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Caring for Orphans.

Many years ago, health professionals used the terms secondary and tertiary prevention. Primary prevention, of course, meant preventing the disease in the first place. Secondary prevention referred to intervention at an early stage before the disease progressed, and tertiary prevention represented the prevention of recidivism. The latter two are aimed at preventing a bad situation from getting worse.

The phraseology may be passe, but not the concept. Disease management (DM), while not nouveau or glitzy, remains a valid discipline that is not often heralded for its unsung hero potential.

For the most part, it's the major money-savers that get attention. Think DM and what do you think about? Congestive heart failure most probably, followed by diabetes and asthma. But you probably don't think about systemic lupus, multiple sclerosis (MS) or myasthenia gravis.

Tucked away in Greensboro, NC, are 90 employees who do think about scleroderma and MS when they think about DM, along with cystic fibrosis, ALS and sickle cell disease. Accordant Health Services provides DM for 14 orphan diseases that don't often get feature articles written about them. These are the same diseases that can stifle and halt otherwise active lives and eventually ring up big bills at the healthcare cash register.

According to Bill McIvor, chief information officer, Accordant's 14 orphans represent a target that combines extensive market and disease analysis. "There is a clear trend toward managed care organizations (MCOs) moving DM programs in-house, managing them internally," says McIvor. Accordant knew that no organization could effectively handle all the diseases that could benefit from DM. Through analysis that included "a combination of market dynamics and disease-specific dynamics, the selection process focused on diseases that have predictable and preventable complications, where multiple bodies of literature exist to support care pathways, and where we have the ability to collect, organize, codify and distribute information."

Depending on the market you live in, says McIvor, any one of these diseases can easily run an annual tab of $15,000 to $17,000. Granted, that's chicken feed compared to even one employer's annual healthcare costs. But employer by employer, aggregate by aggregate--it's a collection of diseases that can cost plenty and that can benefit immeasurably from what is essentially secondary and tertiary prevention.

Successful DM relies heavily on two factors: physician buy-in and patient compliance. McIvor says the program has garnered more than twice the average support from physicians because it provides disease-specific, technology-supported information they can't comprehensively access elsewhere. The Web-based program makes patient participation easy with constant availability of disease-specific libraries, self-management tools, live interactive communities and fast access to specially trained clinicians. Accordant calls the patient response "unprecedented," and says the length of time their visitors spend on the Website is more than twice the average spent at general health information sites.

If there's a best part to all of this, it's not just saving money. It's not just making best-practices information available to clinicians. It's not even providing a nationwide program that a single MCO couldn't support by itself. It's making a bad situation better, possibly better than it has ever been, for thousands of people sidelined by life-altering diseases. That's a concept anyone could love.

Robin blair Editor
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Title Annotation:Industry Trend or Event
Author:Blair, Robin
Publication:Health Management Technology
Article Type:Editorial
Geographic Code:1USA
Date:Oct 1, 2000
Words:531
Previous Article:Disintermediation: The New Competitor.
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