The Integration of Disease Management & the Patient Centered Medical Home
Posted Dec 02 2008 3:08am
The Disease Management Care Blog has made no secret of its prediction (or maybe it's a preference, but, hey, it's my blog) that the 'patient centered medical home' and 'disease management/population health' will become integrated.
While the PCMH is many things to many people, in the opinion of the DMCB, its best features are a) the new version primary care physician and b) a team of hands-on providers. By 'new version,' it means a PCP with a commitment to chronic illness and population-based clinical and economic outcomes. By 'team of hands-on providers,' it means nurses (usually) who can help particularly ill patients navigate an increasingly complex and unending episode of care.
While disease management is the Anti-Christ to many people, in the opinion of the DMCB, it brings a remarkably sophisticated high-volume low-cost outreach/communications/coaching ability that simply cannot be matched by most primary care networks in most geographies. This seems well suited to patients with a chronic condition who need to be engaged in self care, but who do not need much hands-on care.
In order for integration to occur, three things will need to happen:
1) the PCMH pilots will go through the same cycle as DM of inconsistent findings about savings versus usual care. Think MCCD, which was more about the Medical Home. This will diminish some of the hubris and prompt recognition that a wider population reach is necessary.
2) a formula about who is "in charge" will emerge. It will reconcile the PCMH's central clinical role and DM's insurance-risk mitigation role.
3) a successful pilot/demo/clinical trial that passes muster.
The DMCB doesn't think it needs to happen in that order either.
And what does the DMCB do at times like this when it's pondering this stuff?
Why, it breaks into song! Click on the YouTube window and test drive the lyrics below. With apologies to Canned Heat.
Together we'll stand Divided we'll fall we need more data the… cash flows will stall let’s work together Come on, come on let’s work together Now now people…. Because together we will stand Every doc, all the vendors and Plans!
D M, your fees - they suck and the.... costs still rise n’ your …results are luck a …roll of the dice You can do better You know, you know You should do better Ohhhh… So says CBO and RAND, Every blog, doc, buyer and Plan!
Ohhh, M H, you’ve got your share there’s too much doubt and no one cares, what about… the docs they want the money they think, they think it’s just the money Now now people…. and the pilots may tank you’ll be the topic of RAND!
Ahhh, come on now... (RIFF time, dance in front of your computer) Ahhh, come on, let's work together! (Woo hoo!)
Now…, don’t wait too long Until it’s too late…. Let’s mix together and just integrate It’s more efficient the trend, the trend the Fund’s deficient Now now people… Because we can’t afford The usual for the elders of the land!
Oh well now come on you doctors Do a group hug With all those vendors, they are beggin for love To work together C’mon c’mon please work together Now now doctors Because together we can share Every fee that’ll be for Medi--care Ahhh, yes!
(RIFF #2 time, time to dance in front of your computer again)
Because together we can care For all those elders yes, woman and man!