By Charlotte Hovet, MD, MMM, Medical Director, Dell Healthcare Services
Caring for patients with chronic diseases can be painful for physicians, both professionally and personally. Not because of the patients themselves, but because for the last 40 years, despite new and better medications and enormous monetary expenditures, we haven’t been able to make an appreciable difference in outcomes. That’s because the real impact on chronic care happens outside the clinic and the hospital. The lifestyle choices patients make, not the treatments we offer, determine the course of these diseases. And while we’ve tried to educate our patients on the lifestyle choices they need to make, we haven’t really helped them do it.
At best, we have helped our patients delay serious complications. At worst, we’ve watched our patients slide downward, helping them cope with each crisis but unable to prevent the next. On a professional level, it’s frustrating. On a personal level, it’s painful. We see these patients often and we grow to like and even love them. Often, we are witness to incredible courage and good nature in the face of immense suffering. We ache for them and their families.
And for those patients and families, it’s even harder. We can walk away at the end of the day, but they can’t. These diseases permeate every part of their lives, destroying health, creating disability, devastating family finances and robbing children of their parents too soon.
On top of all that, physicians’ financial stability will soon be in jeopardy if we can’t change the chronic care picture. New payment models put us squarely at financial risk for containing and reducing the cost of care. And the only way to really cut costs is to prevent the complications that drive costs up – those that require hospitalization and other very expensive therapies, like dialysis.
Technology Can Help Us Turn The Tide
Now for some good news. Telehealth technology, remote biometric monitoring, health coaching, and patient engagement are proving to be powerful tools in the fight to improve chronic care outcomes. Now, we (or other caregivers on our team) can be there with our patients at the moment of choice: at 9 a.m. in the office, when everyone else is diving into the box of donuts provided by a well-meaning and benevolent boss; at the end of the day, when a patient is stressed from work and a bad commute and must choose between exercise, family obligations and the longing to plop down in front of the TV with a beer and a bag of chips. We can be there in the morning to remind them to take their medications. We can be there to warn them of air quality issues that can make their asthma worse. We can see their weight rise and alert them that their congestive heart failure may be worsening. We can see their blood sugar levels and congratulate them on that walk they took that made the difference. In short, telehealth gives us the power to be there for our patients when they need us the most – at home, in the office, and throughout their days.
That is a power we have needed, and our patients have needed the support we can now offer. To change the course of chronic disease, patients have to remake their lives. Diets, exercise habits, medication routines – they all intrude on the lives that patients want to lead. What patients need most is on-the-spot support: medication reminders; immediate access to answers and information; dietary guidance in the face of temptation; exercise suggestions; and most of all, an ongoing connection with a coach who cares about them.
Building A Chronic Care Model That Works For You And Your Patients
So how do you, as a physician, use these tools to build a system that will help you succeed in turning the tide on chronic disease? First, recognize that half-measures and surface changes probably won’t pay off. To ensure that you and your patients really succeed, you need a comprehensive program that uses all the new tools available.
The good news is that it doesn’t have to be hard, and the financial savings from better outcomes can offset the costs. Here, in brief, is a basic plan for effective chronic disease management:
If we can put these tools to work for our patients, we may be the first generation of physicians who make a real difference in chronic disease outcomes. For those of us who have spent decades despairing for our patients with diabetes, heart failure, asthma, high blood pressure and other chronic conditions, that would mean a lot. In fact, that would mean everything.