Disease Management for the Employer

PHYSMARK and ABQ.MED, PC

October 11, 2005

1. What are we trying to accomplish?

We are trying to lower the cost of delivery of healthcare. Over 70% of healthcare costs are related to chronically ill patients. So although we should focus on these patients – to reduce the cost of managing the diseases of chronic patients, it is also important to maintain the health of those without chronic illness, thus the healthcare segment known as Disease Management (DM).

2. Why is this segment of healthcare necessary?

As medical care becomes more fragmented patient information does the same. Few providers are trained in exercise or nutrition. In addition, keeping up with all of the new advances in medicine, including pharmaceuticals makes it difficult for providers to add new information regarding nutrition and exercise to an already busy schedule.

There is significant variation in information provided by various types of health care providers, causing confusion for the patient. Behavioral health is largely nonexistent in patient education regarding their physical health. It is easy to understand why some patients through up their hands in frustration and do little to improve on their health. Whose advice should they follow?

3. How is DM different from utilization, care and case management?

DM uses an approach called “population based medicine”, which addresses the care of whole populations rather than that of individual patients. It is a community-based strategy for disease prevention and health promotion based on “evidence based medicine” i.e., it integrates individual clinical expertise with the best available clinical evidence from research.

4. What are the DM programs currently in use to treat chronically ill patients?

Most healthplans claim utilize some form of Disease Management, but because they concentrate on high-risk and very sick patients, what they have in place is more closely related to “case” management of individual patients. Not that there is anything wrong with such an approach. By monitoring them carefully and treating them in a home or outpatient setting and keeping them away from ER and hospitals, these programs save money. But chronic diseases by their very nature are “long term” problems, with complications arising decades later. Waiting to treat when complications arise is not the most prudent approach in controlling costs. Recent studies By Dr. Dee Edington at the University of Michigan suggests that assisting early stage chronic patients, both low and medium risk patients, maintain their health results in returns much greater than in just focusing on, as we seem to do currently, the seriously sick ones. There are DM companies that offer to do just that, and interact with chronic patients, one on one or via phone, using “coaches”. This is again a form of care management focused on an individual patient, and because it is clinical personnel intensive, tends to be very expensive. Their marketing mantra of these DM companies is that “every dollar invested saves four” but true evidence of savings is lacking as they will appear several decades later, when a low or medium risk chronic patient continues to be at the same level of risk and does not become a high risk patient requiring hospitalization.

5. How is our method different?

First, our approach is truly population based in that we deal with a community of chronic care patients at a time. Costs are reduced because it eliminates the one-on-one approach practiced by DM companies. “Teach them and they will make better decisions”. We provide education to large groups and help individual patients to take responsibility for their health improvement by doing things such as recording their vital signs and lab test results. Behavioral modification techniques and tools are built in to our system, in order to provide patients a greater opportunity of success. Automated reminders help patients comply with best practices of evidence based medicine and also identify when clinical interventions may be appropriate.