The Scott and White Experience—Chronic Disease Management on a Shoe String

It was a good year—1999. One of our Scott and White Medical Directors had been sent elsewhere to learn about Chronic Disease Management (CDM) and implement a pilot CDM program at Scott and White through the Scott and White Health Plan (SWHP). Scott and White is an integrated health care system composed of a 450-bed hospital, a 500-physician multispecialty clinic, and a 186,000-member HMO, with 15 regional clinics. The appointed leader, one of SWHP’s medical directors, was young, energetic, and authoritative. Without much ado, four RNs were hired, and a physician champion was appointed at each clinic where the nurses would be assigned. Each nurse was given a laptop computer and BOOM—we were in business. Patients were identified by SWHP data or by physicians. The nurses were expected to assess the patients’ status and implement a plan of proactive care.