Disease Management pre-dates by several years the sophisticated information technology now being embraced by the healthcare industry. Yet the marriage between advanced clinical and technological ideas appears to have been perfectly pre-arranged.
Disease management is basically the process of treating chronic diseases across the various sites of care – hospital, physician office, outpatient center, rehab facility and ambulatory setting. It typically involves a specific care plan mapped out through a collaborative agreement between the payer, physician and patient. The most common chronic conditions are diabetes, asthma, hypertension, congestive heart failure and chronic obstructive pulmonary disease.
Under optimal conditions, the patient maintains a high quality of life and the healthcare system keeps a firm lid on costs.
“I want to clearly underscore the importance of IT to my organization and to the delivery of disease management programs and interventions,” said Tracey Moorhead, president and CEO of the Disease Management Association of America. “At a recent conference, [former IT czar] David Brailer, MD, said disease management was leading the healthcare IT revolution. It is the center of the feedback loop for the healthcare team, including the lab, pharmacy and other physicians. It ensures that the physician-driven plan of care is implemented and understood by patients and family members.”
Howard Underwood, MD, who studies disease management trends for the Deloitte Center for Health Solutions, says “disease management data is the blood and IT is the vessel.”
“Disease management is the systemization of healthcare,” said Underwood, who is also an actuary and informatics expert. “The way IT is being used focuses along the continuum of identification and stratification of opportunities, getting patients engaged in the intervention and evaluating it. It’s a continuous loop that evaluates what works and what doesn’t.”
Boosting compliance
IQHealth Services, a unit of the Kansas City-based Cerner Corp., has developed a “consumer-facing” system that focuses on chronic conditions. It is designed for physicians and patients to develop care plans that feed into the patient’s personal health record.
Cerner’s “condition centers” were developed as a care roadmap for chronic patients, with the first one addressing Type 1 or juvenile diabetes. A blue-ribbon panel of endocrinologists established the key indicators, it received support from the Juvenile Diabetes Research Foundation, and Cerner committed $25 million to the project over 10 years.
“That got us going,” said John Larsen, senior practice manager for IQHealth Services. “We now have 8,000 patients and 500 providers who subscribe to the service.”
Under the format, patients log their results into the system, which aggregates and graphs the data. One of the biggest benefits of the program, Larsen said, is a dramatic boost in compliance. Incentives like i-Pod giveaways at Children’s Mercy Hospital in Kansas City have generated a lot of interest, he said.
“We learned that only about 20 percent of the kids were [testing their blood sugar levels] on a regular basis, so we’re battling not just to automate them, but to get them to do it in the first place,” he said. “About 90 percent of these kids can control their condition. They are learning that if they follow the disease management plan, they can drastically reduce complications later in life.”
Education emphasis
Numerous studies have shown diabetes reaching epidemic levels in the United States, fueled by a soaring obesity rate. Nowhere is this more evident than in West Virginia, where 60 percent of the population has been identified as having either Type 1 or Type 2 diabetes.
The Charleston Area Medical Center is devoting considerable resources to a multimedia campaign designed to spread the word. The presentations, known as Mediasite, are provided by Madison, Wis.-based SonicFoundry. Delivered over the Web, the program is geared toward educating healthcare professionals about the latest treatment and care options.
Although disease management’s roots are in cost containment, its profile has risen sharply among acute care facilities because of its value as a prevention tool, said Doug Young, media network specialist for the CAMC Health Education and Research Institute.
“It began as a monetary force, but evolved into a quality of life issue,” he said. “The real nuts and bolts of our diabetes program is the preventative medicine component to it.”
Massaging data
Recording and tracking tools are vital components of IT’s role in disease management because “capturing and tracking information empowers us to make changes,” said Ben Dillon, a self-ascribed “corporate evangelist” for Cedar Rapids, Iowa-based Geonetric. IT systems have the ability to manipulate data in different ways – analyzing and graphing to identify trends and explain to patients what is really happening, he said.
“The focus is on patient empowerment and self-management,” Dillon said. “A big piece of that is simply education. Research shows that patients often cannot properly recall what they have been diagnosed with even only a short time after an appointment, so you can imagine what the level of missed knowledge transfer is when they are presented with a complex condition.”
Dillon says technology has the capacity to change the basic pattern of care for all chronic conditions.
“Some of the payer-driven disease management programs get closer to this with a care manager involved, but having the patient’s care team involved is better,” he said. “In addition, when these tools come from providers, the online components can be connected into other resources and services offered in the offline world, to the benefit of the patient and the provider.”
New directions
Coral Springs, Fla.-based predictive modeling company CareGuide has a different philosophy for health management. CareGuide recently absorbed Indianapolis-based Haelan’s One Care Street predictive modeling system, which company officials say has produced results that defy the national trend of near-double-digit cost increases.
Unlike disease management programs, which try to identify the sickest members of a population based on past care use, the One Care Street system uses current and prospective data to identify which patients are most likely to incur the greatest costs in the near-term, from six to 12 months, said Julie Meek, Haelan’s founder and chief science officer.
“We were looking for a like-minded company and found such synergy with CareGuide,” Meek said of the merger. “They were honest and straightforward enough to look at their experience with claims-based targeting and the inherent limitations, and knew that greater predictive power could transform their care management business from a ‘me-too’ to an industry pacesetter.”
The boomer ‘tsunami’
Managing chronic disease will only get more complicated in the future as the legions of baby boomers become elderly and vulnerable to sickness. That will require healthcare providers to advance disease management automation to an even higher level, said Warren Todd, executive director of the International Disease Management Alliance.
“Though boomers tend to be healthier, we are still facing a tsunami of chronic diseases,” he said. “Technology has to be the solution because there won’t be enough healthcare workers to care for them. We need to be looking at ways to keep people healthier longer and to devise labor-saving tools that require fewer people while still maintaining a high level of care.”
