Sunday, September 19, 2010

In Further Defense of the Term "Disease Management"

We have much to be thankful for in that curious mix of popular mainstream media, 24/7 news cycles and the Internet. In addition to making us so much brainier, our unending connectedness is also helping us to establish new cultural standards. Examples include Lady Gaga's recent meat and greet fashion trend (fans could really see her in the flesh, adding a whole new dimension to the notion of girding one's sirloins... with beef briefs), the totally unexpected SHOCK of the New York Jets' sexist buffoonery when a woman appeared in the team locker room, the laudable courage of State politicians' ability to command improvements in healthcare with the mere stroke of a pen and the use of, er... lawn sausage as a popularity baseline. Case in point is the smart Vince Kuraitis' recent e-CareManagement blog post that reviews the non-merits of the term "disease management" (DM).

Vince brings up the usual criticisms of DM: in this politically correct age, persons really have health challenges, not "disease," while "management" is contrary to our notion of consumer-patient centeredness that is really the province of providers, not physicians. Let's also face it: the DM industry was too uppity. When it stumbled, physicians and the CMS staffers took their just revenge, sealing the comeuppance an eternally negative brand and droopy vendor stock prices. It only makes sense, then, to look beyond the DMCBs use of mere Google page counts and compare the term disease management to established mainstream cultural standards, as Vince has so ably done.

Lesson learned. In fact, the DMCB will stop feeling good about its thousands of weekly hits and compare its web footprint to something that really matters, like the traffic to this YouTube video of a hand-fart rendition of the Star Wars Imperial March.

Why, then, would the wonky and web savvy DMCB remain so blindly loyal to the term disease management?

1. The physician DMCB thinks diabetes, asthma, heart failure, atherosclerosis, hypertension, obesity and other chronic conditions are ultimately diseases. Caring for them involves a combination of treatment approaches that can be packaged into a state-of-the-art management. Nothing about that precludes the patients' participation with their doctors' help. Disease and management may not have cachet but it's still a good description of the reality. What's more, the term is still used in C-suites, national meetings and strategy sessions.

2. While, at its peak, disease management was an all-things-to-all-people panacea, greater market discipline has led to a more precise definition: the use of a package of mutually supportive interventions to improve quality and/or mitigate the insurance risk of a population defined by the presence of a chronic condition.

3. There is plenty of recent peer-reviewed science that is still using that term to describe impressive outcomes. Examples include this and this.

4. While eCareManagement has correctly noted that 1,300,000 Google pages using the term "disease management" is er..... comparatively modest, the term "patient centered medical home" has appeared in 121,000 pages, and the term "accountable care organization" has appeared in 37,700 pages.

5. Health care advances generally also have their own life cycle of high enthusiasm, followed by an over-reacting crash of bitter disappointment and disdain followed, in turn, by intelligent adoption. The Disease Management Care Blog thinks DM has climbed out of the trough into being a standard part of most insurance plan networks. The Medicare FFS benefit exclusion is the exception and certainly not evidence of Medicare's leadership in this area; rather, they're behind the times. By the way, the PCMH and ACOs are almost certain to follow the same glide path.

6. Plus the DMCB doesn't want to go through the hassle of changing its name,

and, last but not least....

7. When the term "disease management" makes a come-back, the DMCB will be well positioned and be able to continue to share the health policy limelight with e-CareManagement

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