Health for life

Now that 2011 is gone, this is a good time for the Disease Management Care Blog pause and take stock. How is it doing?

It likes to think of itself as a unique ongoing journal club on the organization, delivery and financing of health care.  If the DMCB was soup, thered be three ingredients:

1) reliance, whenever possible, on peer-reviewed and published evidence,

2) a physicians "real world" experience and

3) a ready dash of skeptical humor.

The DMCB must be doing something right.  Despite a narrow mix of medical science, economics, effectiveness and policy, the DMCB has attracted a relatively large and elite readership.  If youre reading this, that means you. 

Sophistication

When it looks at the ISPs of its many return visitors, the DMCB sees dozens of academic institutions, big and small name news media outlets, publishing houses, trade associations, information technology businesses, Congress, CMS, the White House, state government, foundations, commercial insurers, hospitals, health care consulting organizations and population management service providers. Many are household names.

It doesnt stop there. The DMCB has been contacted by and gotten to know folks from all levels in the health care industry.  Based on those conversations, it knows this a smart group.  The author of this blog is a better person for it.

The DMCB knows each regular visitor, twitter follower and Google subscriber has been earned one person at a time. It knows its elite readers are knowledgeable, active or interested in health policy, population health management, the patient centered medical home or primary care. These are not casual readers.

And you have a lot of company:

According to Google Analytics mix of ISP addresses and cookies, DMCB Ver. 2011 had 29,000 unique visitors with 42,000 visits. A third were repeat (defined as more than one) visits.  While there is no definition of a "regular" reader, the number of visitors with more than 50 DMCB "hits" in 2011 numbered 5153. There were 786 visitors with more than 200 hits. 

The DMCB also has 416 Twitter followers.  According to TweetReach, the DMCB regularly reaches almost 1500 persons with its tweets.  Depending on re-Tweets, that number can exceed 7000. 

There are also 466 Google RSS subscribers. 

These 2011 numbers suggest there are thousands of persons that regularly read the DMCB.  Every individual visitor, follower and subscriber returned or opted-in based on the DMCB content and only the DMCB content. There is no marketing, emailing or use of any services to promote the DMCB. It doesnt have the advantage of a sponsoring institution or explicit link to a big-name business. And its readership continues to slowly grow.

The DMCB Web Juggernaut

The DMCB is regularly lected and linked in many prestigious web outlets, include HealthHombre, Health Affairs, KevinMD, Forbes, and many sister blogs. Its also appeared in the web sites of USAToday, Wall Street Journal, the Washington Post, Dartmouth Atlas, Business Week and the National Review. Its also been linked in the intranet web sites of many insurers, provider organizations, and health information tech companies.

And, by the way, according to YouTube, the DMCBs videos to date have had 33,486 views.

As testimony to its growing web presence, the DMCB is on the first page when the term "disease management" is Googled.  The DMCBs growing web traffic has ironically made its "Comments" section a target by spammers with links to its dubious medical web sites.  With only one unobtrusive Google "Ad" that generates pennies per click, it still got a check for $100 (prompting the derision of the DMCB spouse, but thats another post).  The DMCB has also been offered - and used - cash to provide link backs.  It also had one complaint lodged over copyright infringement over an image (the post has since been removed, with apologies).  Simply put, folks are paying attention.

Last but not least, the DMCB is proud of its four 2011 peer reviewed publications in Population Health Management, Self Care and the Journal of Comparative Effectiveness Research.

And a thank you....

... to the readers who have commented or emailed with feedback, comments and insights.  To the readers who use their precious time and keep coming back.

In the beginning of 2011, the Disease Management Care Blog amazed, astounded and impressed itself with a series of health care system and industry predictions.  Unlike those lesser blogs that post predictions and conveniently neglect to report back to its readers, the DMCBs commitment to being transparently outcomes-based prompted it to pose the awkward questions that few in the blogsphere are brave enough to ask:  how did its prognostications perform? What accuracy did its augury attain? How did its foretelling function?
Here are the DMCB hunches and brutal self assessments:

1. CMS will delay the January 1 start date for the CMS Shared Savings Program.  The DMCB got that one right.  The usual bureaucratic inertia plus having to respond to the consternation over the initial proposed rule pushed the start date back to April 1.  By the way, this is only one of many missed Affordable Care Act deadlines, so this wasnt all that hard.

2. Despite its luster, adoption of social media in health care settings will not attain a tipping point:  The DMCB got that one right. It knew that front line administrators in clinics and hospitals dont see a financial return on investment for social media and remain notoriously paranoid over HIPAA.

3. Berwick will be confirmed as CMS Administrator.  The DMCB blew this one but should have known that too few U.S. Senators and their staffers regularly read Disease Management Care Blog.  With time, that should change.

4. Naive enthusiasm over the electronic health record and PCMH will bump into painful reality: The DMCB will call this one a draw because use of the EHR has been boosted by the CMS "meaningful use" bribes payments.  Without them, the EHR business case would have to be based solely on spotty quality and phantom claims of cost savings. The PCMH, still lacking any consistent and statistically significant proof that it reduces costs, is still very much alive because of its growing link to ACOs. Thats appropriate, because ACOs likewise lack any proof that they reduce costs.

5. Despite the advent of a new health care era courtesy of Mr. Obama and the ACA, health care costs will depressingly continue to go up.  Bingo says the DMCB.  According to this report on how things are looking for 2011, medical costs are expected to hit 9%.  Thats less than 2010 but still far outstripping the general rate of inflation and evidence that more and more of our GDP is being gobbled up by health care.

6. The population health management industry will continue to thrive:  The DMCB got this right too.  The Care Continuum Alliance is as big as ever and there has been no abandonment by commercial insurers of their commitment to patient coaching and support. 

7. The term "disease management" will use to die.  To the many experts and consultants the DMCB interacts with, purchasers and buyers know that a rose by any other name still smells as sweet.  Call it "care management" or "population health" or "disease management" and no one really seems to care. because they know "disease management" has matured.

8. The political stalemate will continue.  Talk about a no-brainer but even the DMCB underestimated Mr. Obamas reliance on his liberal progressive roots to the detriment of bipartisan compromise.  Yes, theres plenty of blame to share on both sides of the aisle and while it may not be the Presidents fault, the DMCB thinks hes still responsible.

9. Greater interconnectedness will make us more vulnerable and unpredictable "black swan" events will preoccupy Washington DC: while there were no unexpected health care events, who would have foreseen the Arab Spring, the near death of the Euro, the impact of the Tea Partiers and the downgrade of U.S. debt?

10 The DMCB will reach a critical mass - more on that in a future post but its 2011 annual report suggests the DMCB juggernaut is well on its way.

Happier than......

.... a statistician in a care management data center.

.... a diabetes care manager in a crowded pastry shop.

.... a specialist physician at a RUC meeting.

.... a bank robber at a RAC audit.

.... a potato chip vendor outside a medicinal marijuana store

.... a lap band manufacturer at a Governor Christie news conference.

.... a vampire at a glucose meter testing lab.

.... spandex at a wellness vendor trade association meeting.

.... a bankruptcy lawyer at an Accountable Care Organization convention.

.... a CMS official watching a National Geographic Channel special on sloths.

.... a health economist at a fog-machine quality assurance testing facility.

.... a personal injury attorney reading an electronic health record.

.... an ADHD patient with a Twitter account.

and last but not least.....

.... a skeptic discovering the Disease Management Care Blog.

The DMCB invites readers to submit their own.