Disease management firm’s enrollment booms
Disease management firm’s enrollment booms
Web-based system empowers patients
Innovative use of technology, timely response to a niche market need, and demonstrated clinical and financial outcomes have led to unprecedented growth for a North Carolina disease management company.
Greensboro, NC-based Accordant Health Services Inc., which specializes in managing 14 complex, chronic diseases, saw a 726% enrollment gain in 1998, surging from 448 to 3,700 enrollees. The company isn’t stopping there. Enrollment so far in 1999 has reached 7,000, and Accordant executives project they will surpass enrollment of 11,000 by the end of the year.
"Successful implementation with our health plan partners and high patient satisfaction ratings have been the drivers of Accordant’s rapid enrollment growth," said Steve Schelhammer, president and CEO, in a statement on Accordant's Web site. "We continue to demonstrate improvements in clinical, cost-of-care, and quality-of-life outcomes for our managed population. This success has led to increased enrollment with existing clients and construction of additional chronic disease management programs to serve new populations on behalf of our clients."
Schelhammer founded Accordant in 1995 to meet the gaping need he saw for management of rare chronic diseases. After 2½ years of research and development, the company went operational in 1997 and now serves the following conditions: multiple sclerosis, cystic fibrosis, systemic lupus, myasthenia gravis, hemophilia, rheumatoid arthritis, Parkinson’s disease, ALS, sickle cell disease, scleroderma, CIDP, polymyositis, dermatomyositis, and Gaucher’s disease. "Any one of these diseases does not have enough impact for an HMO to build a program on, so we put them together in a constellation," Schelhammer says. "These are less common diseases for which medical expertise is not always readily available and for which there’s a tremendous opportunity to make a difference in both quality and cost."
So far, Accordant’s program is doing just that. At the end of 1998, Accordant reported a 53% reduction in hospital utilization among 754 patients with complex, chronic diseases who were enrolled in the program for at least three months. Also, 98% of enrolled patients expressed overall satisfaction with the services received. Outcomes for specific diseases included:
lupus: 17% increase in lipid screens within the past 12 months and 13% increase in awareness of and compliance with surveillance lab guidelines; cystic fibrosis: 23% decrease in the number of adults reporting low ideal body weight and 7% increase in the use of pancreatic enzymes; myasthenia gravis: 32% increase in compliance with yearly flu shot.Intervention, education, treatment protocols
How does Accordant do it? The key is a disease management model with patient interventions, patient education, and treatment protocols that are based on best practices, says Bill McIvor, executive vice president for business development.
"We select for our medical advisory board luminary physicians from around the world that every patient would like to have," he says. "We get the experts on the disease to build a disease profile with a full understanding of related conditions. These physicians are engaged on a regular basis to talk with our nurses and our medical director about individual cases that don’t fit the protocol."
Accordant’s model is telephone-based. Registered nurses follow scripted assessment tools that include proactive patient monitoring and education to prevent adverse events. Specialized crisis management is provided to reduce the magnitude of events that do occur. When a patient is having a problem, the nurse will e-mail, fax, or call the patient’s physician.
For patients with multiple sclerosis, the nurses will assess any difficulty with urinary tract infections or bowel management. A patient doing well in that area will receive encouragement. A patient having problems will receive an intervention in cooperation with the physician.
"The patient becomes more sensitized to urinary tract infections, and there’s an opportunity to intervene with antibiotics more quickly," McIvor says. "We can eliminate a potentially unnecessary five-day hospital stay." A sample intervention for Parkinson’s patients is a safety assessment of the home environment to prevent falls. The company has in place a formal process to constantly review these interventions and protocols for changes needed based on new research.
Keep the information flowing
It’s not just the protocols that make Accordant’s program successful, it’s also the technology that makes certain no patient falls through the cracks. Accordant has invested in integrated telephone, fax, and Internet systems that allow real-time information transfer between Accordant and patients, physicians, medical advisors, and ancillary providers.
Their proprietary software system automatically generates interventions for patients, even while nurses are still on the phone with them. If a patient answers yes to a certain question, the system will automatically generate a letter or patient education piece to be sent to the patient or physician.
The system also allows predictive dialing of patient phone numbers, and patient’s files pop up on the screen automatically so no time is wasted.
"I saw firsthand the frustrations of patients who wanted to get information in a way that respected them as a person," Schelhammer says. "This technology taps into patient empowerment. It gives patients options to communicate on their own time."
Benefits of Accordant’s technological investments include:
clinical decision support tools that incorporate artificial intelligence and decision-tree logic to enable more efficient patient assessments and systematic interventions; multidimensional data warehouse to integrate patient-reported clinical, functional, and paid claims data; Internet utilization to reach patients, providers, and payers with Web-enabled information; re-engineering of disease management workflow and resource management processes to accommodate new telecommunications and computing platforms.Accordant’s enrollment growth has resulted in the need for more staff and space. The company is doubling the size of its corporate headquarters and is increasing clinical and administrative staff by 474%.
[For more information, contact Accordant Health Services, 4900 Koger Blvd., Suite 300, Greensboro, NC 27407. Telephone: (800) 948-2497. Web site: www.accordant.com.]
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