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THE NUMBERS ARE staggering. Worldwide, 388 million people will die from chronic diseases in the next 10 years. Healthcare
spending in the United States totaled $2 trillion in 2005, and is expected to double by 2015. Chronic diseases account for
about 75% of all healthcare costs. Clearly, disease management and prevention is sorely needed, but it's been a struggle to
change the behaviors of large groups of people. A number of programs are finding success using non-traditional methods.
By leveraging trusted relationships between doctors and patients, CHD Meridian Healthcare, an I-trax company, boosted enrollment
in disease management programs 300% at Goodyear Tire & Rubber Co. in the first year of a research study. The study included
2,000 employees who were invited to participate in disease management programs by a clinician they were familiar with from
the company's worksite health center.
"The premise we were working under was that we could get higher participation rates by clinicians engaging their patients,
rather than through the telephonic approach," says Ray Fabius, MD, president of CHD Meridian Healthcare and a co-author of
the study, Disease Management Engagement Rates: Leveraging the Trusted Clinician. "We were optimistic we would double the conventional rates, but our results were even more dramatic. We've seen a three
to five times greater engagement rate when leveraging a trusted patient-clinician relationship."
MAKING CONTACTMany of the patients were invited into the programs face-to-face during regularly scheduled checkups. Others were phoned by
the clinicians. Dr. Fabius says something as simple as using contact information the patients gave to the clinician, rather
than their employer, greatly boosted initial contact rates.
"One of big challenges involved in disease management efforts is having the right phone number, timing the call when the patient
is at home and actually making direct telephone contact," he says. "We found that people are more likely to share their cell
phone numbers with their clinician than with their employer, which is traditionally how contact information is collected."
Dr. Fabius says the study had a 96% contact rate, which is lower than he would have liked, but still squashed the 56% contact
rate normally achieved through traditional plans. Many types of communication technologies—from call centers to in-home monitoring
devices to e-mail and instant messaging—have been studied in the past, but this was one of the first to measure the results
of relationships.
"We're talking about a behavior change, and that's hard," Dr. Fabius says. "I think we'd all agree that we'd be more likely
to motivate someone to change their behavior if we have an underlying trusted relationship with that person."
In addition to improving contact rates, Dr. Fabius says the initial data points toward increased follow-through rates as well.
Traditional programs lose about half their participants in the first six months, he says. Again, the relationship keeps the
participants engaged.
PUSHING LONG-TERM CHANGE
An innovative disease prevention program in Minnesota is also using the power of relationships, media and the government to
attract and retain participants. Blue Cross and Blue Shield of Minnesota is using funds from a tobacco industry lawsuit settlement
to collaborate with various members of the public and private sector on disease management and prevention.
"The science is clear: We've got to do different things than what we've traditionally done to impact behaviors in a large
population," says Marc Manley, MD, vice president and medical director of population health at Blue Cross.
