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Disease Management Wins Drive Essentia Toward ACO

Joe Cantlupe, for HealthLeaders Media, June 9, 2011

Essentia has established what she terms a true team, of nurses and physicians, overcoming the fact, she says, that physicians, generally, have not been adept at disease management. In the healthcare reform era, that is something that physicians must continue to work on, she says.

"I'm not picking on physicians, but they haven't really been trained in disease management," Wick said. Not all physicians are fuzzy with disease management. "Primary care docs, they get it, they totally get it," she explained. The particular area of concern in developing disease management programs with physicians involves the specialty physicians, such as cardiologists.

Disease management is all about keeping tabs with patients who may lose their way. For instance, as Wick says, patients' doctors may have taken away their salt shakers, and that is all well and good, but deep down, patients are still having a problem with sodium intake. "They still may have that chicken sandwich at McDonald's and they think it's OK, but it's loaded with salt," she says. "That piece of disease management, discussing that, is something nurses are trained to do."

Referring to the subspecialties who sometimes stumble at disease management, Wick says, "I

"I think cardiologists are trained as procedurists and it's harder for them to understand disease management," she says.

To augment its system, the hospital uses a telemonitoring scale system, in which a patient sets up a scale in his or her home, which takes their weight, for instance, and that information is linked into the hospital. The system poses questions about the patient's health and it is something that the patient is supposed to step on every day. Information is transmitted to a cardiac nurse, who can make adjustments if necessary, based on medication, and track the patient's condition.

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