New alliance provides multiple DM programs
Manage the whole patient, not just the condition
The best way to get good outcomes from a disease management program is to manage the patient and not the single disease, says David Plocher, MD, vice president for health solutions of Cap Gemini Ernst & Young (CGE&Y).
Plocher is working with a new division of CGE&Y’s existing health practice to address the need for improved medical outcomes in the health insurance and managed care industry.
Through a strategic relationship with American Healthways, CGE&Y is offering a comprehensive disease management program for more than 20 different chronic conditions. The practice is concentrating on organizations that bear full financial risk for patients, Plocher says.
In addition to commonly managed diseases such as diabetes and congestive heart failure, the organization offers disease management for 15 to 20 other conditions such as arthritis, low back pain, and acid peptic disease. "Our program is based on discovering the most prevalent chronic conditions and finding out the cost of care," he says.
There’s no one solution to managing chronic conditions for all patients, Plocher asserts. "To manage patients who are chronically ill, providers and case managers need to understand the individual patient, how well they understand their disease, and how they learn. The solution requires dealing with the whole person and not just the disease," he adds.
For instance, many patients fail to take their prescription medicine as it is prescribed because they don’t understand what they are supposed to do despite the provider’s and case manager’s efforts to teach them, he says.
"Our attention needs to be devoted toward how people learn, how people change their behavior, and how to improve their adherence to their medical regimes. We have to teach them, then retest how much they learned and customize the plan for each individual patient depending on who they are and how they learn," he says.
For instance, some people learn better by reading. For some, face-to-face dialogue works best. Others prefer to learn through videotapes.
"It doesn’t work to have just one method of teaching people. We have to customize our learning methods and take it one patient at a time," he says.
The CGE&Y-American Healthways Alliance has a unique predictive model that can be used on an entire patient population to identify members who are about to become costly.
"We don’t wait for someone to get diabetes of heart failure. We identify people at risk early on when we can make a difference," he says.
The program stratifies patients into risk categories and sets priorities for outreach according to the risk.
For instance, patients who are really sick may be telephoned every day for several weeks until their condition stabilizes. Those who are at high risk may be visited in their homes by a nurse case manager. Patients who are catastrophically ill are managed by traditional case managers.
All people selected for disease management receive educational materials.
"Our educational process includes alerting patients to watch for various symptoms and signs that should prompt them to call the nurse instead of waiting for the nurse to call them," he says.
The program is staffed by American Healthways nurses in the field. As part of their care management strategy, the nurses select the physicians with the highest-cost patient visits and visit them to explain the program.
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