The most popular position in chronic disease management

If you want to ask what is the most popular position in the field of chronic disease management right now, the answer is undoubtedly Comprehensive chronic disease case manager that connects clinical, public health and payment ends——He is not a traditional chronic disease specialist who sits in a community office and records follow-up files, nor is he a specialist who only sees patients and writes prescriptions. He is a dedicated manager who can cover the entire process of patients from post-hospital intervention, daily management and control to expense write-off.

To give you the most intuitive example, last month I went to a sub-district health service center in southern Jiangsu for research. They posted a recruitment notice for this position in the spring of this year. The annual salary is 250,000 yuan with a staff establishment, which is 30,000 yuan more than the basic salary of a general practitioner with the same seniority in the same unit. After recruiting for almost half a year, they have not yet found a candidate who fully meets the requirements. The director in charge of recruitment sighed at me: “The nurses who came before were either nurses who only knew clinical medicine and didn’t know anything about the medical insurance policies, or they were public health students and couldn’t even tell the appropriate groups for commonly used antihypertensive drugs. It was hard to find a nurse who knew something about commercial insurance, but he didn’t know how to communicate with elderly patients. He would get annoyed by just a few words. ”

Although this position sounds like it is just for "taking care of patients," it is the result of the rigid needs of three parties. There are now more than 300 million patients with core chronic diseases such as hypertension and diabetes in the country. The DRG/DIP reform of medical insurance has been promoted for almost three years. Whether it is a tertiary hospital or a grassroots community, the readmission rate and complication rate of patients with chronic diseases are regarded as hard assessment indicators. If they are not managed well, money will be deducted. ； In the past two years, commercial insurance has also been vigorously promoting exclusive medical insurance for chronic diseases. The risk of loss is not small. There is an urgent need for someone to help control costs from the front end. ； Not to mention the patients themselves. Many elderly patients with chronic diseases have to go to the hospital to get re-examination orders, to go to the medical insurance bureau to apply for special registration, and to take medicine, they have to struggle with what different doctors say. There is a fixed person who takes care of everything, and there are many people who are willing to pay.

Of course, there are many people who disagree with this statement. I met an MCN person in charge at an industry salon a while ago who is doing science popularization on chronic diseases. He said that now he is doing IP for C-side science popularization. With an account with hundreds of thousands of fans, he can start a science popularization cooperation with a pharmaceutical company in the six figures, which is much more profitable than being a case manager. This is not unreasonable. Last year, I did know a blogger who did popular science on hypertension. He was a cardiology nurse. He gained 800,000 followers in half a year by talking about medication taboos, and his advertising quotation alone was only 30,000. But the problem is that the uncertainty of this kind of job is too high. The blogger later said that a beta blocker was suitable for the wrong group, and the patient complained to the platform, and the account was directly restricted. Now he has lost more than half of his followers, all advertisers have left, and he can only go back to the hospital to work. Essentially, you are relying on traffic. Policies, algorithms, or even if you say the wrong thing one day, your job will be gone. It is completely different from the hard-and-required position of a case manager.

Some people also say that the chronic disease MDT coordination position in a tertiary hospital is also very popular and the income is not low. This is true, but most MDT coordination positions are only for patients with severe chronic diseases such as tumors and heart failure. The audience is too narrow, and most of the work is to coordinate multidisciplinary consultation time and organize medical records. The ceiling is very low, and even after working for ten years, I am still a coordinator. But case managers are all-inclusive. Grassroots communities want you to manage ordinary patients with chronic diseases and conduct public health assessments. The post-hospital management center of a tertiary hospital wants you to reduce readmission rates. The health management department of a commercial insurance company wants you to do user retention and cost control. Even now, many high-end private clinics and retirement communities are competing for people. There are too many choices.

I previously talked with a case manager in Shanghai who has been working for three years. She currently manages 217 patients with chronic diseases. The busiest time is from 7 to 9 in the morning. The mobile phone keeps ringing with messages from uncles and aunts, all of which are blood sugar and blood pressure values. She has to read them one by one. If something is wrong, she will immediately give medication suggestions or help make an appointment. At the end of the month, she has to submit control data to the Medical Insurance Bureau and receive assessment subsidies. If the patient has commercial insurance, she also has to help organize claims materials. She used to be a community nurse, and her monthly salary was only 8,000. Now, including the basic salary, patient service fees, medical insurance assessment subsidies, and occasional user training expenses for commercial insurance, she can earn more than 300,000 a year, which is more than the deputy director of their community center earns. Now several commercial insurance companies are poaching her, and the asking price has reached 400,000.

To be honest, in the past few years, chronic disease management was all the rage. Everyone was making apps, smart bracelets, and big data platforms. They spent a lot of money, but in the end they found that it was useless. No matter how fancy your software is, no matter how loud the push notification to remind you to take medicine, the patient doesn’t want to take it or doesn’t take it. If his blood sugar is high, he doesn’t know who to ask. In the past two years, the industry has finally been established, and it has been found that the core still relies on the service of "people", and there are very few people who can connect clinical, policy, and payment, so they naturally become popular.

Of course, this does not mean that other chronic disease positions are worthless. If you are naturally good at content creation and have strong expression skills, you can also make a career in science popularization positions.； If you are good at data analysis, chronic disease epidemiological research positions are also talents that major disease control and pharmaceutical companies are competing for. But if we look at it comprehensively, whether it is the intensity of demand, the stability of income, or the room for future growth, the composite chronic disease case manager is indeed the most popular choice at the moment - after all, a position that can solve the pain points of hospitals, payers, and patients at the same time will never worry about being out of work.