April 16, 2004

VMG launches disease management strategy

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Jim N. Jirjis, M.D., and James P. Bracikowski, M.D., say the recent disease management grant from BlueCross will help point the way to permanent funding for more effective population-based disease prevention. Photo by Dana Johnson

VMG launches disease management strategy

Vanderbilt University Medical Center has received a grant from health care insurer BlueCross BlueShield of Tennessee to fund the pilot phase of a population-based chronic disease management center within the Vanderbilt Adult Primary Care Center.

Leaders of the project say it will improve management of chronic disease and help point the way to permanent funding for more intensive and effective population based disease prevention.

“This will go a long way toward closing the gap between what is and what ought to be,” said Jim N. Jirjis, M.D., assistant professor of Medicine and director of the Adult Primary Care Center.

In population-based medicine, disease groups within a given patient population are identified and new levels of disease monitoring and patient education are used to ensure that best practice is systematically applied across the group. It’s all done within the traditional relationship of doctor and patient, with added support from nurses and pharmacists.

James P. Bracikowski, M.D., assistant professor of Medicine and director of medical management for VMG, is director of the pilot project and leads Vanderbilt’s overall strategy for population-based medicine.

Bracikowski decries the general absence in today’s health system of financial incentives for patient education and the other strategies of chronic disease management. “A number of experts have looked at the funding in health care today and it’s perverse,” he said. “Payment for health promotion and prevention is much less than for the treatment of illness.”

He said the grant from BlueCross is a hopeful sign of change. The grant will pay for office renovation and initial staffing costs for chronic disease management, as well as financial incentives that become payable to physicians when disease management quality measures are achieved.

The pilot project is founded on VUMC advances in clinical information technology that allow Vanderbilt physicians to identify chronic disease patient groups more easily and automatically track whether the course of tests and treatments received by patients in the group meets agreed standards.

Jirjis said representatives from BlueCross were particularly intrigued by a demonstration of StarTracker, the disease management component of the StarPanel electronic medical records system. Using diagnosis codes and test-result ranges, Vanderbilt providers can query the system to find disease groups among patients of their given practice group.

Having electronically assembled the required patient records, the user can draw up rules for automatic prompting of the disease management team, so that, for example, certain test results are automatically flagged in red when their age or value exceeds a particular threshold.

“StarTracker is an extension of the physician’s office, equivalent to having another nurse just to monitor chronic disease,” Jirjis said.

StarTracker was developed by Jirjis and William M. Gregg, M.D., instructor, Biomedical Informatics in the department of Medicine.

“The main reason I like working on StarTracker is that it’s taking medicine in a whole new direction,” Gregg said. “The system today is centered on patient visits and episodic treatment, and that may be inadequate to help patients with chronic diseases and conditions. With these new tools, the approach can now become more patient-centric, and I feel good being a part of all that.”

The disease management pilot will focus on all Adult Primary Care Center patients with diabetes or coronary disease, regardless of payer. Jirjis will work with colleagues to form a consensus about primary care practice guidelines for patients in these groups. Using StarTracker, staff will assist doctors to ensure that tests and treatments are timely and patients are adequately engaged and knowledgeable about their condition.

Doctors will receive periodic reports on the status of these patient groups. Jirjis said the initial six-month performance goals for the pilot include a five-point increase in timely blood glucose testing for patients with diabetes.

Normal overall cost of care for these two patient groups is highly predictable, and Bracikowski said improved medical management could be expected to decrease morbidity and thus reduce the rate of increase in cost to the payer, providing a persuasive demonstration that would interest more insurers.

“I think there will be increasing interest,” Bracikowski said. “This is the first step in a long-range plan. The nice thing is, we’re hooking up funding for doing the right thing.”

He foresees more demonstration projects with insurers and with large employers, in which a variety of models for funding and incentives may emerge, all having the theme of tying payment to quality.

A few of the possibilities include selling disease management to insurance companies on a per member per month basis, or applying a higher fee structure to chronic disease patient groups. Bracikowski expects demonstrations of improved quality to drive increases in market share for Vanderbilt Medical Group.