After I published my article last month suggesting that the Care Manager might be becoming the most influential person in healthcare, the Chief Medical Officer at my company CareCognitics, Spencer Kubo, asked me if he could expand the discussion and share the importance of the role doctors play in chronic care management as well.
Before I share his thoughts and perspectives as a doctor, I thought I’d first acknowledge that my previous headline was a bit click baity in nature. At the end of the day, it’s not really a competition between doctors and care managers and it doesn’t matter which one is more influential. The reality, as Spencer Kubo describes below and I say at the end of my last article, is that healthcare is a team sport and each player has their strengths and weaknesses. The point of my previous article was to highlight the rising importance of the care manager in healthcare and wasn’t meant as a commentary on the importance of doctors. We’re going to need everyone on board to improve healthcare and doctors play and will continue to play an important role.
Now, here’s some thoughts from Spencer Kubo, Chief Medical Officer at CareCognitics, on the role and importance of physicians in chronic care management:
Sunny Tara’s article was insightful, provocative and visionary. Certainly, the growing role of the care manager is transforming medical care and facilitating the transition to value based systems. The points about scale (# doctors/# patients), cost effectiveness and relationship building are spot on.
But, at the risk of sounding like Jack Nicholson in “A Few Good Men,” I would like to add some commentary on 2 often overlooked points about the role of the physician.
First, we need physicians to make the correct diagnosis. It would be great if patients presented to the clinic or hospital with a large note on their forehead that said “I have diagnosis X.” Then it would be very simple to activate treatment plans. But patients commonly present with non-specific symptoms and confusing signs. Patients need physician’s expertise and experience to sort through the noise and confirm the right diagnosis.
A simple example to emphasize the point – essential hypertension is easily defined by a sphygmomanometer. But how and when does one eliminate the possibility that a patient might have one of the secondary causes of hypertension, such as renal artery stenosis, primary aldosteronism, or Cushing’s disease? I for one would not depend on Dr. Google, especially when some of the testing is invasive.
There is hope that machine learning can help in making diagnoses but sometimes the clue to the correct diagnosis is not in the content but the way the message is delivered. Consider “I have chest pain” vs. “I have CHEST PAIN!!!” Intuition and the “art of medicine” are often needed.
Second, we need physicians to develop a treatment plan. This plan includes recommended treatments but also physiologic markers that help monitor whether the treatment is succeeding as planned (or causing harm) and whether or not treatments have to be escalated. As an example, the decision to escalate to consider surgery or device therapy requires a careful and comprehensive evaluation of risks, benefits, likelihood etc.
The bottom line is that patients come in a million shades of gray. Yes, there are tendencies and probabilities, but I have yet to meet a patient who says “it should be good enough if you treat me like the vast majority of patients.”
Once the diagnosis and treatment plan are established, there is no question that the care manager then becomes the most important cog in the machine. Physicians are not trained to be coaches and the effective execution of the plan does not require that level of expertise. The care manager has been transformative in monitoring and encouraging adherence to treatment plans.
And there is a second critical transformation that the care manager has enabled – bi-directional communication. No longer do we have to depend solely on the patient contacting the physician. The care manager has turned this one-way communication pathway to include regular communication initiated by the care manager, proactively checking on the progress of the patient. This is a million times more effective than the traditional paradigm.
We are in in such an exciting time in medicine – so many new developments that are sure to improve outcomes!
About Sunny Tara
Sunny Tara is the CEO and Founder of CareCognitics, a digital health company applying casino loyalty principles and data science to transform patient behavior. CareCognitics’ platform brings patented technology innovation from the casino, hospitality and retail industries to deliver unprecedented patient experience and digital engagement that, in turn, drives transformational patient behavior. Sunny works to create a win-win for physicians, payers and people with chronic conditions alike. His mission with CareCognitics is to improve the quality of life (QOL) for one million patients by 2022.
