1. Results of Our Disease Management: Incomplete Success
Our benefits were clear but incomplete
Our cost was high (case manager intensive, triage center) compared to insufficient benefit to OUR health system
At a time when managed care proportion-of- patients stabilized/decreased = less benefit to our system
At a time of decreased re-imbursement
Physician Compliance- paper-based or ‘present-on-computer’ were insufficient to improve compliance ‘enough’

2. Conclusion:
NOT that ‘Disease Management is‘wrong’ or can’t /doesn’t work or even too expensive
BUT that need a better way is needed to incorporate its principles into the practice of providers in the care of patients and to do so in a cost-effective way

3. Principles of Disease Management: Effectiveness Appreciated
Improves quality- the drivers for safety are:
IOM
Leapfrog/ Third Party payers
Accreditation Agencies
Value= Cost vs Benefit
Time to Achieve ROI- ‘Japanese’ vs. US mentality
Gatekeepers- failed
Squeezing payments- has reached limits
Therefore, CMS, OTHERS, moving to Disease Management
Baldwin, Disease Management, Healthcare Informatics, pg 54, Feb.,2003

4. Principles of Disease Management: Solution Translation from a: Paper-Based Diabetes Disease Management Program to implementation via KNOWLEDGE-BASED, OUT-PATIENT, COMPUTERIZED PATIENT RECORD

5. Solution: Technology
Comprehensive Clinical Workflow- Patient History Template,Physician Template
Guideline-Based Decision support- computerized reminders,computerized best-practice rules/alerts/bring up order sets,dynamic decision support
Education- patients (E-health portal), physicians and other care givers (made intrinsically part of process of care)
Education-for alerts given, allow jumps to complete guidelines, references, bibliography ,URLs
Communication processes- connect patient to Care Givers (E-health portal)
Track outcomes, administrative decision support, performance reports

6. Principles of Disease Management: KNOWLEDGE-BASED, OUT-PATIENT COMPUTERIZED PATIENT RECORD
Decision Support Module : runs
Screens patients for early identification/diagnosis
Rules (of Omission, Commission) against DISCRETE data in patients database
Triage Rules
Rules against multiple triggers to actually recommend therapeutic interventions/changes(= Dynamic Decision Support)

7. Health Management Plan (HMP) Overview
Inputs
Dis.Man. System
Rule based engine
“Standards of Care”
Outputs
Basic Health Summary
Evidence-Based
Best Practices
Medications
Computerized
Patient Record
Reminders
Alerts
Diagnoses
Results
MD -
What to do?
When to do it?
How to do it?
Patient
Patient Hx/MD Forms