Monday, May 7, 2012

Disease and Population Health Management Programs Do NOT Exclude Other Conditions

Playing 'whacamole'
"Immunizations cause autism." 

"Health care blogging will never lead any serious beer money."

"Disease management coaching focuses exclusively on just one disease."

These are three falsehoods that bubble up in the unlikeliest of places, including cable news outlets, replying to the DMCB spouse's asking "and what did you do today?" and webinars, webcasts and other educational meetings about population health and disease management.

While the Disease Management Care Blog finds all three vexing, the most irksome is the canard that the commercial health coaching service providers purposely limit their programs to just one chronic condition, like diabetes, weight loss or readmission prevention.

While that may have been the case in the earliest versions of disease management, that narrow approach was dropped years ago. That's because patients typically seek advice for a wide range of overlapping concerns and the good nurses hired by the vendors will respond to them.  The vendors also understand that their shared risk and performance guarantees depend on claims expense that is driven by the synergies of multiple co-morbidities. 

While a purchaser, insurer or accountable provider organization may start out with a focus on a population defined by a single condition - such as diabetes mellitus - that doesn't mean their protocols and care plans won't span the continuum of care and include hypertension, tobacco abuse, depression, housing, chatting about the grandkid and responding to concerns whether this will be finally be NBA superstar LeBron James' year.

And the published literature supports the DMCB's contention that modern population health management is multifaceted.  Examples include this seven-condition program for dually eligible Medicaid beneficiaries in Georgia, this Midwest employer-sponsored program that enrolled persons with multiple care needs and this physician-focused program that used pay-for-performance to improve measures across multiple conditions.  Check out some vendor web sites and you'll see references to "whole person health," the "interrelated aspects of social, emotional, and physical health" and "a holistic view of member health across internal and external care management initiatives."

That being said, the DMCB knows that perception and reality can be two different things. Given the whac-a-mole persistence of the "single disease" myth, the DMCB says the population health management community may benefit clarifying the broadness as well as the depth of their offerings as they continue to build their brand.

Image from Wikipedia

1 comment:

Rebecca Dubowy MD MBA said...

I couldn't agree more with the importance of emphasizing the need to understand the whole person in order to effectively manage a chronic disease. Interestingly, we find ourselves educating not only potential customers about this approach, but also existing customers.
To give just one small example: one discussion we find ourselves not infrequently having with our partners is about why we work to help our diabetes program participants to improve their sleep habits.
We have a short memo explaining the key important links between health, diabetes and sleep that we provide our clients.
To help improve health, it truly take a holistic view of a person within the context of their own unique world.