Silos. We usually use that metaphor when talking about the need to accept increases in one category of spending as a condition of reductions in other categories, and it's most often to justify spending on pharmaceuticals. But silos are where you find them, and coordination of care, the subject of our cover story, is a another example. It's no secret that managing each of a patient's conditions individually can be a bad idea and can be detrimental, but coordination is not all that easy. It has been called the major challenge for managed care in the coming decade, and as luck would have it, there are good reasons for thinking we can make progress down this road.
Peter Kongstvedt, MD, a partner in Capgemini, notes that the interventions are getting better and the databases upon which those interventions rely are becoming more comprehensive. Victor Villagra, MD, president of Health & Technology Vector, a consulting company specializing in disease management, advocates creation of meta-guidelines for multiple chronic conditions.
William R. Gold, MD, the chief medical officer at Blue Cross and Blue Shield of Minnesota, interviewed at length, seems to want the health plans themselves to take a more active role in DM, one of the foundations of care coordination. "Plans have a population and case managers, but few plans have diabetic case managers who only deal with patients diagnosed with diabetes."
Even our Legislation and Regulation column describes one candidate's plan to require private health plans in federal programs, Medicare, and Medicaid to adopt chronic disease management programs. All of this is interesting, and not just in a theoretical way.