I’m working on a management discussion question and need an explanation and answer to help me learn.

Appalachian Medical is a multidisciplinary medical practice that has embraced the community-of-practice concept of Accountable Care Organizations (ACO). This practice forms a multi-professional committee to identify services in order to improve clinical outcomes, maintain health in the population, and increase efficiency. There are over 50 physicians in the group practice, occupying 5 clinics spread over different locations. All five clinics are centrally emerged with a specially-designed Electronic Health Record (EHR) system capable of presenting patient information in a relevant, meaningful fashion.

The patient population that Appalachian Medical serves is demographically diverse, and Type 2 Diabetes Mellitus (T2DM) is a common diagnosis among these patients. This population provides a wide opportunity for the practice group to learn more about the disease. Specifically, since the practice also focuses on disease management of complex chronic conditions, such as T2DM, not only can this high-risk population potentially advance the knowledge about the associations of T2DM, but also provide a target for intensive interventions aimed at lowering glycosylated hemoglobin (HbA1c) blood levels. However, due to limited financial resources, the committee has to devise a strategy to identify those patients who are inherently more critical in order to use the resources at a much higher rate in these patients than other T2DM patients. The ultimate goal is to reduce HbA1c levels within 6 months for some patients.

Appalachian’s committee concludes that by deploying literature-tested predictive models, a focused strategy could be employed to help the team to select patients who require interventions, such as life coaches and other intensive treatments. However, such models require analysis of several patient variables obtained from the patient EHR, such as age, gender, race, prescription history, physician visits, family composition, occupation, benefit coverage, etc.

Case Study Questions

1. Some of the variables to be analyzed include personal and family factors. Present arguments for including patients and families in the initial team discussions.

2. Although the patient information is readily accessible through the EHR system at Appalachian Medical, should the patients give consent to participate in the intensive interventions? Provide justification for your answer, citing relevant Federal regulations.