Finding the first domino for your care management participants

Blog – March 16, 2016
Andrew Mellin
Andrew Mellin, M.D.

By Andrew Mellin, M.D., vice president, medical director, RedBrick Health

A Diabetic.  A Hypertensive.  A COPDer. I can’t count how many times I’ve heard a patient referred to by his or her disease. Nobody is “just a diabetic.” Nobody just has a disease or condition. Every individual is a complex interplay of clinical, behavioral, socioeconomic, genetic, spiritual, environmental and many other factors.

So is it surprising to learn that when people seek help to support their overall health and well-being, they often do not want to talk about their condition?  RedBrick Health has found that when people with diseases like diabetes, COPD, or heart failure first connect with our live coaches 80% of the time they don’t want to talk about their conditions; instead, they want to talk about some other aspect of their lives. The majority of the time they want to discuss improving another factor in their life that could directly improve their clinical condition.  As we’ve worked with these individuals, we’ve seen multiple times how identifying and addressing that first key factor – what we call the “first domino”- makes a measureable difference in changing that person’s path to health and well-being.

Here’s an example: Mary is a factory worker, obese, hypertensive, and has an HbA1c of 9.5. Mary is identified as a “high-risk diabetic.” Her doctor told her to lose weight and exercise, but she has been unable to make changes over the past few years. Mary’s “problem” is not diabetes. She has a high level of stress about supporting her family, which keeps her up at night during which time she mindlessly eats. Through live and digital coaching programs, Mary has learned that her first domino is stress. By learning how to more effectively deal with stress and be more resilient, Mary now sleeps better and is more mindful about her nutrition. She starts losing weight and reduces her diabetes medications.

What does this mean for managing the health and well-being of populations? Clearly, there is an important role for supporting very high acuity individuals through case management. Diseases can be complex, and people often need help from clinical experts coordinating care among their providers, and ensuring they receive the appropriate level of clinical support and all elements of evidence-based care. While this is enough for some, this approach alone may not make a meaningful, sustained change in the underlying behaviors that can improve each person’s disease and overall health and well-being.

The ideal approach augments case management with live and digital solutions that catalyze each person to identify his or her intrinsic motivation for change and find that first domino, regardless if that domino specifically addresses clinical elements of the condition or addresses lifestyle behaviors that underlie it. Then the individual needs ongoing, continuous step-by-step support through his or her personal journey towards better health.

The next time you look at the list of diabetics, COPDers, and CHFers in your population, remember that each person on the list has a first domino that most likely won’t fall by only addressing the disease. The best way to keep the dominos falling is through ongoing, individualized support that considers all domains of that person’s overall health and well-being.

Contact us to find out how we can help your care management participants find their first domino.