Collaboration improves scope of disease management

March 1, 2006

Health plans reinforce to the patient what the physician has already told them.

The most important interaction in the healthcare continuum is the physician-patient relationship. Everything else is designed to support this relationship.

This is especially true when it comes to patients with chronic illnesses. For those patients, the personal relationship they have with their primary care providers (PCPs) can be the difference in whether they follow their prescribed routine.

Another important relationship in the healthcare continuum is between health plans and their providers. It's a relationship that sometimes has been strained in the area of disease management. For that reason, disease management programs have often worked in silos, where there is little communication among health plans, providers and members.

Many health plans, however, have begun to take a different approach to disease management programs. If these programs are successful when there is little communication with providers, they reason, then there would be even greater success if health plans, providers and members worked together.

That change in attitude has put a new emphasis on the role of the provider in disease management programs. Health plans are creating programs that encourage collaboration and cooperation between themselves and providers, themselves and members, and providers and members.

Health plans are not trying to supplant physicians in disease management. Rather, they want to collaborate with physicians to improve clinical outcomes. Physicians who have limited time and resources when dealing with their patients are welcoming the help and actively participating in dialogues with health plans to improve disease management.

"We can achieve a meaningful collaboration with physicians," says Susan Beane, MD, chief medical officer for Bronx, N.Y.-based Affinity Health Plan. "They are asking us to co-manage many of their patients with complex and chronic conditions. This is a major evolution."

PROGRAMS MORE MEANINGFUL

Affinity has created management programs for pregnant women and their newborns, for those trying to quit smoking, as well as for members who are asthmatic, diabetic, HIV-positive, or suffering from congestive heart failure. In each instance, physician involvement is critical, Dr. Beane says.

"Disease management programs are becoming more meaningful and providers can view them as a positive part of what they can offer their patients," she says.

This year, Affinity will convene a series of work groups to discuss how it might improve outcomes by co-managing patients. That fits into Affinity's philosophy of being the hub where providers and members can work together to improve clinical outcomes, Dr. Beane says.

"We help members looking for good care find a provider willing to deliver that care," she says. "We can help make that happen in a more effective, efficient and patient-centric manner."

Ongoing dialogue with providers is also an important part of the disease management programs of Nashville, Tenn.-based Healthways Inc. (formerly American Healthways).

"We know that physicians are pressed for time. It is difficult to provide the repetitive communication and education needed [with patients] to make sure that treatment plans are understood to the depth necessary," says James Pope, MD, executive vice president and chief medical officer for Healthways. "The disease management organization, as its primary mission, can try to support and extend the physician's reach."

Dr. Pope says a "healthcare team approach" to disease management includes the health plan, providers and members.

TREATMENT PLAN

In a collaborative setting, health plans reinforce to the patient what the physician has already told them. When all sides are communicating, patients can tell their physicians that they might need to take a test or drug because the health plan's nurse told them that might be the course of action given recent symptom development. And the nurse would advise the patient to bring the subject up during the visit if the physician did not bring it up.