May 15, 2009

Chronic Support for Chronic Diseases, But, How to Reimburse for It?

On 5/13 President Obama, in his effort to keep healthcare reform on the front burner, sent a few deputies on a mission: find the best private-sector employee wellness and prevention practices in an effort to help other companies and federal workplaces implement these. I bet one of best practice that will be an element of each success story will be programs utilizing technology-based solutions (telephonic, intranet, internet, hand-held device, etc.) to provide frequent and chronic support.

Why? Study after study underscores the critical need for ongoing support for disease prevention and chronic disease care. People need a coach, peer-supporter, or behavioral counselor; cheering them on as they struggle to live healthfully in our less-than-healthy environment.

A hurdle, however, is that our healthcare system, as we know it now, only reimburses healthcare providers for in-person care. Want to discuss a person’s blood glucose control and make medication changes via the phone? It’s not covered! Want to e-mail a person to offer strategies to prevent weight gain? It’s not covered!

Yet, again, studies point to the effectiveness of these interventions for weight management, implementation of lifestyle change or diabetes control. Mayer Davidson, MD drives home this dilemma in his 2/09 Diabetes Care editorial commenting on a study which effectively implements internet-based follow up provided by an RN, “Unless payment mechanisms can be established to reimburse providers for the time and effort these effective interactions require, these new promising care models will remain just that—(unkept) promises.”

But Neal Kaufman, MD, MPH, founder and CEO of DPS Health in California, in The Healthcare Revolution Will Not Be Televised, It Will Be Online, is more hopeful: “It is hard to see that small advances in the industry are happening, but as is usually the case during a paradigm shift, it is only obvious after it has happened…Online tools can extend the medical practice and provide this support through cost-effective programs that help clinicians guide their patients to better manage their conditions…”

Healthcare reform must not only harness innovative technologies to implement chronic support to prevent and manage chronic diseases, but it must also find solutions for reimbursing healthcare providers and systems for effectively implementing and utilizing these cost- and clinically-effective tools.