Disease Management 2.0?
It seems like it has become fashionable in the Health 2.0 community to say:
1. Disease management doesn’t work
2. We need to incentivize people to stay healthy and not get sick in the first place
While I agree with these statements, I think it’s time we raise the bar in the conversation and begin to propose immediate and specific solutions. Once you dig into what it will take to keep people well and address the needs of the costliest 20% of the healthcare population, it gets so very complicated, so very fast. And we only add to the problem if we expect one company, technology or initiative to solve it, even if it is a Health 2.0-type solution.
First, let’s break these two statements down a bit more. Disease management really translates to demand management and effective resource utilization i.e.; keeping chronically ill people out of the hospital/ER and minimizing redundant tests and procedures. The second issue is about prevention of disease which requires motivation strategies, health education and tools for self-care.
The fashionable trash talking of disease management is mostly about the first type. Call that push disease management. The question is whether we can use Health 2.0 tools to make pull disease management easy enough.
While
these challenges require different approaches, when we start to think
of taking control of our own health within a Health 2.0 perspective,
disease management and wellness programs are much more a part of a
continuum. Indeed, we are all a little bit sick, or potentially sick.
Someone with 4 chronic diseases living in Mississippi may be very
different than the yogic vegan in Northern California. But the yogic
vegan could one day get breast cancer or Alzheimer’s disease and the
person with 4 chronic diseases still needs to know how to eat right and
exercise.
Health 2.0, with its clear focus on the individual, recognizes
that there are many ways we interact with our health in our daily
lives, not just when we deal with our health plans or our doctors. We
need to question the logic of large companies being paid large sums of
money by other large companies to manage us and our personal health. It
would be like saying we need to fix the environment by hiring a call
center to remind us to turn off the lights in our living rooms, to
recycle after dinner, to keep the thermostat at a comfortable 68
degrees and to bike to work the next day.
Health 2.0 not only
fosters the mindset that managing our health is our responsibility, it
also provides some of the most effective tools.
So let’s look at some common complaints
about why it’s difficult to stay healthy or effectively use the
healthcare system and how Health 2.0 tools might make a difference
cheaply, effectively and immediately.
I need more motivation to stick with a healthy routine
Join Daily Strength or another online community and get your friends to keep you on track with your diet and fitness goals. Or check out VirginLifeCare which lets you accumulate health miles when you do something good for your body.
My doctor doesn’t spend enough time with me
Join a practice where the doctor will spend more time with you and offer web-based visits and your health information online. Metropolitan.MD is a great example. It might cost you a bit more but if you feel you have needs that aren’t being met in a 15 minute office visit then chances are it’s worth the extra money.
I can’t get an appt with a doctor quickly enough, or after hours or on weekends, so I need to go to the ER
Many
doctors offer secure email messaging and there are credible websites
where doctors can provide initial answers to your question off hours.
Try Medhelp.org . There are also doctors who will make house calls. Look at Jordan Shlain’s SFoncall and Jay Parkinson’s practice as examples.I had to get my test repeated because I switched doctors
There
are services that will allow you to request results or diagnostic
images from your doctors offices via secure file sharing - ok for this
you’ll have to wait but I know of one product in deep alpha.I didn’t know I was predisposed to a condition (or I would have done something about it)
You can order tests for a single genetic condition online directly through DNADirect . Now DeCODEme, 23andme and Navigenics
will be offering genome-wide arrays or tests. You can use the results
to map out and personalize your future health activities.I’m overwhelmed by all the information on the web; I don’t know what’s credible and what isn’t
Read a wisdom card on Organized Wisdom - they have doctors and lay-people compiling the best information on the web for particular health topics.
So
you want my “program” for disease/wellness management - well it’s not
per member per month. It’s not about companies selling the management
of your health information to other companies claiming they’re doing
something for you while you are but a number in their health risk
assessment algorithm. It’s much more in your hands and at your
fingertips than ever before. You do actually have to move your
fingertips, to a keyboard, to a website, to a phone…phew, okay,
that’s your workout for today. Tomorrow, you can actually register for
these services.
Indu Subaiya
Health 2.0 Developer Challenges
I agree with your original two statements, but I think you miss when you break them down. DM is not utilization management. It will typically increase office visits and pharma costs. But #1 is still correct. The failing of DM is that it doesn't offer causality. You can't prove that the conversation you had with Patient X resulted in them NOT going to the ER that month. What DM needs to focus on is tracking real outcomes. A1c at 11? Let's work this care plan and we'll keep tabs over the course of the year to see if you can get it to 7. Keeping tabs = office visits with your PCP and some labs. THAT'S true disease management.
Your idea of pull is intriguing but not currently viable. There's a reason why there's new Health 2.0 sites sprouting up like search engines in 1997. There will always be some subset of the population that is actively engaged in their health. But unfortunately, they only represent about 20% of the population, and they certainly are not a high union with the 20% that is high cost. Ultimately you need both working in harmony, but the critical path is to force accountability to maximize incentive and engagement. There are ways to do this but it doesn't start with pull.