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Why the Disease Management Industry Thinks It Makes Sense for Patient Centered Medical Homes

Posted Aug 12 2010 11:04am
The Disease Management Care Blog listened in on the August 12 DMAA seminar that was given by Darren Schulte of Alere and Greg Sharp of Ideal Family Care in Colorado. It was titled "Towards a Collaborative Care Delivery Model: The Role of Population Health Management in the Patient Centered Medical Home."

This was well worth the DMCB's time because it provided important insights on how the population health improvement providers, formerly known as the privately held disease management organizations (DMOs), are positioning themselves in response to the Patient Centered Medical Home (PCMH). As Arte Johnson would say with his classic catchphrase, "very interesting....." If you missed the webinar, you could also say "very convenient....." of the DMCB to take notes and share them here.

First off, it's clear that the health insurance reform contained in the Affordable Care Act will fall short of assuring satisfactory access to health care, especially primary care. Following the passage of Massachusetts' health insurance reform, there were credible data that indicated that one in five patients had difficulty in obtaining primary care and that only about 40% of internists were accepting new patients. This may be a coming preview for the rest of the United States.

The PCMH is one solution. Yet, despite widespread support for it among physicians, many independent practices, especially the smaller ones, may find that implementing it will be a tall order. Enter the DMOs. They share in the commitment to "patient-centric care models" and believe that this can be the basis for "win-win" alliances between industry and the physicians' PCMHs. The DMOs believe they can provide synergistic and complementary partnerships with physicians struggling to create PCMHs and can help disseminate the early successes of the PCMH into these and other health care settings.

If that sounds like a stretch, check out this article that was published in Health Affairs. When the authors looked at successful PCMH pilots, they found four key features: 1) meaningful financial incentives, 2) access to data that allowed performance management, 3) expanded patient access and 4) dedicated non physician coordinators. The last one is bolded by the DMCB because it's a key point. The authors found that the coordinators could be embedded in the practices or located in community health teams. That latter option - providing nurses in the community - is what the DMOs are offering.

The DMOs are betting that a critical mass of physicians will like the idea. They're also confident that health insurers and employers will also like the evolution the DMOs away from working independently of patients to being better aligned with the physicians.

Which naturally brings up a new set of catchphrases. The DMOs are offering MEDICAL NEIGHBORHOODS, because IT TAKES A VILLAGE within a healthcare ECOSYSTEM that has a virtuous cycle of provider alignment, patient convenience and universal connectedness. In that context, community-based coaches can engage patients for those primary care practices that chose not to build a fully functional PCMH.

"Why not?" say the DMOs. They have have the experience, the tools and the resources. They offer a bundle of services that can be individually adapted to individual primary care sites. They can provide tailored levels of management assistance, decision support, patient coaching and monitoring.

Last but not least, DMOs are not being naive about the challenges involved in pulling this off. They know that there will be physician skepticism, imperfect insurer/hospital/provider integration, that payment reform may fall short, that sponsorship cannot be taken for granted, that there will be a tension between the unknown of "virtual" vs. onsite care management and that the DMOs have an uphill battle to face over past history and lingering perceptions.
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