|
Send this issue to a friend
|
|
|
Vol. 3. No. 6
|
November/December 2001 |
|
|
|
Disease Management's Little Known Secret
by Paul R. Reich, M.D.
A health plan was shocked to learn that the cost saving from its currently out-sourced congestive heart failure (CHF) disease management program was reduced from 74% to a mere 14%. As a result, the Medical Director was instructed to bring the program in-house.
How hard could it be to take a cardiovascular nurse and bunch of educational brochures and newsletters, and duplicate the functions of the out-sourced disease management program for 500 members? This Medical Director soon found that the problem was not developing the program's content, but rather keeping track of the members in the program. Not only tracking their clinical data and their progress, but also sending them enrollment letters, telephone reminders and packages of information became a nightmare to contemplate.
All of a sudden it was clear that the major attraction of an out-sourced program was the member tracking application used by the vendor. How does a plan considering in-sourcing its disease management program obtain or develop a member tracking system?
First to consider are outside vendors who have developed robust tracking systems that are for rent, so-called application service providers or ASPs for short. These companies use the Web and are accessed by plans, or even members, through Web browsers. These services can be expensive, but they provide a means for plan disease managers to store member demographics and track progress through the program. Some enable devices in the member's home to collect and report body weights and blood pressure, and quiz patients concerning their clinical status. They
require plans to extract from their claims databases member and provider information and load it into the servers that maintain the Web tracking system. They can be limiting to plans that wish to send their own brochures and newsletters, or integrate with an automated telephone reminder system.
A second solution is to build one's own tracking system using newly available database applications. In the past it has been very expensive to build these tracking systems with multiple functions and capacity to track large numbers of individuals. The cost of highly trained programmers and licensing fees for programs such as |
|
Oracle have severely limited plan development of these systems. Less expensive database applications such as Microsoft's Excel, Foxpro or Access have either limited capabilities or inability to share data among large groups of case or disease managers.
Underneath most IT manager's radar screen is a program called Filemaker 5.5 which is easily programmed by health care professionals willing to invest time in learning how to configure its screens. At a low cost it can be loaded on a PC with Microsoft's Windows 2000 Professional operating system and shared by up to 250 users. The functionality that can be created in such a disease management tracking system is very impressive: It stores demographics, benefits and the member's personal physician network with contact information. Nurses use stored assessments that, for example, stratify members into different levels of acuity, measure quality of life, or calculate salt intake. They track the members' standard of care activities. For example, in diabetes, the dates of eye and foot exams and Hb A1c determinations. Laboratory results, obtained either from contracted laboratories or from self-reporting, are not only stored, but can be charted. Drug data from the plan's pharmacy benefit manager is easily retrieved along with any other clinical data needed by the disease manager.
The software allows for a "tickling" function whereby all disease managers are linked and may "tickle" for their enrollees telephone reminders, fulfillment center requests for educational materials, dietary consultation from a registered dietician, referral to case management, or follow-up nurse phone calls. Each morning their "To Do" list is printed and serves to guide their daily activities. A fully functional report writing module is easily created that allows the staff to produce management reports at the click of a button. These reports can be used to balance nurse caseloads, track any billable costs or support the disease management program's need to report outcomes.
Health plans that wish to develop their own disease management program should consider gathering a nurse with experience in managing patients with the disease to be managed, an IT person familiar with simple networking functions and a Filemaker 5.5 programmer. Working together, this team should be able to produce a disease management program at minimal cost that can "touch" thousands of members and coordinate the activities of the up to 100 disease managers. Filemaker 5.5 programmers are available in every metropolitan area at www.filemaker.com.
Scheur Management Group has a fully functional and tested system and the expertise to implement it in your plan. Now, there's the secret, so no excuses for not participating in the disease management revolution.
About the author: Paul R. Reich, M.D. is SMG's Disease Management Development consultant who has created customized computerized disease management programs in CHF and Diabetes for The OATH's health plans. He believes that each health plan, each geographical area, has its own nuances which need to be addressed specifically to their needs. Dr. Reich's career spans 23 years as a practicing physician and eight years as a physician executive for Harvard Pilgrim Health Care, one of the leaders in health care innovation and care quality in the United States. |
Back to The Insider Index
|
|
|
