Advanced Disease Management: Helping Patients Cope with Serious Illness

Meeting the demands of both healthcare reform and patients and their physicians, advanced disease management (ADM) programs are a patient-centered tool, like palliative care, that addresses serious illness from the perspective of intensive comfort care. They are typically run by physician groups and healthcare systems.

A nurse practitioner often leads the ADM team, partnering with the patient’s PCP or specialist physician. Other team members can include a physician, pharmacist, social worker, dietician, spiritual care counselor and/or therapists, as needed. Together they:

• Address pain and symptom management
• Educate the patient and family about the trajectory of the illness and what to expect
• Help the family talk about complex medical decisions that must be made and how treatments will affect everyone’s quality of life

Like palliative care, ADM bridges the gap between curative care and hospice. The goal is to save money for insurers, including Medicare, while providing appropriate care for patients with serious progressive illness. According to a recent study in Health Affairs, medical costs in the last year of life are $80,000 per patient in the US, with more than 44% of those costs spent in hospitals.¹

How Advanced Disease Management Helps Patients and Families

ADM keeps patients out of the ED, ICU, skilled nursing facility, etc. It supports physicians by serving as a “first responder” to patients and families with fear, anxiety and questions who may demand frequent attention. And it communicates with patients about advance care planning and end-of-life care, topics research shows are not handled consistently or well by most physicians.²

Like palliative care, ADM is covered to some extent by some insurers—home visits, for example, may not be included. Services not covered by insurance can be paid for by the patient. ADM is appropriate at any stage of the patient’s disease and can be received along with curative treatment. ADM serves as a gateway, easing patients and families into home hospice services—sometimes earlier than would otherwise happen.

Advanced disease management is another device developed to achieve the Triple Aim, and to address end-of-life care appropriately. It is early initiation of palliative measures and intensive comfort care begun when there is still time to improve the quality of life for a seriously ill patient.

¹http://content.healthaffairs.org/content/36/7/121

²https://www.johnahartford.org/blog/view/talking-with-patients-about-end-of-life-care-new-poll-reveals-how-physician