Patient Centered Medical Care and Disease Management

The Disease Management Care Blog is ashamed to admit that 'Patient-Centered Medical Care' (PCMC) has been treated by it as something of an afterthought. What is this concept and what are the implications for disease management?

It turns out that the famous Crossing the Quality Chasm report has included ‘patient centeredness’ as one of the six pillars for the reform of healthcare. In order to achieve this, health care delivery should be customized based on the patient’s values, have open sharing of information, be evidence based and placed under the ultimate control of the patient. There is a good review on the topic here.

This has several important implications:

1) health care delivery will need to be far more flexible and accommodate a range of patient preferences, including doing nothing to being highly aggressive.

2) variation, that bane of the Dartmouth Atlas, the NCQA and quality improvement weenies everywhere could turn out to be a good thing if it is the result of truly empowered patients using their own values and preferences.

3) measurement of 'quality' will be a heluva lot more difficult, since the ‘denominator’ will need to be based on what a reasonable fully informed patient would have chosen for treatment of their back pain, management of their diabetes or use of the ICU with life threatening illness at the age of 90. That reasonableness includes getting an MRI anyway, opting for an A1c of 7.2 and having everything done even if the chance of survival is less than 1%.

4) insurers should embrace it because, in balance, when reasonable patients are fully informed about the risks, benefits and alternatives to various treatment options, proportionately more opt for less invasive (and therefore less expensive and possibly higher value) treatment.

5) once again, disease management should have a huge role to play because it has the resources and institutional intelligence to pull off fully informed patient empowerment. In fact, the DMCB believes disease management organizations should not only emphasize 'PCMC' as part of its suite of services and embrace it as part of its policy advocacy.

PCMC is not an afterthought. It's what disease management has been doing all along.