By Rose Lucas, RN

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The health care industry is looking like old Scrooge every day, between the doctors’ fees for services that don’t come with the Marcus Welby, MD bedside manner and the faster than a speeding bullet price rises in pharmaceutical drugs. The industry is looking pretty grungy and disease management is being touted as the brand new super cleaner to polish up that tarnished image. Being sold as the “warm fuzzy” of the cold, hard science of medicine, disease management (DM) programs are manned by nurses, the traditional educators in health care. Don’t you think that it is about time they packaged and marketed what has been happening to us nurses for years? I can’t remember the last time I told someone I was a nurse that they didn’t turn around and ask me a plethora of questions pertaining to their mothers, their brothers, or their own health care? This was a smart move by the health plans, pharmaceutical companies and hospitals alike to capture this guaranteed consumer audience and turn it into a cost saving program for the industry.
 
But aside from the feel good portion of the show the industry wants you to see, there is a sinister, cost saving side to why Old Scrooge is being so generous. Disease management programs also identify and stratify high cost cases by identifying risk management / high cost populations through patient profiling through the data collection process that is part of the DM process.  Since the ultimate goal of any program is to show a return on investment through the DM care interventions activities with their members, the goal for DM is cost cutting practices through patient care interventions by DM. Examples are abating  the use of emergency room visits when there is a Primary Care Physician available for office visits, or personal care practices that can be utilized when the overuse of PCP visits occurs. It is the DM philosophy that by providing the patients’ education in the best practices towards their individual medical needs they will stay healthy longer with the equally nice side effect of cutting high user costs.
 
DM is extremely helpful for a caregiver, for many times caregivers are left with questions that weren’t addressed during the hospitalization of the patient or office visit. It is often the DM nurses who find themselves fielding inquiries from both the patient and caregiver. Ideally, instruction should be given in this setting as the core issues of patient care can be met with both the subjective and objective eye for care. At times, the patient inadvertently omits key components that later prove to be barriers to providing the best practice decisions. Often it is the caregiver that fills in the pieces for the DM nurse to facilitate understanding of the education provided. In turn, DM can provide the empathic ear as well as untried care practices the caregiver can implement while providing care. DM can provide a Win-Win situation for all parties involved.

 

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