|
Money
and Medicine; Bedside Visits, on the Telephone
by
Milt Freudenheim
New
York Times, February 17, 2002
After checkups at the Staten Island
Medical Group, Albert Agate used to
say, "I should have asked my doctor this; I
should have asked my doctor that." But the
waiting room would be crowded, and the
doctors often seemed pressed to move to
the next patient.
"They were not giving me that time that you
need," he said.
Now, Mr. Agate, 66, a retired postal worker with diabetes
and heart
problems, can present his questions by telephone to Joanne
Anderson, a
registered nurse who knows his case and calls him regularly
to advise him
about diet and medications. "Joanne will sit with me
on the phone for 45
minutes," he said. "She always has the answer."
Ms. Anderson works for CorSolutions Inc., a company in Buffalo
Grove,
Ill., that is one of dozens in a fast-growing and sometimes
controversial
business called disease management. These companies provide
information
and advice to hundreds of thousands of patients with serious
medical
conditions, including asthma and depression, and especially
to those with
multiple maladies.
Most health plans have had programs, of varying size and
effectiveness, that
have aimed to keep their members healthy enough to stay out
of hospitals.
But companies specializing in disease management have thrived
in the last
year or so as plans have retreated from cost-cutting measures
that deny or
delay care, upsetting patients and physicians.
As they signed up Blue Cross plans, employers and other
insurers, revenue
for disease management companies rose 39 percent last year,
to $485
million, versus $350 million in 2000, said Al Lewis, a consultant
in Wellesley,
Mass., who helped negotiate some of the health plan contracts
for the
companies.
Aetna (news/quote), for example, one of the largest managed-care
companies, hired American Healthways (news/quote), based in
Nashville,
and LifeMasters Supported SelfCare, of Irvine, Calif., last
year to help
patients with congestive heart failure avert repeat attacks.
Dr. John W. Rowe, chief executive of Aetna, said there had
been "a
fundamental change" in managed-care methods, which have
included
restricted networks of doctors. "Those tools have lost
their power," he said.
He sees the new services as adding value for doctors and patients
and taking
managed care "beyond being a fiscal intermediary, which
managed cost
much more than it managed care."
The advice and monitoring is particularly useful for patients
with more than
one medical problem. People with diabetes who are clinically
depressed "use
three times as much health care in a year as those with just
diabetes alone,"
said Dr. Paul Wallace, executive director of the Care Management
Institute
at Kaiser Permanente, the big California-based network of
doctors, clinics
and hospitals.
But some doctors criticize the disease management approach.
"Once you
have a third party in there who has never seen the patient"
and is working
from computerized instructions, "there is the potential
for cookie-cutter
management that may not be of benefit to the patient,"
said Dr. William J.
Hall, an internist in Rochester who is president of the American
College of
Physicians-American Society of Internal Medicine.
Warren Todd, executive director of the Disease Management
Association of
America, a trade group in Washington, said: "We antagonized
the doctors.
We sent letters to doctors that said, `We are now managing
your patient.' "
But both sides are trying to bridge the gap. The disease
management
companies say they have been making an effort to work more
closely with
doctors.
Mr. Lewis, the consultant, said many doctors had come to
accept the
disease managers as an extension of their practice, not as
an intrusion.
Dr. Archelle Georgiou, medical director of the United Healthcare
division of
the UnitedHealth Group, says the company's disease-management
program
tries "to be the eyes and ears for the physician."
The insurers and disease management companies have statistics
to trumpet
their effectiveness - "11 percent more children with
asthma sleeping through
the night," for example, from UnitedHealthcare.
But Dr. Carolyn Clancy, a research director at the federal
Agency for Health
Care Research and Quality, which monitors health care disparities,
said that
there was "very little evidence" to prove the effectiveness
of care by software
and telephone. "We are encouraging more research,"
she said. "It is very
much needed."
The National Committee for Quality Assurance, a nonprofit
group that
accredits health plans and care providers, has started evaluating
disease
management companies. Next year, it will require them to use
standardized
effectiveness measures. Margaret O'Kane, president of the
quality-assurance
group, said disease management was not a complete solution
to the rising
costs of health care. It is "not enough to contain the
costs on the scale they
need to be contained," she said.
But Mr. Agate in Staten Island appreciates the help. He
had quadruple
coronary bypass surgery after a heart attack four years ago
and later
developed Type 2 diabetes, a common combination that lands
many patients
in the hospital. "I could use all the help I can get,"
he said.
Back to top
|
