Disease Management and Its Implications for Outpatient Physician Practice: A Memo for Physicians

While disease management may be viewed with skepticism, suspicion, or outright hostility, there are several reasons why this approach to care may warrant physician support. The care of patients with chronic illness in usual primary care practice is beset by significant quality gaps, and significant improvement due to other initiatives such as the electronic health record, pay for performance, or consumer-directed healthcare insurance has yet to be consistently demonstrated. In contrast, an emerging body of peer-reviewed literature is demonstrating that disease management does lead to improvements in clinical quality. Disease management is also an intervention that is closely linked to primary care and, thanks to its willingness to assume many of the tasks of patient engagement, can offload and improve practice efficiency. If successful, it can lead to greater reimbursement from pay for performance, and future iterations of disease management may also reimburse physicians for work effort and quality achievements that support its programs. The electronic health record may introduce new challenges, such as a greater reliance on remote messaging, that can also be addressed by this approach to care. It is also possible that future versions of consumer-directed plans will accommodate disease management approaches in an attempt to protect the healthcare consumer with chronic disease from high out-of-pocket expenses. Last but not least, as disease management and the chronic care model evolve, physicians and the sponsors and suppliers of disease management services may find approaches to care that adopt the best elements of each.