Physician Reminders versus Telephonic Care Management

A Kaiser study compared use of telephonic care management with reminders to primary care physician for ongoing management of LDL-C levels. Their findings: "Patients with coronary artery disease can maintain their lipid levels after discharge from a
disease management program.
- Disease management programs for patients with heart disease improve processes of care and risk factor profiles for the patients enrolled; however, they are resource intensive.
- Patients can maintain lipid levels after discharge from such programs through the use of
electronic laboratory reminder letters.
- Such a system of follow-up will allow disease management programs to provide care to
other high-risk populations without the need for additional resources."

This supports the idea that you can successfully help physicians maintain adherence to a treatment plan with relatively inexpensive interventions. You can then focus more intensive care management on those patients that continue to experience care gaps. The alert engine that I have been working on for the last 18 years typically identifies over 20 care gaps per 100 members with a change rate of over 60%. This not only reduces risks for the total population but the identified care gaps also help to identify patients at need for intensive care management.