who are "sick."  They assume their clients want a say on getting from their current health status to a desired health status and strive to help them get there.

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