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July 24, 2001

# Disease Management Update

report released by the Institute of Medicine (IOM) in March 2001 noted
that, overall, US health professionals were not prepared to deal
effectively with chronic disease. To address this pressing matter,
Warren Todd, president of Disease Management Resources, LLC, spoke to
grantees on July 24, 2001 about the evolving state of disease management
efforts.

Todd recalled comments by W.K. Kellogg Foundation President, William C.
Richardson, who chaired the committee that developed the report,
"Crossing the Quality Chasm: A New Health System for the 21^st^ Century.
Richardson said, "The system is failing because it is poorly
designed..." and noted that the American health system often wastes
resources by providing unnecessary services and duplicating efforts,
leaving unaccountable gaps in care and failing to use the strengths of
all health professionals.

Todd went on to address the issue of how to reengineer the current
system of care by utilizing the new generation of disease management
program models, which are vastly different from those introduced just a
few years ago, and the careful planning and development required prior
to effective disease management program implementation. He discussed
development of organization-specific disease management goals and
emphasized the importance of installing the appropriate computer-based
infrastructures required to track and manage these programs effectively.
Todd believes that effective information technology is a critical tool
for supporting the changes required to repair an ailing health care
delivery system and that health professionals must be open to embracing
technology support.

Four recognized criteria are considered essential to the successful
development of any disease management program:

-   ***Specific Objectives*** -- Very specific objectives must be
    formulated that are clearly aligned with an organization's mission.
    Goals must be meaningful and measurable.

-   ***Leadership Commitment*** -- Organization leaders must be fully
    committed to implementing disease management programs. Without
    leadership support, the system cannot work.

-   ***Technology Insertion*** -- Organization staff must be willing to
    set up the systems and infrastructure needed to build an effective
    program and support critical information tracking and evaluation
    activities.

-   ***Effective Provider-Patient Communication*** -- Consistent
    communication on all organizational levels is vital to successful
    disease management efforts.

Specific Objectives

In developing its objectives, a disease management team must be willing
to undertake significant data mining. Team members must identify which
populations can benefit most from disease management protocols and which
interventions are most appropriate to each target group. For example, in
the case of diabetes, should the focus be on those at risk for diabetes,
or on those already diagnosed with the disease? Keep in mind that
disease management programs are no longer rigid or narrowly defined.
They cannot afford to be. Today, many models overlap. Diabetes programs
can cross over into programs designed to lower cholesterol or address
cardiovascular disease, end stage renal disease, retinopathy,
neurological conditions and even amputations. Clear objectives drive the
scope and design of individual programs that differ by organization as
well as intent, but artificial borders or barriers among related
programs should not hinder Case Managers from working effectively with
their patients.

Leadership Commitment

An organization's leadership contingent must be committed to full
development of disease management programs and be open to looking at how
they work for other providers in the community. It is often helpful to
tap into existing community resources, becoming appraised of lessons
learned from those colleagues with prior experience on a design team or
advisory board that can help guide development efforts.

Technology Insertion

Todd emphasized the role of evolving technology as a key to improving
the US health delivery system. He believes that paper-based reports will
soon be relics of the past, but that easy access to patient information
will be only one of many benefits of well-designed technology-based
systems. Effective systems will encompass all aspects of a provider's
mission, organizational culture, financial resources etc., and will act
as a catalyst for improving teamwork among health professionals and
including patients in decision-making processes.

Effective Provider-Patient Communication

Today's disease management programs are more fluid as health care
providers acknowledge the need for change, keeping in mind the ways many
aspects of medicine and patients' concerns often interrelate. As these
programs evolve, the need to continually encourage effective
patient-provider communication becomes increasingly evident and critical
to patient compliance and overall program success.

In its March report, the IOM recommends that the Federal Agency for
Healthcare Research and Quality (AHRQ) identify at least 15 common
chronic conditions for which health care professionals can devise
strategic treatment plans that, once implemented, have the potential for
significant improvement in health outcomes over a 5-year period.
Thoughtfully designed, organization-specific disease management programs
can act as building blocks for successful redesign of a fragmented
health care system, transforming it to a well-integrated, efficient,
effective system where patients with chronic conditions, whether insured
or uninsured, routinely receive the care they need.

