Wednesday, July 22, 2009

A Call To Action For Physicians.... From a Brit (and an endorsement of disease management)

Baron Darzi of Denham, Ara Warkes Darzi, KBE, FMedSci, HonFREng, FRCS, FRCSI, FRCSed, FRCPSG, FACS, FCGI, FRCPE has a Perspective appearing in the July 22 New England Journal of Medicine (NEJM). It's available as a free download, and it's worth a look by anyone interested in how all those academic initials can make someone smart enough to intelligently comment on health reform. It also has some good points that warrant the attention of the disease management community.

Dr. Darzi is an eminent surgeon from the Imperial College of London who was instrumental in a recent effort to change Great Britain's ailing National Health Service (NHS). While the problems were different than those facing the Yanks today, Dr. Darzi believes there are commonalities in the two countries' efforts at health reform. There are three lessons, says he, that worked for Her Majesty's Government and they may work here.

They all focus on the physicians:

1. It's up to the physicians to help keep the debate focused on the patients and the outcomes that count. That's the key to providing a 'strong common purpose.'

2. Physicians need to get involved in linking the amount of funding and the amount of care in a model that meets American values.

3. They need to educate policy makers and politicians about the value of different levels of care. It's not robotics or bigger hospitals, but primary care access, 'innovations in public health and lessons from the emerging discipline of behavioral economics' [bolding mine].

The Disease Management Care Blog realizes that it's easy to dismiss this as idealistic nonsense, but it says not so fast. Individual physicians need to join organized medicine (options are here and here; there are others between the two extremes) and/or write to their elected representatives. They need to email the politicians, write letters to the editors and speak in church basements about the non-linear link between the spend and outcomes and how to humanely limit healthcare inflation. They need to help cool the allure of technology and talk about access not only to primary care physicians but other under appreciated entry-level care options. The quality and quantity of their input needs to save our well meaning President Obama from his repetitive nostrums and allowing bad legislation to be passed.

This is the flip side of a prior posting by the DMCB that described the Brits' herulean efforts at reaching out to the physicians. They recognized that they needed to solicit the docs' input. This was not only to get their buy in, but because their support turned out to be a critical success factor.

Which brings up two points about the disease management industry:

1) They've had some hard lessons on the need to solicit physician input. The industry needs to continue to use what they've learned to find common ground with the providers in the three areas described above. There is strength in numbers.

2) Those of us that have been working in disease management should be very pleased at the NEJM-level endorsement of our 'innovations in public health' and the business models developed (examples here and here and here and many others) that leverage precisely the 'behavioral economics' that can make a big difference in addressing chronic illness. That is what the industry is all about. It is why it remains a crucial ingredient in any health care reform that has any hope of meaningful success.

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