A marketing approach to innovation in chronic care: new value for patients in Lombardian region

Abstract

Introduction : Disease management programs typically refer to multidisciplinary efforts to improve the quality and cost-effectiveness of care for patients with chronic diseases. This trend highlights the importance of assessing the clinical and public policy implications of this phenomenon from the perspectives of patients’ best interests and quality of care. This approach has been implemented in Lombardia Region (Italy) since 2011 for a set of chronic diseases in a sample of 5 Local Healthcare Units. The project is called CReG (Chronic Related Group) and aims to define a new organizational model to coordinate and integrate primary care for chronic patients out of the traditional “hospital-based” approach, with a key role played by Accura, a private disease management company. Theory and methods : Our research is focused on the evaluation of this project, in order to understand the clinical, social and economic value created for the enrolled patients based on qualitative and quantitative research: 3 focus groups involving chronic patients and their caregivers, family practitioners and nurses and 315 CATI (Computer-Assisted Telephone Interviews) to chronic patients. Results : The analysis shows that the patient's overall feeling towards this approach is positive. Data depict an improvement in trust towards the general practitioner but no evidence of significant change in trust towards Regional Health Service. The quality of human interaction with case managers (during consultations as well as during phone calls) is a critical success factor. Data show that MD’s prescriptions to patients enrolled in CReG are more compliant with clinical practice guidelines, just with reference to healthcare services and not to drugs. Discussion : From the performed analysis, it is possible to see how patients’ attitude towards CReG changes according to the degree of services usage. Conclusion : The analysis shows that Lombardia Region CReG definitely creates value for chronic patients. Some concern arise as for the economic burden of the prescriptions for patients who perceive an increase of the out-of-pocket financial costs and might reduce their compliance in drug consumption. Lessons learned : In order to maximize the perceived value of a disease management program, four value elements should be emphasized: (1) the quality of human interaction, (2) the availability of mobile tools and apps, (3) the deployment of a full range of opportunities for patient empowerment and (4) the existence of a digital social environment for patients’ experience sharing. Limitations : The assessment was conducted in an early stage of CReG and patients’ usage of the offered services was still limited. Suggestions for future research : A second assessment should be performed in a mature stage of CReG projects, including a benchmark analysis between different geographical areas.