Todd suggested perusal of the following websites for additional
information:

-   [www.iom.edu](http://www.iom.edu/) - for the March, 2001, report
    entitled, "Crossing the Quality Chasm: A New Health System for the
    21^st^ Century"

-   <http://www.americanhealthways.com/buildbuy.pdf> and
    [http://www.americanhealthways.com/res
    art01.pdf](http://www.americanhealthways.com/res art01.pdf) - for a
    disease management process discussion for diabetes from a leading
    provider of disease management programs.

DISEASE MANAGEMENT UPDATE CALL PARTICIPANTS:

+------------------+---------------------------------------------------+
| ###### Name      | ###### Organization                               |
+------------------+---------------------------------------------------+
| Amy Lewis        | Health & Hospital Corporation of Marion County    |
|                  | Marion County CAP                                 |
+------------------+---------------------------------------------------+
| Ana O\'Connor    | Alameda Medical Center, CA                        |
+------------------+---------------------------------------------------+
| Angelique        | Management Assistance Corporation                 |
| Raptakis         |                                                   |
+------------------+---------------------------------------------------+
| Anne Kircher     | Sangre de Cristo Community Health, NM             |
+------------------+---------------------------------------------------+
| Audrey Smolkin   | HRSA Philadelphia, PA                             |
+------------------+---------------------------------------------------+
| Betsy Buser      | Indigent Care Collaboration, Austin TX            |
+------------------+---------------------------------------------------+
| Brenda Theus     | Shelby County Health Care Corp, TN                |
+------------------+---------------------------------------------------+
| Carolyn Emanuel  | Family Health Center, SC                          |
+------------------+---------------------------------------------------+
| Cheryl Duran     | Health & Hospital Corporation of Marion County    |
|                  | Marion County CAP                                 |
+------------------+---------------------------------------------------+
| Cheryl McInerney | Cambridge Health Alliance                         |
+------------------+---------------------------------------------------+
| Crystal Welch    | Valley Health Systems, Inc., WV                   |
+------------------+---------------------------------------------------+
| Cynthia Walker   | CHOICE Regional Health Network (Sally Schourup)   |
+------------------+---------------------------------------------------+
| Darlene Cass     | University of Texas Medical Branch                |
+------------------+---------------------------------------------------+
| Daryl Patterson  | Health Source/Hudson Health Plan                  |
+------------------+---------------------------------------------------+
| Dave Fant        | Shenandoah-Potomac CAP                            |
+------------------+---------------------------------------------------+
| Debbie Bardin    | Hudson Headwaters Health Network                  |
+------------------+---------------------------------------------------+
| Dennis Williams  | NC Dept HHS Pitts County                          |
+------------------+---------------------------------------------------+
| Diane Weldert    | Health Improvement Partnership                    |
+------------------+---------------------------------------------------+
| Dianna Grant     | The Med                                           |
+------------------+---------------------------------------------------+
| Doree Lynn Miles | Primary Care Coalition Montgomery County, MD      |
+------------------+---------------------------------------------------+
| Edgar Brisbon    | PA CAP Health Federation of Philadelphia          |
+------------------+---------------------------------------------------+
| Ellen R. Shaffer | San Mateo County Health Works                     |
+------------------+---------------------------------------------------+
| Frank Zampiello  | HRSA                                              |
+------------------+---------------------------------------------------+
| George E. Ricks, | Erlanger Health System, TN                        |
| Sr.              |                                                   |
+------------------+---------------------------------------------------+
| Holly Detzler    | CHOICE Regional Health Network (Sally Schourup)   |
+------------------+---------------------------------------------------+
| Jack Epstein     | The Flint Group                                   |
+------------------+---------------------------------------------------+
| James Burnosky   | RWJ: Communities in Charge                        |
+------------------+---------------------------------------------------+
| Jason Ladner     | Community Health Council, Manhattan KS            |
+------------------+---------------------------------------------------+
| Joanne Omi       | NY City Health & Hospital                         |
+------------------+---------------------------------------------------+
| John Cragin      | Boston Medical Center                             |
+------------------+---------------------------------------------------+
| Judy Szalapski   | Hennepin County Med Center, MN CAP                |
+------------------+---------------------------------------------------+
| Julia Pearce     | Cherokee Health Systems, TN                       |
+------------------+---------------------------------------------------+
| Julie Hill-Clapp | Las Clinicas del Norte                            |
+------------------+---------------------------------------------------+
| Karen Amstutz    | Health & Hospital Corporation of Marion County    |
+------------------+---------------------------------------------------+
| Katherine        | Middlesex Health System, Inc., CT                 |
| Schneider        |                                                   |
+------------------+---------------------------------------------------+
