Know the DM essentials
Experts say you need these four components
If your organization is already committed to developing disease management (DM) programs, there are some essential components necessary to successfully implement those programs. If your internal infrastructure lacks any of these components, your disease management programs may be destined for failure. They are:
1. Leadership. "You must have buy-in and support from the top down. Organizations who are truly doing disease management are creating a change in philosophy from fee-for-service, episodic care to comprehensive preventive care," says Laurel Fuqua, RN, MSN, administrator of the Gastrointestinal Liver and Nutrition Care Center and director of disease management at Vanderbilt University Medical Center in Nashville, TN.
"If you can get your top people to buy into a disease management philosophy, then you can develop programs that are successful in the long term, not just stop gap measures. Disease management that meets the needs of patients also meets the needs of organizations," says Peggy Pardoe, RN, CCM, CPHQ, product development analyst for University Care with the University of Maryland Medical Center in Baltimore. "But you can’t save money without spending money. Disease management programs are costly. You must have support at the top."
You must also have your providers on board, cautions Sanjaya Kumar, MD, MSc, MPH, clinical project specialist with the Baton Rouge-based Louisiana Health Care Review, a peer review organization contracted by the Health Care Financing Administration in Baltimore to improve quality of care for Medicare recipients in Louisiana. "Every time you develop a new disease management program, you must allow your providers a period of comment. Let your providers have input. They may add something you’ve overlooked. And, they are more likely to comply with your protocols."
2. Disease management mindset. "You must ask some key questions to help you understand where your organization stands right now, today, in terms of disease management," says Fuqua.
Questions you should consider include:
• What percentage of our daily efforts focus now on disease prevention?
• What percentage of our services are available in outpatient and other alternative settings?
• To what extent have we carefully evaluated our current efforts at prevention and costs?
"If the answer to any or all of those questions is 0%, then you have a lot of groundwork to do before your disease management programs succeed," notes Fuqua.
3. Integrated case management. "Case management is the tool that assures that your standards of care for disease management are translated during the delivery of care," explains John C. McDonald, RN, MS, CPHQ, administrator for general medicine and adult primary care at Vanderbilt University Medical Center. "If your disease management protocol calls for certain lab tests to be performed at regular intervals, case management is the tool you use, whether you are a primary care physician, physician extender or nurse, to make sure those tests are performed on schedule."
Most organizations have some type of case management, notes Kumar. "Find out what is currently being done for patients in your organization. You may find that many of the functions you want to include in your disease management programs, in terms of care received and follow-up after inpatient discharge, may already be taking place," he says. "You may be able to coordinate your disease management efforts with those of the case management staff and work with them to coordinate your programs."
You may need to change some of the operations of the case management department to better support your disease management programs, adds Kumar. "That’s when you realize again the importance of that top down buy-in for your disease management efforts."
4. Outcomes management capability. "You have to be able to gather data that shows you’ve had an impact on patient health," says McDonald. "That requires determining certain indicator points and tracking them. For example, we know that diabetics are less likely to develop chronic complications if their Hemoglobin A1C is kept as close as possible to 7%."
"You have to figure out which outcomes will help prove the effectiveness of your efforts and then determine what systems you need to measure them," Pardoe explains. "You don’t have to start out with a sophisticated information system. You can start small and expand as your program expands."
How do you use your data?
One way to determine your data analysis capabilities is to write a request for proposal (RFP) to your own organization, says Kumar. "Too many times, the right hand doesn’t know what the left hand is doing in large organizations," he notes. "Have your disease management team perform a needs assessment, then send out a RFP to see what is already available in your own organization. In addition to data analysis, you’re going to need analytical support. You need to understand and interpret the data once it’s gathered. Check to see if your organization has an academic affiliation you can tap into. Publicize your needs. There are hidden people within your organization. Don’t reinvent the wheel."
And, if you are going to the time and expense of gathering data, make sure it’s data you can really use, adds Kumar. "Don’t collect it if you’re not going to use it. Go back to your clinical goals and program parameters. Does the data you plan to gather support them?"
"Many of the functions you’ll want to perform can be done with readily available business software, like Microsoft Excel. Don’t let the need for information systems hold back your disease management efforts," says Kumar.
It’s also important to determine a consistent approach to collecting outcome data for each disease management initiative you develop, says Pardoe. "This will save time and establish a uniform way of looking at outcomes, while comparing the effectiveness of your various disease management programs."
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