02/23/2010
Stanford's Chronic Disease Self-Management Program (CDSMP) launched in 1992, and the results were impressive. People who completed the program had more energy, engaged in more social activities, gained confidence, improved communication with physicians, and developed an overall sense of empowerment. Lorig published these results in the journal Medical Care in 1999, along with even more tangible findings: those who completed the program reported fewer doctor visits and fewer nights in the hospital. Overall cost savings could be substantial. Based on a conservative savings estimate of $500 per patient, if even 10 percent of the 133 million chronic-disease sufferers entered such a program, health care savings would be $6.65 billion in the first year alone.
First adopted nationally by Kaiser Permanente in 1998, the CDSMP and others like it have spread rapidly and are now offered in most states and 20 countries. "I just feel awe at how it's taken off," says Lorig, who has adapted her workshop for online use and whose book—Living a Healthy Life With Chronic Conditions—is now in its third edition.
"This is a powerful program that has transformed the lives of people who go through it," says June Simmons, CEO of Partners in Care Foundation, a nonprofit community health organization responsible for disseminating the Stanford program throughout California. The foundation has offered 285 workshops and reached more than 3,600 Californians; it aims to enroll 9,500 Californians by 2011. "That's still not enough," insists Simmons. "The current system needs to provide more funding and insurance reimbursements so it can be more widely available."
With the exception of Kaiser, which pays workshop trainers and offers the Stanford program as a standard benefit, most insurers do not cover the cost of prevention and self-management programs. "Few people get reimbursed for these programs," says Lorig, "which is why we need health care reform."
"Most health plans are only beginning to address chronic-care management," adds NCOA's Nancy Whitelaw. "There's a disconnect in the traditional medical-treatment model in that the importance of prevention, nutrition, and disease self-management is not yet embedded in our notion of what delivers health. But we're trying to change that."
NCOA and other organizations such as the National Health Council—whose core membership includes about 50 of the nation's leading patient-advocacy groups—are lobbying hard to ensure that the health care reform bill of 2009 addresses the needs of people with chronic illnesses.
In the meantime, at Stanford University, Kate Lorig and her Patient Education Research Group push on, training new workshop leaders (5,000 so far) around the country. Also in development are disease-specific (cancer, diabetes) versions of the program.
On a blazing-hot Wednesday afternoon in September, at a senior center in Van Nuys, California, a CDSMP workshop is in progress. Another crucial element responsible for the program's success soon becomes clear: the knowledge and empathy of workshop leaders, one of whom, on this day, is Sharon Janis, the woman who lost both her father and mother to chronic illness.
Recruited and trained as a workshop leader after she completed her own training, Janis continues to adhere to her Action Plan, working out at the gym most mornings and cutting out sweets and other high-calorie fare. So far she has lost 80 pounds—and she's determined to lose 30 more.
"I have the attitude that I'm going to live a good, long life even with diabetes," says Janis. She plans on traveling again—first to Israel, then a return to Paris. Only next time, she continues, "I won't have to worry about my health getting in the way."
Mary A. Fischer, a writer in Los Angeles, last wrote for this magazine about biologic drugs (November-December 2009). |
