Thursday, June 21, 2012

"Hovering" - A New Term for Disease Management?


That's the term used by Drs. Asch, Muller and Volpp in a New England Journal article on care management that gets it mostly right for the wrong reasons.

Noting a few hours of face-to-face visit time with a doctor over the course of a year doesn't come close to meeting the full-time needs of patients with chronic illness, the authors describe how wellness, medication compliance, transitional care and telemonitoring programs have stepped in, especially for 'hot spotter' patients.

Sounds good, say the authors, but they argue that these "conventional" disease management programs have "not fulfilled their promise" because of 1) unjustifiable personnel expenses and 2) the difficulty of maintaining patient engagement.

They feel things will change for the better. That's because

1) payment mechanisms are now demanding "accountability,

2) the science of behavioral economics allows for a better understanding of what motivates patients and

3) the price of wireless and internet-enabled devices is dropping.

So, when all three of these ingredients are optimally combined for the right kinds of patients, they say the resulting "hovering" will drop health care costs and increase quality. They describe an example of an automatic pill-bottle reminder system that is linked to patient lottery reward that has been shown to increase medication compliance and reduce hospitalizations (which, by the way, was described four years ago by the DMCB here).

Dr. Asch et al are technically correct but unfairly portray the disease and population health management service providers as behind the times. They couldn't be more wrong.

The vendors have been working on an "accountable" risk-basis with health insurers for over a decade, have led the way in the use of behavioral economics in their programs, have been closely aligned with telemonitoring services and regularly use the technology of predictive modeling to identify those patients who are mostly likely to benefit.

One thing the vendors have not done, however, is use the term "hovering" in their marketing materials, peer-reviewed publications or national meeting presentations. 

Which begs the question: how about changing from the DMCB to "Hovering Care Blog?"


1 comment:

Denny Brennan said...

Are we at gerund #2 in the provider engagement countdown? At #3, we heard "huddling," summoning images from "Horsefeathers", and, today at #2, "hovering," which is rarely used to compliment a service provider's - or any other relationship's - behavior? What will take the top spot?