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Disease Management’s Ace in the Hole

by jsidorov

The World Health Care Blog welcomes Jaan Sidorov as a new contributor. Dr. Sidorov writes the Disease Management Care Blog, where this piece 1st appeared.

Is there potential for future combined versions of both ‘disease management’ and the ‘patient centered medical home?’ DM brings remote multi-channel coaching, scalability and an understanding of performance guarantees in an inflationary insurance market. The PCMH leverages the physician-patient relationship, ‘high touch’ engagement and is one of the ingredients in the resuscitation of primary care. It can be argued each makes up for the weaknesses of the other. Accordingly, combining both makes a lot of sense.

Yet, the PCMH is in ascendancy: numerous pilots underway, the support of academia and policy makers is deafening and a big Big BIG Medicare demo is in the chute. Feeling confident, PCMH advocates appear to be in little mood for modification of their care model. Who can blame them?

Just wait. The PCMH’s life cycle is about 5 years behind disease management and rapidly reaching the red dotted Peak of Inflated Expectations. After the pilots demonstrate blunted quality improvements and just how difficult it is to reduce claims expense, disillusionment will give way to dialog that is focused on building better and combined approaches to population care.

We’re only weeks away from the college football season and its lesson that there is nothing like early season losses to bring players and fans back to the reality of planet earth. Our colleagues on the PCMH ’side of the aisle’ believe well intentioned doctors and nurses, because they ARE doctors and nurses, can ‘educate’ patients into doing the right things. The disease management organizations and their nurses moved beyond this years ago. Once gravity intrudes, all stakeholders interested in population-based care able to focus on new approaches to chronic illness that focus on even more effective versions of patient coaching that interlock across the care delivery spectrum.

If you haven’t read this fascinating article by Linden and Roberts, you should. This is DM’s greatest strength, the ace in the hole that cannot be easily imported into primary care medical homes. Think about taking these approaches and industrially mixing them with the kind of consumerism described in books like Buying In and its abundantly clear that we’ve only begun to scratch at the surface of patient behavior change.


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