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Megatrend Spotting: Collaborative Care Management Networks

Harmony

“Why can’t we all just get along?”  Rodney King


The Megatrend: Collaborative Care Management Networks (CCMNs)

It’s been quite a while since I spotted a new Disease Management Megatrend, but here’s one that’s long overdue:

Collaborative Care Management Networks will be necessary to achieve optimal care coordination.

The trend in a nutshell:  payers (and others) are recognizing that optimal care coordination will require collaboration among health care stakeholders. This CANNOT be achieved with yesterday’s proprietary IT and business models.

CCMNs will share many — perhaps all — of the following elements:

  • Multi-payer participation
  • Common clinical guidelines
  • Common IT infrastructure enabling information exchange and shared workflow (highly desirable today, essential in the future)
  • Financial incentives for care providers to participate
  • Trust

An article in the September issue of Disease Management Advisor goes into more depth about CCMNs.


What are Some Examples of CCMNs?

Think of Collaborative Care Management Networks as an umbrella term encompassing most of the care coordination experiments being conducted today:

Institute for Clinical Systems Improvement , Minnesota

State Chronic Care Initiatives: Iowa, Pennsylvania, Vermont, Washington, Rhode Island, Colorado, others

Improving Performance in Practice initiatives

Patient Centered Medical Home (PCMH) initiatives

Accountable Care Organizations as described by Elliott Fisher at Dartmouth

…and others.  Please add to the list.


Isn’t All this Obvious?

Perhaps it’s obvious in hindsight, but the health care industry is slow on the uptake.

I first wrote about the problem in 1999 , describing it as The FedEx Phenomenon. This term is shorthand for health plans and DM company proprietary (non-collaborative) efforts to get physicians to follow prescribed clinical guidelines:

Here’s how it works.  10 AM: The FedEx truck drops off the health plan’s new written guidelines for managing patients for a specific patient condition, e.g., congestive heart failure (CHF). The cover letter (which is never read) states that the health plan expects the doctor to use these guidelines in managing THEIR (the health plan’s) patients.  12 Noon:  The guidelines are buried in a closet with dozens of other protocols issued by multiple other health plans.  A variation:  the guidelines are in the trash by 5 PM.

Here’s the managed care plan’s side of the story:  Tremendous statistical variation exists in the delivery of health care by physicians; this variation suggests that patients are getting less than optimal care at excessive cost.  Study after study is showing that clinical guidelines are highly effective at reducing variation, improving quality, reducing cost, and increasing patient satisfaction.  For example, the national average annual rate of rehospitalization of patients with CHF is about 23%; patients in CHF disease management programs have are hospitalization rate of about 1%.

Here’s what we hear from doctors: “My complaint is that this guideline is dumped at my doorstep.   I’ve had no input into it. I have no systems in my practice to implement it.  I participate in contracted provider networks for a dozen different plans.  Each of them has given me clinical guidelines for multiple conditions; each of the guidelines is in a different format and contains differences in recommended treatment approaches.  I don’t get paid for all the extra work that would be involved.  There’s no way I can keep track of all this!  Maybe it’s true that guidelines could improve patient care, but darn it—I resent that anyone tells me how to practice medicine.  And if I took the time to know all this stuff, I’d have no time for treating real human beings.”

The bottom line restated: Care coordination efforts pursued using yesterday’s proprietary IT and business models are doomed to failure.



If this CCMN concept sounds half-baked, that ‘s because IT IS half-baked.  Please consider this first posting on CCMNs as early thoughts — I’ll be writing more in the future and I welcome your input.

This work is licensed under a Creative Commons Attribution-Share Alike 3.0 Unported License. Feel free to republish this post with attribution.