South Florida Hospital News
Thursday August 6, 2020

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October 2004 - Volume 1 - Issue 3


Disease Management: Through The Eyes of the Craftsman

Disease management is a concept with more potential to improve patient care than any other modern care management initiative. It addresses much of what is wrong with medical care in a systematic and measurable fashion. Reducing the demand for services by aggressively managing and monitoring care is a win-win situation for patients and payers. Disease management vendors and health plans have written volumes about its value, but often with disappointing results. A disconnect between these entities and the treating physicians who provide the care has not been adequately addressed. The fundamental goals of both physicians and DM entities are the same. Both want the best possible outcomes. What then accounts the differences?

Disease Management entities have relationships with defined populations and look for subgroups that meets the criteria to be managed. This is the 80/20 rule. Physicians manage patients one at a time specifically looking at the uniqueness of each individual. Decisions are made in the context of a person and not simply a disease. It is often difficult for them to generalize or categorize. The mindset of physicians is that of the craftsman. The end product of the "art of medicine" is the patientís care. Disease management entities target disease states that have significant cost and adverse impact on communities. This is an admirable goal and should not be minimized. Physicians may express concern over perceived economic decision-making and resist being a part of this process.

Disease management entities often focus on improving outcomes for patients with common chronic conditions that can require complex decision-making. The physician craftsman does the same. Unfortunately, the physician encounters barriers. How does he/she know which services the patient received from other providers? What are the issues for this patient that may lead to poor compliance? Is the patient medically literate? Do they have transportation? Can they afford the care? Finally, how does the physician provide comprehensive care including preventive care services and get a fair reimbursement for the extended amount of time needed with each patient?

Solutions exist to resolve the misalignment of incentives created here. The answers are multiple and include recognition by each entity that cultural differences exist. The answers are multiple and include recognition by each entity that cultural differences exist. Each must appreciate the goals of the other and be willing to change somewhat to become a player on the team to improved outcomes. Many physicians will embrace their craftsmanship role and the professional satisfaction that goes with it. They have not invested in technological tools to remind them when services are needed, provide written educational materials to patients, or connect them to information from the multitude of providers who share in the patientís care.

We need to move in the same direction if patients will benefit from that move.

Symptoms of an Inadequate HealthcCare Delivery System

  • Increasing Professional Liability Rates
  • Performance/Knowledge Gap
  • Declining Patient Satisfaction
  • Declining Employee Satisfaction
  • Fragmented Care Delivery
  • Fragmented Technology
  • System Capability vs. User Needs Mismatch
  • Continued Investment in 19 Century Systems
  • Perceived Lack of Time
  • Outcomes vs. Cost Mismatch
  • Supply vs. Demand Management
Paul McLeod, M.D., Chief Medical Executive for MED3OOO and Assistant Dean of Florida State University College of Medicine, Northwest Florida Campus, can be reached at or (850) 494-5929.
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