Disease management is a preferred model in the managed care industry to save costs and improve patient health. Typically, programs are aimed at reducing hospitalization rates for conditions such as diabetes, congestive heart failure and asthma. Can it work for patients with obstructive sleep apnea? You bet, say two providers whose programs have increased compliance rates and created a buzz among referral sources.
S.W.E.E.T. DREAMS
Health Complex Medical, Waterbury, Conn.
Successful compliance of patients with obstructive sleep apnea is the goal at Health Complex Medical. Its S.W.E.E.T. DREAMS disease management program relies on compliance tracking to provide details on how patients are doing and how to address problems that are indicated by the results.
Laura Castricone, CRT, is director of clinical services for the company. Castricone says she and her staff of 13 clinicians “exhaust all avenues” to ensure patient compliance and produce positive short- and long-term outcomes. This approach involves detailed education, mask choice and, if needed, the use of auto CPAP to determine appropriate pressure levels.
“We try to be partners with the sleep labs and the doctors and let them know that we're here to help them help their patients and make their patients compliant in any way, shape or form that we can,” Castricone says.
“We try different masks, and we will send therapists out any amount of times to re-educate them about the equipment or anything else they don't understand.”
The company provides 24/7 emergency coverage so patients can call at any time to report a problem.
“We try to troubleshoot issues over the phone, but if we cannot come to a satisfactory solution that way, we will send a respiratory therapist to the home to see the bigger picture. If a patient has a broken or non-functioning unit, we will lend them one while we send theirs off to the manufacturer for diagnosis and /or repair,” says Castricone.
The S.W.E.E.T. DREAMS disease management program focuses on the critical areas of education and compliance and uses the acronym S.W.E.E.T. to describe the components, including:
S - Set-up: Patients have the opportunity to spend time one-on-one with a clinician and try equipment and interfaces.
W - Watchman: The follow-up program ensures patients are complying with their prescription and prompts intervention when problems arise.
E - Equipment maintenance and reorders: Patients are encouraged to replace their supplies in a timely fashion to help facilitate compliance and therapeutic results.
E - Education: The clinical team frequently speaks at area sleep support and A.W.A.K.E. group meetings.
T - Team approach to therapy and treatment: By utilizing a team approach to care, Health Complex Medical partners with physicians, sleep facilities and patients to provide quality care, education and support.
SLEEP HEALTHY PROGRAM
Premier HomeCare, Louisville, Ky.
Premier HomeCare believes educating patients with obstructive sleep apnea is a solid investment in patients' health and the future of the company.
The company's disease management program, Sleep Healthy, is initiated with all sleep therapy set-ups. Patients receive educational materials and customer support services to help them better understand their diagnosis and their prescribed therapy. The amount of education they receive along with continued follow-up ensures patient compliance, according to company officials.
“We commit a lot of time to the initial set-up,” says John Cason, vice president of marketing. “We drive home the long-term effects of untreated OSA and reinforce the information [the patient] received from the sleep lab. We then contact them within 24 to 48 hours to determine if they are having any challenges with the therapy.”
Premier HomeCare also has a “one-time” mask-fit guarantee that allows patients to exchange their mask at no cost if there are complications during the first 30 days.
Program participants receive a 20-page booklet that includes information on diagnosis, treatment and common issues such as side effects, equipment maintenance, travel, equipment problems and patient concerns. It also lists frequently asked questions about OSA and OSA therapy. Additionally, patients can access charts that detail concerns about equipment and therapy and address possible causes and solutions.
Cason adds the company's disease management program is about educating referral sources as well as patients about the importance of therapy. This is done through routine educational programs and creative initiatives such as an affiliation with local YMCAs that offers program participants a free 30-day trial membership.
A recent innovation has sales representatives wearing t-shirts to promote the message that treating OSA results in a healthier lifestyle. To date, six out of seven of Premier's locations are involved in the YMCA program.
The benefit for physicians, says Cason, is that the program provides appropriate assessment of patients' functional level and improves their quality of life. It also allows for a steady line of communication between the company, its patients and physicians.
The Sleep Healthy program involves these components:
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Education on the disease process, prescribed therapies and medications, and equipment management;
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Home visits by a licensed health care professional, typically a respiratory therapist;
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A home assessment;
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Respiratory assessment with oximetry screening; and
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Follow-up reports to the referring physicians.
Through its disease management program, Premier HomeCare has seen:
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Improved patient compliance;
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A reduction of hospital readmissions and emergency room visits;
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Increased patient self-management of the disease process;
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Increased awareness of the mask fulfillment program; and
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Increased awareness in primary care physicians.
