In general, economies have already been squeezed out of the acute health care system by group purchasing, generic medication use, critical pathways and other efficiency efforts. Once patients are in the Emergency Room, an outpatient setting, or even starting down a perfectly designed and executed critical path, it's too late. Only by beginning intervention post diagnosis and before acute events occur, can fundamental healthcare changes and their resultant savings be realized. The disease management approach, with or without using home telemedicine technology, is a fundamental shift which often meets resistance. Because it's not the way facilities and providers, particularly physicians, are structured or trained to practice and deliver health care, it appears threatening.
Chronic illness consumes an increasingly large percent of the health care dollar.
Pareto's law is evident in health care delivery where a small group of chronically ill patients consumes a large percentage of the cost of care. Surprisingly, Pareto's law holds as well in military health care. So that incidence does occur within the military health care system, where one would think the population would be younger and healthier. And as the DOD moves toward Medicare subvention, care of even more elderly and chronic patients will challenge the healthcare delivery system financially and operationally. Within the DOD, evidence of positive results from disease management is beginning to occur.