Monday, December 15, 2008

The DMAA Issues a Statement on Principles for Health Care Reform: A Summary and the Implications for Disease Management

Well, it’s official. The DMAA has followed the American Medical Association, Commonwealth Fund Commission, the American Heart Association, America’s Health Insurance Plans, AFSCME, The Association of American Medical Colleges, the American Hospital Association, the American College of Physicians, and AARP in having something to say about health care reform.

Keep in mind that the DMAA represents a host of health insurers, employers, advocacy groups, health care provider organizations, research groups, pharmaceutical companies and - oh yes - for profit disease management organizations. As a result, DMAA has access to some considerable mojo in the topic of population health, particularly in the area of chronic illness, prevention and disease management. They're very much worth listening to.

By the way, think the term "population health" is some sort of jargony pseudo-scientific marketing notion cooked up by a bunch of for-profit vendors intent on sucking the life-essence out of a struggling health care system? Think again. The Disease Management Blog thanks the colleagues in the public health arena for coming up with a perfectly valid and correct definition: it saved the DMCB the effort.

But getting back to the issue at hand. According to the Statement:

DMAA believes the goal of health care reform should be to improve the quality and efficiency of care for all consumers.” (The DMCB finds use of the term 'efficiency' curious but very appropriate. It addresses not only the notorious lack of coordination in an ala carte fee-for-service system, but speaks to the Number 1 driver of costs, the frenzied use of technology irregardless of it's incremental value).

DMAA then follows up with some bullet points (DMCB commentary in italics. It's allowed to do that because..... well, afterall, this is its blog):

Seek to improve the health of the entire population (in fact, that point is in the latest DMAA Outcomes Guidelines Report: outcomes evaluations should not be confined to only those were called by the remotely positioned nurse-coaches):

Increase access to affordable health care coverage options (compared to many other health care interventions, disease management is a bargain);

Center on the needs of consumers (patient centered care anyone? The DMCB believes a substantial proportion of enrollees like having their own nurse regularly giving them a call);

Improve consumer health knowledge and confidence (self care is truly the secret sauce in chronic illness, prevention and wellness);

Encourage engagement and accountability of patients, their families and caregivers (patient centered care part 2, anyone? The DMCB believes a substantial proportion of spouses, parents and children like having their spouse, child or parent being being regularly called by their own nurse);

Reward value and quality across all payers and providers (while there is the Holy Grail of reducing claims expense in excess of the cost of the program, sooner or later we're all just going to have to accept that sometimes when it comes to quality, you get what you pay for);

Promote integrated, coordinated care (with non-physicians - versus the physician hero doing the countless mundane tasks of chronic illness care in the course of a 12 minute 32 second one-on-one office encounter. The DMCB asks why can't some of the teaming be 'virtual?');

Increase the availability of primary and preventive care (and one approach is for disease management programs to PAY physicians for primary and preventive care services. Some disease management programs are doing just that);

Promote transparency of price and quality (what a marvelous idea. The DMCB suggests the DMAA members lead this transparency parade by being the first in the health care industry to post all their otherwise opaque fees and risk arrangements on-line).

Support providers who implement health information technology to improve safety and coordination (the DMCB would like to point out that disease management organizations have already made considerable health information technology resources available for providers);

Implement a national health data repository (and open-source it? That may be radical, but there is merit to harnessing the wisdom of crowds to independently mine data bases for new insights. Why can't the disease management organizations pool all their diabetes data?);

Include rigorous evaluation of clinical and administrative interventions, with feedback loops to continuously improve health care delivery (the DMCB believes this is so critical that it should not only be first in this list, but that organizations in the business of population health should tithe in support of studying their programs' outcomes); and

Support the continued use of tax benefits to expand insurance coverage (insurance coverage is necessary but not sufficient for access to health care).

Like the last post about the IOM Report, the DMCB likes what it's reading. Hopefully the Feds will listen.

No comments: