Sunday, October 12, 2008

Another Door Opens to Collaboration Between Providers & Disease Management Organizations in the Medical Home?

The Disease Management Care Blog recommends readers check out the e-CareManagement Blog for an outstanding summary of an update on the upcoming Medicare Medical Home Demo. My colleague Vince Kuraitis provides a great summary of the additional details on how this demo is going to be set up.

The DMCB is still digesting all the information, but it is happy to congratulate CMS on its recognition of the importance of one key critical success factor for the Medical Home: clinical teaming. It appears CMS is also doubling down by recognizing the potential role of external disease management organizations. Quoting from the Medical Home Standards’ “Element C” of “PPC 3: Care Management” (and bolding below from the DMCB):

The practice uses a team approach in managing patient care. Shared responsibilities are designed to maximize use of each team member’s level of training and expertise. In small practices, this may be designated roles for the physician, the nurse and the administrative person if there is one. In most practices, the availability of nurse case managers will only be through the patients’ health plans or other large organization. In some practices physicians may handle significant patient care responsibilities, especially for complex patients. Disease management or care management may be provided internally by the practice or group or available to the patient externally, usually through the health plan.

The DMCB may be mistaken, but at 1st blush, it appears the Demo is agnostic to the location of the personnel necessary to enable “non-physician staff to collect information prior to appointments,” “execute standing orders for medical refills, test ordering and preventive services” and “educating patients/families about managing conditions.”

Does this mean the door is open to joint applications from physician groups AND disease management organizations to participate in the Medical Home Demo?

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