Another Door Opens to Collaboration Between Providers & Disease Management Organizations in the Medical Home?

The Disease Management Care Blog recommends readers check out the e-CareManagement Blog for an outstanding summary of an update on the upcoming Medicare Medical Home Demo. My colleague Vince Kuraitis provides a great summary of the additional details on how this demo is going to be set up.

The DMCB is still digesting all the information, but it is happy to congratulate CMS on its recognition of the importance of one key critical success factor for the Medical Home: clinical teaming. It appears CMS is also doubling down by recognizing the potential role of external disease management organizations. Quoting from the Medical Home Standards’ “Element C” of “PPC 3: Care Management” (and bolding below from the DMCB):

The practice uses a team approach in managing patient care. Shared responsibilities are designed to maximize use of each team member’s level of training and expertise. In small practices, this may be designated roles for the physician, the nurse and the administrative person if there is one. In most practices, the availability of nurse case managers will only be through the patients’ health plans or other large organization. In some practices physicians may handle significant patient care responsibilities, especially for complex patients. Disease management or care management may be provided internally by the practice or group or available to the patient externally, usually through the health plan.

The DMCB may be mistaken, but at 1st blush, it appears the Demo is agnostic to the location of the personnel necessary to enable “non-physician staff to collect information prior to appointments,” “execute standing orders for medical refills, test ordering and preventive services” and “educating patients/families about managing conditions.”

Does this mean the door is open to joint applications from physician groups AND disease management organizations to participate in the Medical Home Demo?

HIGH AND RISING COSTS: DEMYSTIFYING U.S. HEALTH CARE SPENDING

I have seen an advance copy of this very comprehensive report on the growth in health care spending. If you are in DC next week, I highly recommend this event to you:HIGH AND RISING COSTS: DEMYSTIFYING U.S. HEALTH CARE SPENDINGNew Report Synthesizes the Literature on the Growth of Health Care SpendingConcern about high and rising health care costs in the United States has increased sharply in

giving thanks

We are off to the family cottage in Northern Ontario for the Thanksgiving week end.

Want to imagine what it will be like?

Put together these people

and these people


Make them a whole lot grubbier, add three dogs (two of them long-haired sibling wild puppies).

Put them in a three bedroom cottage in the woods, on a lake.

It will be chaos but it will be fun.

I have chemo the day after I get back, so my next post won't be until next Wednesday, at the earliest.

Happy Thanksgiving!

It's Times Like This That Transform Industries

This is not a pretty picture. In the last three months, Healthways’ stock price has gone from just over $25 a share to about $9. The Disease Management Care Blog checked the various finance ‘HWAY’ message boards and blogs and couldn’t find any special insight into what’s going on. Everyone’s stock prices are down and maybe HWAY is just suffering along with the rest.

So what is going on? Of course, Healthways' customers - the health insurers - are stressed and their stock prices have tumbled also. Not only have the investments holding up their reserves and surpluses taken a hit, business-purchasers will be in no mood to put up with future premium increases – which will further stress the bottom line. Health insurers and self insured employers may be forced to offer low-premium/bare bones benefit products stripped of wellness or prevention. On the chronic condition side, expect the Medical Directors, Chief Actuaries and CFOs to have some tough discussions on whether their contracts with disease management companies actually improve the medical loss ratio. Finally, the DMCB has also raised questions about the business model and the need to adapt to changing expectations.

But the Disease Management Care Blog is still bullish on the industry and especially the concept. Disease management remains a policy favorite at many levels in Federal and State government and employers are unlikely to simply walk away from their health care activism. What’s more, there aren’t many other patient-friendly ideas out there that increase quality and temper costs. Expect 'disease management' to remain one of the go-to solutions in the short and long term.

With a P/E ratio of 8, the DMCB doesn’t think Healthways is going to vaporize. Instead, it is looking for something else is going to happen. There is a Healthways Earnings Conference Call on Thursday Oct 16 at 5 PM EST and the DMCB will try to be there (or at least read the transcript) and be on the alert for hints.

It’s times like this that force industries to transform. It not only makes grist for the blogging mill, it’s ultimately good for healthcare consumers.

image from the Motley Fool.

Time to Get Real--On the Economy and Health Care Reform

I just got a call from a reporter at one of the major news organizations to talk about the chances for health care reform.We both commented on the almost surreal environment we are all in. I'm not sure if my friends and neighbors are in denial or just numbed by the recent cascade of events in the financial world. Up on the Hill and in the presidential campaigns it's business as usual when it

lost

Reading Lene's post on dreams yesterday got me thinking about a post I wrote on that subject last March.

And then last night I had a panicky dream that I was lost in a hotel (hotels and houses seem to be key themes for me). First, I could not find my friends' room and then I could not return to my own. I could not remember my room number. Halls led to nowhere or to places that were completely illogical (like an ice rink). Calls on hotel phones went unanswered, were connected to people far away from the hotel, or produced directions that made no sense (or that I could not remember. These are key fears of mine as a chemo patient - forgetting things or not being able to understand them).

At one point, I was trying to open a door and it turned into a folding wall. For a few moments, I was trapped.

The last thing I remember, was finding the front desk. A woman was giving me directions when my younger son woke me up. Perhaps my dream was about to resolve itself.

I have not been able to fight the lingering feeling of anxiety this morning.

I did have an appointment with the doctor who works with my oncologist yesterday. It was a reassuring appointment, though, as she repeated again that my CT results showed no change from the previous five.

Perhaps I am feeling a little lost now that the book is finished.

The first two weeks after I was done, I felt relief and a sense of freedom.

And taking a break from MyBreastCancerNetwork.Com is definitely the right thing for me right now.

But I think I might be suffering from a case of "what's next?"

I am someone who once really defined herself by work and I have really struggled with the shift in identity that came with being a cancer patient (I feel great most of the time but I am in bed for the days after treatment. My oncologist does not want me to work and I am fortunate to have disability insurance).

One of my goals for myself for this year was to begin to think of myself as a "Writer." In order to do that, I need to keep writing.

I am excited at that prospect.

But I think I am a little scared, too.

The American Heart Association Supports Disease Management (again)

From 'The American Heart Association's 2008 Statement of Principles for Healthcare Reform' published in Circulation and available online:

'Any healthcare reform proposal should provide sufficient public health funding, medical education funding and clinical training resources for programs that improve chronic disease management, care coordination and patient-centered care. To address the growing needs of the population and to respond to the success of team-based approaches to care delivery, healthcare reform efforts also should support and promote the development of new models of care delivery, including those that emphasize the roles of allied health professionals.'

The Disease Management Care Blog seconds that motion.

Hat tip: HealthHombre