| Katie Figari     | WAHEC                                             |
+------------------+---------------------------------------------------+
| Kevin Driesen    | AZ Rural Health Office                            |
+------------------+---------------------------------------------------+
| Kim Beggs        | Comprehensive Community Health Initiative, IL     |
+------------------+---------------------------------------------------+
| Linda Potts      | Comprehensive Community Health Initiative, IL     |
+------------------+---------------------------------------------------+
| Liz Whitley      | Denver Health & Hospital Authority, CO            |
+------------------+---------------------------------------------------+
| Luanne Nyberg    | Hennepin County Medical Center, MN                |
+------------------+---------------------------------------------------+
| Lynn             | Inova Health Care Services, Fairfax VA            |
| Evans-Reister    |                                                   |
+------------------+---------------------------------------------------+
| Margaret Flinter | Middlesex Hospitals                               |
+------------------+---------------------------------------------------+
| Margo Connors    | North Country Health Consortium                   |
+------------------+---------------------------------------------------+
| Mark Snyder      | Cherokee Health Systems, TN                       |
+------------------+---------------------------------------------------+
| Mary Helen Mays  | El Paso CAP                                       |
+------------------+---------------------------------------------------+
| Melanie Matney   | Palmetto Health - Richland Care                   |
+------------------+---------------------------------------------------+
| Mike DeLucca     | FL CAP                                            |
+------------------+---------------------------------------------------+
| Natalie          | Health Federation of Philly                       |
| Levkovich        |                                                   |
+------------------+---------------------------------------------------+
| Peggy Caudill    | UK Center for Rural Health, SKYCAP                |
+------------------+---------------------------------------------------+
| Ray Greedy       | CHOICE Regional Health Network (Sally Schourup)   |
+------------------+---------------------------------------------------+
| Ray Knight       | Family Health Center, SC                          |
+------------------+---------------------------------------------------+
| Rhoda Nichola    | Department of Health, UT                          |
+------------------+---------------------------------------------------+
| Robin Rowland    | Lighthouse Alliance                               |
+------------------+---------------------------------------------------+
| Ron Cookston     | Harris County Public Health and Environmental     |
|                  | Services                                          |
+------------------+---------------------------------------------------+
| Ruth Woolum      | SKYCAP Hazzard                                    |
+------------------+---------------------------------------------------+
| Sandra Frieson   | TLC - The Med                                     |
+------------------+---------------------------------------------------+
| Sandra McCollum  | First Choice Community Healthcare, Inc.           |
+------------------+---------------------------------------------------+
| Seema Verma      | Health & Hospital Corporation of Marion County    |
|                  | Marion County CAP                                 |
+------------------+---------------------------------------------------+
| Sheila McGlone   | Health Source/Hudson Health Plan                  |
+------------------+---------------------------------------------------+
| Sherri Roosa     | Ingham County Health Department & Community       |
|                  | Health Promotion Program                          |
+------------------+---------------------------------------------------+
| Stan Reed        | IU Medical Group/Health & Hospital Corporation of |
|                  | Marion County                                     |
+------------------+---------------------------------------------------+
| Tammy Eberly     | Tiahoga CAP                                       |
+------------------+---------------------------------------------------+
| Tammy Stoltz     | PCAP Pima CAP                                     |
+------------------+---------------------------------------------------+
| Tom Lewis        | MD CAP                                            |
+------------------+---------------------------------------------------+
| Tom Irons        | NC CAP                                            |
+------------------+---------------------------------------------------+
| Tricia Trinite   | HRSA - Denver                                     |
+------------------+---------------------------------------------------+
| Vicky Lewis      | Pima CAP                                          |
+------------------+---------------------------------------------------+
| Warren Todd      | HOST                                              |
+------------------+---------------------------------------------------+
| William Bateman  | NY City Health & Hospital                         |
+------------------+---------------------------------------------------+
| William Runyon   | Health Net/Health & Hospital Corporation of       |
|                  | Marion County                                     |
+------------------+---------------------------------------------------+
| Provider         | Sangre de Cristo Community Health, NM             |
+------------------+---------------------------------------------------+
| Provider         | Sangre de Cristo Community Health, NM             |
+------------------+---------------------------------------------------+
| Synthesis        | Synthesis Professional Services                   |
| Writers          |                                                   |
+------------------+---------------------------------------------------+

Summary Developed By: Synthesis Professional Services, Inc.