Archive for July, 2004

Preventative Medicine

July 29th, 2004 by Melanie Matthews

Yesterday during our audio conference on The Role of Behavior Modification in Disease Management: How To Maximize Your Program’s Effectiveness, one of our speakers mentioned the shift that needs to occur from sick care to preventive care in the U.S, remarking that we take better care of our cars than we take care of our bodies.

And while I eat my five servings of vegetables and fruits a day, exercise at least five days a week, drink 8 glasses of water daily, and am in “good health,” I hardly ever go to the doctor for “prevention.” I do, however, change my car’s oil every 2,000 miles.

It seems that even though my habits are healthy I still need “behavior modification.” 

Highlighted during yesterday’s conference, was a pilot project conducted by CorpHealth for a large employer group with 75,000 lives. The pilot project included 20,000 lives, Richard Citrin, vice president of health and productivity at CorpHealth. Based on an identification process, nearly 7 percent of the group was identified as being at risk for high healthcare utilization. The project used a variety of engagement and intervention strategies to address this group.

Also presenting was Gregg Lehman, president and CEO of Gordian Health Solutions. Gordian uses a combination of tools for effective behavior modification, including personal physicians, health coaches, educational materials and a supporting care team. 

July 15th, 2004 by Melanie Matthews

Even though managed care rates are increasing at slightly slower rates, the industry is still bracing for double digit increases in HMO and PPO rates in 2005, according to early results of the annual Milliman and Robertson survey. Final results will be published in October.

The industry will undoubtedly continue to turn to other methods to control these rising rates, including disease management, predictive modeling, consumer driven healthcare. During Controlling Healthcare Costs in 2004: A Three-Pronged Approach,an audio conference hosted by the Healthcare Intelligence Network in February of 2004, Lora Hedin, Senior Director, Product Management, HealthPartners, Alexandria Schweitzer, Assistant Vice President Consumer Driven-Health Care, Tufts Health Plan and Jim Woodburn, MD, MS, Major Account and Corporate Medical Director, Blue Cross Blue Shield of Minnesota, described how these strategies were working in their organizations.

Hedin said their organization is working toward creating a traditional marketplace where the consumers, buyers and providers of a product are aligned appropriately. Cost-shifting gets the consumer’s attention. By educating members on price and quality differences, it drives members into the most efficient, effective providers or makes them share in the cost.

Liberty by Tufts Health Plan is a second-generation consumer-driven health plan that combines the best of consumer-driven healthcare with the best of managed care, Schweitzer said. The plan provides incentives to control discretionary spending and protects against less controllable expenses. It also provides members with a variety of tools to help members become better consumers of healthcare, including online health content, and audio library, a symptom checker, a nurse advice line, HRAs and decision support tools.

Anecdotal evidence confirms that the plan helps members behave like active consumers and adopt healthier lifestyles. Data confirms that the plan components reduce high-cost utilization, lower costs for controllable expenses and increase members’ preventive activities, Schweitzer explained.

The disease management program at BCBS of Minnesota began in March 2002 and now provides disease management programs for 17 conditions. The combination of the 17 conditions impacts between 12 and 15 percent of a commercial population, accounting for between 40 and 45 percent of total claims expenses.

The care support program was implement by stage, Dr. Woodburn said, with diabetes and heart program starting in March 2002 and the 11 extended conditions beginning in June 2002. Enrollment in the program was triggered by claims data. Overall, there was a 11 percent decrease in ER visits and a 14 percent drop in inpatient admission. The intervention was most effective for members with heart conditions – ER visits were down by 10 percent and inpatient admissions were down by 46 percent.

Electronic Medical Record — Friend or Foe?

July 8th, 2004 by Melanie Matthews

In just two weeks, the first installment of a national health information technology plan will be delivered when HHS convenes Cornerstones for Electronic Healthcare. on July 21-23 at the Washington (D.C.) Convention Center.

With President Bush’s mandate for a national EMR within 10 years, healthcare organizations are beginning to debate the benefits of the EMR and whose is going to foot the bill.

While the benefits of the EMR are not doubted – improved efficiency and patient safety – the cost of the technology has prohibited many organizations from implementing healthcare information technology.

During recent testimony before the Subcommittee on Health of the House Committee on Ways and Means, Andrew M. Wiesenthal, M.D., Associate Executive Director, Kaiser Permanente, called on Congress to provide financial incentives to healthcare organizations to implement electronic medical records. To read the full testimony of Dr. Wiesenthal and others, visit:
http://waysandmeans.house.gov/hearings.asp?formmode=detail&hearing=155

We’ll keep you posted after July 23.