Chronic Conditions: Why Disease Management Programs Fail

 As a Type I diabetic, I enthusiastically endorse any attempts to give people with chronic health conditions like mine greater control over their health. We all need to take more personal responsibility for our health, and disease management programs offer tools to make this easier and therefore more productive. The problem is that they rarely take hold in a patient's life. 

Here are a couple of reasons why:

  1. Disease management programs are usually contracted out to companies that have a weak connection to the patient's personal doctor. Despite all the information that they have about individual patients, these program feel like they are being done by outsiders. Without the imprimatur of the patient's actual physician, they feel optional and marginal.
  2. For regular follow up, most of these programs rely on written communication such as newsletters rather than more direct communication via the telephone. Most patients with chronic conditions are over the age of 50 and prefer to communicate with a medical professional over the phone for anything you want them to take seriously. The newsletter often looks like another piece of junk mail rather than important information about their health.
  3. Even personal intervention via the phone often gets discounted if the nurse or other medical professional cannot demonstrate an ability to assist in tangible ways. I was enrolled into a program through my health insurance plan to assist me in managing my diabetes. For a while I received monthly calls from a nurse who was very personable and wanted to help. The problem was that she never had answers for any of my questions. She also never set any baselines to which we could refer in analyzing my condition over time. After a while, the calls trailed away and stopped.

Here are a few suggestions that would make these programs vital rather than afterthoughts for me:

  • Get my doctor involved. If he doesn't know about the program and is not invested in it than neither am I. 
  • Communicate with me first by phone. Use that phone conversation to find out how to communicate with me going forward. For me, the best mode of communication for most things will be email or even a smart phone app but set that up with me via that phone conversation. There are lots of good technological tools now available. Use them but don't assume usage without getting me on board first.
  • Set baselines and goals from the onset. "How is is going?" doesn't mean much to me unless you are referring to specifics.
  • Set bonuses and penalties for activities that affect my overall health. If my insurance plan makes less or more moeny based on my adherence to a disease management program, I have a feeling they will work harder to figure out how to keep me involved. 
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