Comments on: Testing a new way to provide health care

By: SDS PLAN

SDS PLAN — Mon, 12 Apr 2010 20:52:16 +0000

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By: Anne Llewellyn

Anne Llewellyn — Mon, 26 Oct 2009 00:04:43 +0000

Tom, I think the key to the success of the medical home is the Case Manager, a nurse who has training in care coordination and can take the time to access a patient to determine barriers to adherence. The case manager has the expertise to talk to the patient gain their trust and help them become an active participant in the plan of care. The case manager also will raise issues that the physician/patient can address and document the process so that outcomes are reported and the model can be evaluated. With the proper documentation system, the case manager should be able to show the history of the patient's course of care before the care coordination model was started and with interventions how that course of care has improved. Physicians and nurse case managers can make good partners and I am excited to see these types of
program become more widespread.

Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN

By: Tom Morrow

Tom Morrow — Wed, 21 Oct 2009 15:41:28 +0000

This approach WILL work but proving it will be difficult. I ran numerous health plans and also was the medical director for a large disease management company. As with the disease management programs typically run by vendors or insurers, the analysis is difficult and expensive.

How do you prove a negative, i.e. an admission that did not occur. You can do pre/post in a given time period for a population but the analysis then needs to include other non hospital based costs that are certain to go up such as diabetes classes, extra visits to the office for acute issues,increased costs for medications if the patient is now compliant, etc. Physicians are not typically set up to perform these analytical studies and MCOs would need to have a huge percentage of a given practice to obtain a significant sample size for the analysis.

I just hope that the practices are rewarded early on as the costs are long term to a practice and current reimbursement methodology does not reward the programs individual physicians will develop.