What "Disease Mangement" means for managing disease

Whether you consider "Disease Management" (capitalized) a movement or an industry, it wouldn't have emerged in any form, much less its present form had the health care system been systematically doing "disease management" (uncapitalized).

These programs started in the 80's as experiments run by HMOs and medical centers. Then, pharmaceutical companies picked up the idea and essentially turned it into medication compliance management. Though some of these programs are still running, the concept is way too limited and the approach is rife with conflicts-of interest. The movement then morphed into the efforts of an entrepreneurial industry. Remember when primary care physicians were going to save us by acting as "gatekeepers," coordinating care? Well now there's an industry to do it, but it's still not integrated with the systems actually caring for folks.

Today, the program elements should probably include in one form or another at least the following:

Client and opportunity identification. This should not only include those who are currently patients, but those who aren't but should be. (Remember Sherlock Holmes and the dog that didn't bark?) And the Pareto Principle applies big time -- small percentages of patients accounting for big percentages of expense. Find them and determine what the manageable risks are.

Reach, engage and maintain contact with patients. The system's working assumption is that the patient takes the initiative and the system responds. That's not enough.

Navigating the healthcare system. Too often, an individual moving through (or not moving through) the health care system appears to be on a random walk. A physicist would call it Brownian Motion, as we patients get bounced from one place to the next.

Physician & other provider support. Get them the information, tools and organizational supports to make it work.

Timely healthcare responses. We all know of patients with conditions that can run out of control in a day or two and closer, ongoing monitoring of the condition can trigger an intervention to prevent the loss of control.

Treatment compliance. Duh. I'll post later on a physician who doesn't believe there's any such thing as a non-compliant patient. There are only non-compliant physicians.

Personal health management. Right, no chips and beer while watching the football game this weekend. But a perhaps more realistic physician said to me: Recognize reality, if you know the patient is going to have chips and beer despite your advice and his good intentions, then adjust his meds accordingly. Now that is tailoring care to the patient.

Ongoing program evaluation and improvement.

Maybe we'll eventually get it right and design and manage systems in an integrated fashion. But in the meantime doing "Disease Management" is better than doing a lousy job of "managing disease."

Comments

[Al Kapstrom, MD]

Pleased to find your site. Greeting from Southern California where we are experiencing the juggernaut of never-ending, impoverished illegals for whom the various governmental agencies insist on top quality care, the exponentially expanding regulators, the glut of personal injury litigators and the upward slime of the vendor's costs.

[TomH]

I'm heartened to hear that California regulators are on the job - especially now that I know that some doctors wouldn't provide "top quality care" to some of their patients in the absence of regulatory oversight.