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Perspectives on Integrated Associations in Healthcare

Posted by Matt Breese on May 31, 2016

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There is no end to the value of good communication. For organizations that share a common purpose, such as those involved in the delivery of healthcare services, communication is the difference between an effective and an ineffective system. Without integrated communication, organizations that play varied roles in caring for patients operate in parallel universes, risking the duplication of services and potential clinical errors, and missing out on the clinical and operational efficiencies and benefits of shared information.

Evidence-based medicine promotes team-based care. If we expand the concept of evidence-based care beyond the direct-care environment, we see real value in including community pharmacies and pharmacy benefit managers, payers and even professional and government organizations in the definition of team. In years past, before the advent of computers, the Internet and electronic health records (EHRs), integrating communication among all of those entities would have been both resource intensive and time consuming. Today, health information technology (HIT) solutions make it much easier to communicate, and share and consolidate information.

Exhibit A: Chronic Care Management

Chronic care management is a prime example of the value-added benefit of using HIT solutions to improve communication and, therefore, patient care. According to the Agency for Healthcare Research and Quality (AHRQ), over the last two decades chronic conditions replaced acute and infectious diseases as the major cause of death, disease and disability in the United States.

Patients, providers and payers all benefit from effective chronic disease management programs. Patients avoid acute episodes and hospital stays. Providers improve the quality of life for their patients, while also being able to better manage patient scheduling and demands on their time. And, payers avoid higher costs associated with hospitalizations. Although some may suggest these efforts are often at cross purposes (reducing costs versus improving care and quality of life), it is in everyone’s best interest to provide cost-effective, quality care.

The Academy of Managed Care Pharmacy (AMCP) suggests that, “Disease management programs should emphasize the prevention of exacerbations and complications using evidence-based practice guidelines and patient empowerment strategies, while evaluating clinical, economic and humanistic outcomes to improve overall health and quality of life for patients.”

The first step in disease management is to identify patients who may benefit from a comprehensive program. Because not all patients with chronic illnesses require services beyond basic care, an HIT solution can serve as a conduit for consolidating critical health information, such as claims data, evidence-based practices, and identifying the most appropriate approach (in-office visits, telephone outreach, electronic communication, case management, support groups and counseling, or a combination of strategies).

Disease management programs are varied, but all promote at least one of the six core elements of the Chronic Care Model (CCM), which Ed Wagner, M.D., MPH, MACP, director (emeritus), MacColl Center for Health Care Innovation at the Group Health Research Institute of Group Health Cooperative, developed a number of years ago. Those core elements are:

  1. Healthcare organization and leadership
  2. Linkage to community resources (e.g., nutrition counseling, peer-support groups, data for patient registries)
  3. Support of patient self-management
  4. Coordinated delivery system design
  5. Clinical decision support
  6. Clinical information systems

As an integrated player in team-based healthcare delivery, the AMCP sees comprehensive disease management programs improving:

  • Safety and quality of care
  • Access to care
  • Patient self-management
  • Financial cost containment without sacrificing quality or patient satisfaction
  • Efforts to provide population-based health improvement programs

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Topics: Industry Trends, Market Access, Provider