Physicians appreciate DM assistance

Company works hard to build good relationship

Christobel E. Selecky actually has had physicians thank her for sending them treatment guidelines along with information about their patients with chronic diseases.

"Instead of assuming we’re telling them what to do, they feel like it’s a convenience. We’ve had doctors say thank you," says Selecky, chief executive officer of LifeMasters Supported Self-Care Inc., an Irvine, CA-based disease management company.

When the company started offering its disease management services to health plans in 1994, the staff took pains to involve the physicians and keep them happy.

"We have to overcome years and years of resentment about medical management programs. A lot of it was about managed care in general and the thought that anyone would be questioning physician judgment. I spent 15 years at a health plan and had my share of doctors saying, Who are you to tell me how to practice medicine?’" she adds.

Physician involvement is a key to the success of a disease management program, Selecky asserts. "We are by no means, seeking to substitute for or replace the physician. Rather, we hope to enhance physician care by partnering with doctors to provide information. It is very important to include not only the chronically ill patients in a disease management program but his or her personal physician as well, whether it’s a primary care doctor or a specialist," she adds.

When LifeMasters starts up a new relationship with a health plan, the company’s chief medical officer sets up communication with opinion leaders if it’s a network model or heads of the medical groups who work with the health plan.

During their meetings, the LifeMasters chief medical officer explains the company’s philosophy and reassures physicians that the company’s aim is to help them, not tell them what to do.

The company sends materials to physicians as they enroll patients, telling the physicians who they have identified and what they are going to be monitoring. They give the physician the option to change the parameters of the data.

For instance, the company’s disease management plan normally calls for monitoring a five-pound weight gain in a week for congestive heart failure patients, but LifeMasters will change it to two pounds, ten pounds, or whatever number the physician thinks would be best for that particular patient.

"Because we are computerized, we can do it for each patient and each physician, and it makes them feel like we’re not doing cookbook medicine and that they are in control," Selecky adds.

Instead of sending the physicians a big book of guidelines, LifeMasters send them a short form of the national guidelines for the disease each time the patient’s data gets outside the norm set by the physician.

For instance, when a physician receives a weight gain alert for a patient, the second page of the fax includes brief information from the American Heart Association guidelines.

The treatment recommendations are based on national guidelines. "We are not here to tell the doctors they’re not practicing good medicine. We’re her to provide them with a tool to monitor their patients between office visits and to provide them information so they don’t have to look it up when they get an alert," she adds.

The alert enables the physicians to act quickly when a patient has a problem and to quickly decide whether they just need a change in medication or if they should come into the office or go to the emergency department.

"We find this is very important in getting physicians to buy into the program. They see this as an extension of their office. We call it decision support for physicians," Selecky says.