Last Thursday I along with 20 other physicians met with Governor Bredeson for over an hour and a half. He was selling his TennCare reforms. Most of us listened. Some of us praised him. Some griped and others gave him new ideas, which he jotted down.
Most obviously, Tenncare will undergo major structural changes by limiting pharmaceutical choices and doctor visits. However what struck me most about the governor’s strategy was a new initiative called “disease management program.”
What is a disease management program and why would the governor and not doctors or managed care organizations be talking about this?
Everyone agrees that our basic system of health delivery in the United States is flawed. Care is segmented and episodic – from one doctor visit to another – from one hospitalization to another, almost as if patients do not change in their health conditions between visits.
It is also flawed because it is the doctor who is responsible for the entire care of the patient, not a team of professionals including nurses, dieticians, and therapists. Lastly, it is flawed by the fact that health providers do not assist patients in taking more responsibility for their own care. Medical care under the disease management program changes the present system to be more continuous, more team oriented and more patient centered.
But wouldn’t such a care system cost a lot more money? No! A disease management program improves care and decreases cost. For example in a disease management program in Ashville, North Carolina, a diabetes care coordinator assisted patients in understanding their medication, adhering to their diet, arranging appointments to all the providers and making the patient responsible for their sugars. All these simple measures resulted in a remarkable difference. The net savings was 100,000 dollars for 100 diabetics in a program over one year, and the quality of care was significantly improved. The Governor knows this, and that is why he is encouraging disease management initiatives for chronic diseases such as diabetes and congestive heart failure.
Ultimately, the disease management program is a care coordinator helping the patient efficiently navigate the maze of our medical system.
I really didn’t understand what a disease management program was until I had to shuttle my father between 3 doctors, 2 labs and one hospital. Reports from one lab would not be available to the doctors, notes from one doctor would not be current, and there was no one to educate him about his new medicines and the importance of adhering to them. I became his care coordinator – helped arrange appointments, lab tests, pulled them together on a 3 page document and sent it with him at each of his doctor visits.
The results were remarkable. He did not have repeat cholesterol levels drawn. His doctors were pleased to have ready and up to date information as well as opinions from other doctors and my dad took responsibility for his care with his care coordinator’s navigational help.
A better system is needed and the Governor is on the right track with disease management programs – the net result will be quality care, decreased cost, and better patient satisfaction.