Disease management requires different skills

Know the difference between the two activities

If you are a case manager who also is performing disease management activities, keep in mind that the two activities require distinctly different skill sets, suggests Rufus Howe, RN-C, MN.

"Disease management is not your mother’s case management. It’s a distinctly different field," adds Howe, vice president of product development for American Healthways, a Nashville, TN, disease management company.

There are some common threads in both processes, but disease managers need some specific skills that aren’t needed by people who do case management, he adds.

Howe suggests that disease management be recognized as a specific profession with its own professional organization, professional certification, and educational programs.

"Disease managers are largely unsupported professionally. It’s a rapidly growing field due to third-party validation of the value of disease management interventions. I believe that disease management is a profession in its own right, just like case management is a profession," he adds.

Howe estimates that about 3,500 people currently perform disease management activities in this country, a figure he expects to grow. "Disease management exists in a variety of settings and with a variety of approaches. I believe that we need to lay out a definition and scope of practice for disease management and provide support for people in the profession," he says.

"If someone wants to do disease management, this is a good starting place. You should know whether you are aligning yourself with that particular approach," Howe notes.

While registered nurses are the predominant profession in disease management, he points out that there are exercise physiologists, licensed social workers, respiratory therapists, registered dietitians, and even pharmacists who do disease management.

"Disease management is accepting and tolerant of different professionals participating, while case managers tend to be registered nurses," he says.

Four distinct plans of care

Howe, who has worked in disease management since 1983 when he started a hospital-based diabetes program, explains disease managers often coordinate four distinct plans of care:

  • the plan of care developed by the physician, which focuses on treatments and procedures;
  • the patient’s perceived plan of care, which is influenced by the patient's experiences and environment;
  • the plan of care from the health plan, which is influenced by utilization management criteria;
  • the best-practice plan of care that has been developed through evidence-based research.

"Disease managers follow a process that is unique and need a different set of skills and focuses from those used by case managers," he says.

Unlike their counterparts who do case management, professionals who do disease management need to know about targeting populations, using predictive modeling, and stratifying patients by level of acuity, Howe adds.

"Disease managers need to know more about medical appropriateness than the typical case manager. They don’t typically get involved in authorization for service, utilization management, or coordination of services." Typically, disease managers work with stable but chronically ill patients, while case managers care for acutely ill or injured, high-cost patients who are rarely stable, he adds.

Disease management is a long-term process that may last for years, while case management tends to be event-based and usually involves only short-term care management, Howe notes.

"Disease management is longitudinal in nature. Disease managers provide long-term education and support for chronically ill people for seven or eight years or even longer. It’s a long-term partnership," he says.

Disease managers tend to focus on core conditions such as diabetes, asthma, coronary artery disease, and depression and because they talk to people all day long with these conditions, they need a comprehensive understanding about the disease, and the evidence-based approach to treatment. Case managers tend to be more generalists, coordinating care for a patient with multiple trauma, another with cystic fibrosis, and another who has been hospitalized for a heart attack, he adds.

Disease managers must address medication issues and help patients make lifestyle changes by exercising, losing weight, and managing stress.

They must be adept at helping to prevent accidents because chronically ill people often have problems with fires, falls, and other accidents because of failing eyesight, diminished coordination, and decreased mental capacity, he says.

"All of these things are pivotal for a disease manager to address, but they are not necessarily things that case managers focus on," he says.

According to Howe, disease managers need to be skilled in helping patients change their behavior in a far more involved way than case managers.

"Case managers don't have the time or inclination to work on readiness to change. They open a case, close the case, and move on to the next patient. That’s what they’re supposed to do. It’s hard to tell if someone on a ventilator is ready to lose weight. It just doesn't work that way." he says.