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A New Approach to Self Management of Chronic Diseases Category: Healthcare Practice by - October 29, 2013 | Views: 23953 | Likes: 2 | Comment: 3  

Chronic disease self management and training

Healthcare Innovation: NutriTutor® Introduces a Different Appraoch to Patient Education and Self Management of Chronic Diseases 

Few Americans ever learn how to prevent and treat their chronic diseases by following evidence-based guidelines. This lack of disease self-management knowledge has profound financial and emotional consequences on people with chronic diseases, also their families, employers, and the whole of society.

Long before primary care practices were given the responsibility, as medical homes for chronic diseases, to offer patient-centered training Laurie Van Wyckhouse, a Registered Dietitian, set out to solve this very problem. Armed with her Master degree in education and the philosophy that solutions must be winning for all effected parties Van Wyckhouse transformed the patient training paradigm from one that is clinician-driven and lecture-focused, to an interactive learner-centered model designed to empower and support. Hence the establishment of NutriTutor®, providing patients with low cost access to medical training; physicians with a new medical home compatible service line; insurance companies with fewer claims; wellness companies with a genuine medical service; employers with reduced absenteeism; and all citizens with lowered healthcare costs. 

NutriTutor®, complete with telehealth clinician assistance, offers the first step to solving the chronic disease crisis in our nation.  

The epidemic of chronic diseases in our country creates a growing need for businesses, government agencies, medical clinicians, and individuals to proactively control the rising cost of healthcare. Forty-five percent of Americans suffer from at least one chronic disease, while 27% of Americans have multiple chronic diseases. This second group costs our nation $2.00 out of every $3.00 spent on healthcare. According to the Centers for Disease Control and Prevention, chronic disease accounts for about 75% of the nation's aggregate health care spending. In taxpayer-funded programs, treatment of chronic disease constitutes an even larger proportion of spending - 96 cents per dollar for Medicare and 83 cents per dollar for Medicaid. A Milken Institute analysis determined that treatment of the seven most common chronic diseases, coupled with productivity losses, cost the U.S. economy more than $1 trillion dollars annually. The trickle-down effect is profound. Corporate America now spends an unsustainable 44% of benefit costs on healthcare. Our nation is reeling under the burden of uncontrolled chronic disease and yet, according to the Milken Institute analysis cited above, modest reductions in unhealthy behaviors could prevent or delay 40 million cases of chronic illness per year.

Unfortunately, reimbursement for medical disease management training is not available for most chronic diseases. When it exists, compensation is so complex and time-consuming to process that many dietitians in private practice refuse to participate.  Patients are forced to pay out-of-pocket for services rendered. Comparatively few hospitals offer out-patient medical education services, and for the most part, programs are treated as an afterthought. Worse, one-on-one and group training classes rarely supply critical skill development and are costly. To eliminate these problems, both reimbursement and training strategies must be overhauled.

The realm of diabetes supplies us with a good example. People with diabetes develop double the chronic diseases and cost the nation 230% more than people without the disease. Diabetes Self-Management Training (DSMT) is a ten hour long medical training program that teaches people with diabetes all they need to know to stall disease progression and manage their multiple chronic diseases. DSMT is a reimbursed program that supplies a proven $4.34 return on investment for every dollar spent, yet potentially as few as 1% of Americans ever learn how to manage their diabetes.   (Boren, Fitner, Panhalkar, and Specker 72-96 and "Diabetes Education Fact Sheet") The American Association of Diabetes Educators End of Year Report describes some of the barriers preventing patients from taking advantage of this essential training (Peyrot):

  • 41% of physicians do not have enough referral sources
  • 21% of people taking classes are not covered by insurance
  • 38% of patients report they cannot fit classes into their schedules
  • 28% of physicians do not like the quality of the programs

Customary DSMT programs are focused on clinicians and reimbursement; therefore, they are replete with learning barriers. For patients, these obstacles include poor accessibility, lack of skills training, high fees, inconvenient class schedules, and inconsistent quality of teaching. Once the ten hours of lecture has ended, patients are left trying to apply the overwhelming amount of information received using skills they do not have, and with little or no support. The current state of reimbursable diabetes training leaves abundant room for improvement. Policy-makers and clinicians must keep in mind that peoples’ very lives are at stake.

What do people rely on in the absence of evidence-based learning?   

Empirical indications suggest that most Americans learn how to manage their chronic diseases through widespread and unreliable advertisement-based messages. We have all experienced this. To demonstrate this premise; should carbohydrate foods be avoided when you are trying to lose weight or control diabetes? If you answer, “yes”, you have fallen victim to effective and deceptive advertising. (To learn what scientific evidence supports, read the following message from the American Academy of Nutrition and Dietetics.) Gimmicks and fabrications will never effectively control chronic disease. All Americans must have access to evidence-based training if we hope to contain healthcare costs and improve lives.

By combining the cost-effectiveness of technology with solid training principles NutriTutor® sets the new standard for medical disease self-management training. For a fraction of the usual cost, learners receive comprehensive training, telehealth assistance, and long-term social support. Learner-centered and brimming with interactive skill practice and personalized feedback all programs come with customized meal plans using a proven weight loss system and a robust set of customized downloadable tools. Programs encourage disease ownership, critical thinking, goal-setting, behavior change, lifelong learning, relevant communication with the healthcare team and appropriate use of medical services. NutriTutor® provides patients the best opportunity to manage their chronic diseases and prevent disease progression.

Positioned for reimbursement and flexible for both patients and companies, NutriTutor® programs achieve compliance with legal, medical home and value-based purchase guidelines. Outcomes are collected and shared with the medical team for proper coordination of care while customized platforms allow for telehealth and onsite clinician integration from any company and any location. Training can be purchased through NutriTutor® by individuals or groups, and companies can offer turnkey branded training from their own websites. NutriTutor® is a powerful and flexible tool designed to combat an unrestrained and expensive epidemic of chronic diseases.

  1. Anderson, Gerard. Chronic Care: Making the Case for Ongoing Care (2010): n.pag. Robert Wood Johnson Foundation. Web. 28 Oct 2013. 
  2. "About the Crisis." Rising Rates of Chronic Disease and the Future of Health in America (2013): 3. Partnership to Fight Chronic Disease. Web. 28 Oct 2013.
  3. "Chronic Disease Costs U.S. Economy More Than $1 Trillion Annually." Milken Institute Study (2013): n.pag. Partnership to Fight Chronic Disease. Web. 28 Oct 2013.
  4. National Diabetes Fact Sheet, 2011 (2011): n.pag. U.S. Department of Health and Human Services, Centers for Disease Control. Web. 28 Oct 2013. 
  5. Boren, S, K Fitner, P Panhalkar, and J Specker. "Costs and Benefits Associated with Diabetes Education: A Review of the Literature." Diabetes Educator. 31.1 (2009): 72-96. Print.
  6. "Diabetes Education Fact Sheet”. American Association of Diabetes Educators, n.d. Web. 3 April 2012. 
  7. Peyrot, Mark. AADE DSMET Access Grant Project, 2007 End of Year Report. (2011): n. page. Web. 28 Oct. 2013.

About the Author

Laurie Van Wyckhouse, MS, RD/N, LD/N, author and creator of NutriTutor®, has taught people how to manage their chronic diseases for over 30 years. Visit us at www.nutritutor.com.

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