Chronic Condition Self-Service: An Idea Whose Time Has Come?

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Opportunity To Expand Self-Service Into Major Chronic Diseases

Although the applications to ED, male pattern baldness, and performance anxiety demonstrate the viability of health care self-service, the model could have a much larger impact when managing chronic disease. Chronic conditions account for 75 percent of US health care spending yet are poorly detected and managed. Detection rates for chronic diseases range from 41 percent (mental health) to about 76 percent (diabetes). Detection rates are 47 percent for chronic obstructive pulmonary disease (COPD) and 60 percent for hypertension, and the latest national hypertension overall control rate was 48 percent. Outcomes are even worse in vulnerable health populations (for example, underserved minorities, people living in rural areas, LGBTQIA) and for high-stigma conditions (for example, schizophrenia, prescription and illicit drug use, HIV/AIDS).

Patients face several barriers within the current chronic disease care delivery model:

  • Doctor’s offices are often far away and out of reach, lack after-hours availability, and lack cultural and language accessibility.
  • Individuals with chronic conditions are perceived to require ongoing face-to-face interactions with a physician to manage their condition. The encounters, usually spaced three to four months apart for well-controlled patients, each require the patient to spend a few hours in a doctor’s office and away from their jobs and families for a total of 10–15 minutes of contact time.
  • Patients are expected to self-manage their condition for the 5,000 waking hours of the year between office visits.
  • The appointment scheduling structure for many providers is limited to 15–20 minutes for each follow-up visit, regardless of the patient’s comorbidities or communication barriers.
  • In their rush to collect information to meet quality metrics and justify their bill, providers often do not deliver value-concordant care or assess a patient’s barriers to initiating or maintaining behaviors to maximize their quality of life.
  • For those patients who are poorly controlled, some physicians feel ill-equipped to make the case for treatment intensification, leading to clinical inertia within the specific encounter and burnout for the provider.

Self-service could address many of these barriers. Self-service would be available on-demand with replies and other interactions at the consumer’s convenience, be language and culturally appropriate, provide check-ins as frequently as the patient would like or need, be driven along evidence-based pathways with health care workers working at the “top of their license,” use technology to automate most of the documentation (facilitating long-term reporting), and only use physicians for patients not responding to repeated escalations on a chronic care pathway.

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