Tag: Disease Management

More on the Death of Disease Management

Jaan Sidorov

Posted 1/30/12 on The Disease Management Blog

At the email prodding of several colleagues, the Disease Management Care Blog next turns its attention to a blog posting by Archell Georgiou MD provocatively titled “The Death Of Disease Management (Finally!).  The Archelle on Health Blog contrasts the industry’s early promises of evidence-based medicine plus patient self-care with the bitter fruits of non-existent savings, the disappointing Medicare Health Support (MHS) demo and a just-published anti-disease management New England Journal article.

Using that last Journal article as the final word, Dr. Georgiou provides her readers with a graveside eulogy of what went wrong:

Continue reading “More on the Death of Disease Management” →

Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment

Douglas Elmendorf

Posted 1/18/12 on the Congressional Budget Office Director’s Blog

In the past two decades, Medicare’s administrators have conducted demonstrations to test two broad approaches to enhancing the quality of health care and improving the efficiency of health care delivery in Medicare’s fee-for-service program.

Disease management and care coordination demonstrations have sought to improve the quality of care of beneficiaries with chronic illnesses and those whose health care is expected to be particularly costly. Value-based payment demonstrations have given health care providers financial incentives to improve the quality and efficiency of care rather than payments based strictly on the volume and intensity of services delivered.

Continue reading “Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment” →

Important Research From Medicare Demonstration Projects: Almost Nothing Works

Robert Laszewski

Posted 1/23/12 on Health Policy and Marketplace Review

I will suggest that most of us believe the way to control health care costs, and at the same time maintain or improve quality, is to both use the managed care tools we have developed over the years, and perhaps more importantly, change the payment incentives so that both cost control and quality are upper most in the minds of providers and payers.

The Congressional Budget Office (CBO) has just released an important review of Medicare’s results in testing those ideas. The news is not good.

From the CBO’s blog post:

In the past two decades, Medicare’s administrators have conducted demonstrations to test two broad approaches to enhancing the quality of health care and improving the efficiency of health care delivery in Medicare’s fee-for-service program. Disease management and care coordination demonstrations have sought to improve the quality of care of beneficiaries with chronic illnesses and those whose health care is expected to be particularly costly. Value-based payment demonstrations have given health care providers financial incentives to improve the quality and efficiency of care rather than payments based strictly on the volume and intensity of services delivered.

In an issue brief released today, CBO reviewed the outcomes of 10 major demonstrations—6 in the first category and 4 in the second—that have been evaluated by independent researchers. CBO finds that most programs tested in those demonstrations have not reduced federal spending on Medicare.

Continue reading “Important Research From Medicare Demonstration Projects: Almost Nothing Works” →

The National Nurse Act of 2011

Brian Klepper

On December 15, Rep. Eddie Bernice Johnson (TX-30) introduced HR 3679, The National Nurse Act of 2011.

The legislation, co-led by Rep. Peter King (NY-3), would elevate the existing Chief Nurse Officer of the US Public Health Service to the National Nurse for Public Health, a new full time leadership position that can focus nationally on health promotion and disease prevention priorities.

Teri Mills, MS, RN, CNE

Teri Mills, a Certified Nurse Educator at Portland Community College in Oregon and President of the National Nursing Network Organization (NNNO), introduced the idea of a National Nurse in a 2005 NY Times op/ed. Here is an excerpt from that article.

…Nurses are considered the most honest and ethical professionals, according to a recent Gallup poll. It’s the nurse whom the patient trusts to explain the treatment ordered by a doctor. It is the nurse who teaches new parents how to care for their newborn. It is the nurse who explains to the family how to comfort a dying loved one.

Continue reading “The National Nurse Act of 2011” →

A Population-Based Care Management Lesson: What Telephonic Disease Management Lacks In Individual Effectiveness Is Made Up By Its Greater Reach

Jaan Sidorov

Posted 11/17/11 on the Disease Management Care Blog

In yesterday’s post on the role of telephonic disease management for obesity, the Disease Management Care Blog pointed out that POWER was a landmark study that demonstrated that remote lifestyle counseling performed as well as traditional face-to-face counseling.

A New England Journal of Medicine editorial accompanying thePOWER article points out that there may have been an additional factor that explained the results: patient attendance at the in-person counseling sessions dropped off precipitously as the trial progressed (an average of only 2 out of 24 scheduled visits after the seventh month), while the telephonic approach achieved 16 out of 18 scheduled contacts.

The DMCB agrees and suggests this is an additional virtue of remote telephonic disease management.  While in-person counseling may have more of an individual impact, it does little good if  patients no-show.  In contrast, “high volume” telephonic counseling may have more of a population-based effect, because a lower intensity intervention has greater absolute impact if it’s delivered to morepersons.

NIH scientist Susan Yanovski’s editorial falls short on capitalizing on that insight.  While it grudgingly points out that POWER shows “PCPs can deliver safe and effective weight-loss interventions in primary care settings,” it neglects to mention the two important implications of POWER:

1) non-physician team members acting in collaboration with PCPs are an important resource in the national battle against obesity and

2) offering a variety of communication channels increases reach and gives more patients new and effective options to access anti-obesity programs.