Do Patients Need Disease Management?
By George Martin, MD – Senior Medical Director for Health Integrated

Disease Management (DM) programs, as currently structured, are focused on prevention of acute exacerbations of chronic conditions. NCQA has a list of the things that should be done for patients with specific diseases. Within this measurement structure it has been demonstrated that if these measurable outcomes are met, the population being treated will have better health and cost less. So far so good, but my question is “Have we improved the health of the patient?” Further, have we empowered the patient to remain well (by removing any barriers and by education, access to health resources, etc.) or are they dependent on a DM program to maintain their health?”

Good DM programs can and do provide education and some level of empowerment to patients to live healthier lives. NCQA has chosen not to incorporate these efforts into their standards. NCQA is all about measurable standards and empowerment is difficult to measure. But, empowerment is what sustains the patient when they are again on their own. In  our current climate, employers routinely change health plans. Plan “A” may have a DM program that addresses congestive heart failure but plan “B”, the new plan, may have found that addressing asthma was their choice. If plan “A” has not empowered the patient but rather caused the patient to be DM dependent then the patient will not sustain improvement when the program disappears. It’s a vicious cycle that repeats itself every year at benefit renewal.

For those of you who have read much of the previous writing of this blog you will know that we are deeply committed to helping make those who can be independent, independent. There are those, of course, whose illnesses are so advanced that they are no longer capable of independence. Those patients are apt to have multiple chronic conditions and require Case Management (CM) or be enrolled in+ Special Needs Programs (SNP). The standard DM program is focused on the medical needs of a specific disease and its associated processes.

The complicating factor is that we forget that medical needs are not independent of behavioral needs. When I was in medical school, the Department of Psychology at our local VA teaching hospital decided to do psychological testing on the patients in the coronary care unit. Remember, at that time the care was only supportive. No clot busting. No CABG. No PCI. Tests were administered and a conference was held. The results demonstrated that the patients were depressed. Consider the full scenario for a moment: you have just gone through some of the worst pain in your life and now are in an ICU where you have limited access to family. The lights are constantly on and there is constant noise and frequent alarms. You do not know if you will live or die or if you will ever be able to function normally again. Surprise, you are depressed.

Now consider the flip side. You have depression and diabetes. Because of your depression you have little energy to address your medical condition. Your HgB-A1c goes to 14.1 and you develop chest pain, which you ignore. Your health continues to spiral down and soon you end up being in a DM program for your diabetes. Do they have the resources to understand your behavioral health needs or do they just push you to get to the doctor to get your dilated retinal exam (DRE) because it is a measurable outcome. Do not suppose for one minute that we think the DRE is not needed but this business is a balance of patient and population needs.

Let’s not lose sight of the patient needs.

Your thoughts? You can reach me directly at healthexecforum@healthintegrated.com, or comment directly in the blog.

As always, thanks for reading and for your input.

George Martin, MD

This entry was posted on Sunday, February 12th, 2012 at 11:57 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.