My wife has a chronic illness and can’t drive most of the time. She has an essential monthly medical appointment in an office that is forty-five minutes away. She always waits an hour to see the provider. Sometimes two. Just think about that. An hour and a half driving. An hour waiting. Every year, seeing that one provider takes a more than a day out of our lives and my wife sees several doctors.
Diabetes is a similar chronic illness. Patients don’t just have diabetes. They have diabetes and eye problems, heart issues, and kidney disease. Some have foot ulcers. They see a different specialist for each of those problems. Many are on multiple expensive medications. The people who have the most damage from diabetes and high blood pressure are the same people who find going to a doctor’s office most challenging. They are the poor, the disadvantaged, and those who are away from home in their work. They have difficulty arranging transportation, a baby sitter, or time off from work as frequently as they need medical attention. They often don’t get the care the need. That means they develop more complications and cost.
Patients must see a doctor in person for their diabetic care because that is how providers are paid. Primary care providers are paid to see a patient in person and to document that visit in a note. That is it. The more visits the doctor produces, the more she is paid. As you all know, a doctor only has about 10 minutes with each patient. If the patient has back pain and a rash to discuss, the sugar and blood pressure level may not be addressed. There may not be time. As a consequence, only 44% of Americans have their blood pressure controlled to goal. In most practices, that one provider is responsible for making certain that you have an eye exam, blood and urine tests for kidney function, and a foot exam. It simply does not work. Gaps in care are not the exception, they are the rule. Our system is not designed to make sure the goals in the checklist above are achieved for every patient every time. But we have proof that achieving those goals more consistently dramatically reduces diabetic complications and the cost of related artery disease.
We can deliver this necessary care today with more convenience, with less cost, and with more patients in compliance and with better outcomes. How? Here’s one way:
Patients can conveniently and reliably check their blood pressure and blood sugar at home. Home blood pressure measurements are more accurate than office measurements. Both measurements can be used to adjust diabetes treatments in the office and over the phone.
Eighty five percent of the management of diabetes and related conditions can be done remotely. Nurse coaches or case managers can develop an ongoing trusting relationship with patients over the phone this way. They will help patients understand the diabetic condition and why certain simple interventions make such a powerful difference. That is central to better care and patient engagement. Patients are more likely to follow recommendations from a person that they trust.
When the patient has high pressure or glucose, the nurse can alert a telemedicine doctor that the patient needs a change in treatment. Protocols keep the nurse and the provider on the same page. Using a protocol means that you can explain how you achieved your excellent results so that you can replicate, systematize, and scale it. We have seen this in other areas of medicine. Use of the Surgical Safety Checklist has helped to dramatically improve post-surgery outcomes by consistently following a standardized set of protocols. It’s the same with U.S. commercial aircraft today…a firm protocol is followed before any plane leaves the gate.
Making sure that patients receive the optimal medical therapy outlined in the checklist means that not as many will have eye, kidney, or foot problems. Required annual in-person visits can be easily arranged for eye and foot exams over a video or phone call. The same goes for ordering labs remotely to document cholesterol, hemoglobin A1c, and kidney function.
Documenting success is straightforward with the proper data platform. Record baseline blood pressure, sugar, and LDL cholesterol. Monitor patients for their use of best practice medications and smoking cessation. With more patients using the checklist medications, and fewer patients smoking, you will know that patients are doing what they need to do and you will see the risk factor numbers coming down. Urgent care visits, hospitalizations, heart attacks, strokes, and amputations will decrease. Cost will go down.
When you see the risk factor numbers come down, patients on the medications in the slide, and fewer patients smoking you will know that patients are doing what they need to do and you are being successful. You can also track costs, urgent care visits, hospitalization, heart attacks, strokes, and amputations. You can document the benefits of your new system.
Patient-centered care does not required fancy buildings and face-to-face visits. It requires a coordinated, integrated team effort following a firm protocol just like in the surgical suite or the airplane cockpit. And that is, to make certain every patient receives best practice patient engagement, lifestyle instruction, and the 12 items listed in the checklist every time.
That is patient-centered care for diabetes and its related conditions like heart artery disease. Patients in rural areas, on the road, or in disadvantaged neighborhoods can all receive this excellent care. It makes a huge difference. We can help you get started now.
The legacy unacceptable fee-for-service is dead, and has been dead for a long time in my book. Medical homes supported by a trusted caregiver team in person or remotely will be the future, like it or not. It’s already here.
This is invaluable information that providers can/should be using consistently but don’t. How to institutionalize this practice as SOC?