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E-CareManagement News

April 4, 2001

HEALTH PLANS AND PHYSICIANS AGREE ON CLINICAL GUIDELINES -- MINNESOTA SETS STANDARDS FOR BEST PRACTICES!

Minnesota is becoming the first state in the nation where medical care is built around the systematic use of science-based best medical practice protocols developed by physicians and supported by major health plans. Collaboration, not competition, is the goal of Minnesota's leading medical groups and health plans when it comes to quality health care.

Click here to read details about clinical improvements methods developed by the Institute for Clinical Systems Improvement (ICSI). An article in the New York Times further describes the ICSI project.

A previous issue of E-Care Management News described the need for parties in the health care delivery system to work together in one value chain to treat patients with chronic diseases and conditions. "The FedEx Truck Phenomenon" has NOT worked -- when individual health plans dump clinical guidelines at a doctor's doorstep at 10 AM, they are trashed by 5 PM.

This project unquestionably is the right thing to do....we wish them success in pulling it off!

GROUP PRACTICE PHYSICIANS WELCOME INCREASED ROLE FOR THE INTERNET

"Survey on Internet Use by Medical Groups"
Health Technology Center, Pricewaterhouse Coopers, Institute for the Future
Press release and Toplines.

This survey polled physicians and leaders in medium and large group practices. It found widespread agreement that computers have already had a positive impact on the practice of medicine and quality of care:

96% of those surveyed agreed that these technologies will make the practice of medicine easier and improve quality of care before 2003.
More than a third of the physicians and practice leaders consider Internet-enabled core business and clinical services to be essential advantages.

Physicians identified six Internet-enabled services as "essential" for future success:

Diagnostic reporting
Claims processing services
Pharmaceutical information
Purchase of medical office products
E-mail communication with patients
Electronic medical records

Respondents agreed that the greatest barriers to rapid implementation of Internet-enabled services are a lack of uniform standards for health information and the inability of current health information applications to communicate with each other.

Commentary: very encouraging findings! The reality is that the majority of physicians in America do not practice in medium or large groups....are the results projectable to other settings?

EMPLOYEE PRODUCTIVITY -- THE LAST FRONTIER FOR DEMONSTRATING DISEASE MANAGEMENT (DM) EFFECTIVENESS

"A Focus Only On Medical Costs Vastly Underestimates True Costs Of Employee Health Conditions"

Integrated Benefits Institute (IBI), February 2001

A February 2001 quantitative case study by IBI questions the wisdom of evaluating health plan effectiveness by examining only costs of medical treatment. When employers ignore disability absences and lost productivity, they risk underestimating the total costs of employee health conditions by as much as 80%.

Commentary: improving employee productivity is a relatively unexplored "holy grail" opportunity for DM processes and DM companies. While the value proposition of improved employee productivity is intuitively appealing, researchers have just begun to scratch the surface in this area of exciting possibilities! Much of the state-of-the-art is described at the Institute for Health and Productivity Management website.

AD -- CHRONIC DISEASE STRATEGY WORKSHOP

The Institute of Medicine's (IOM) recent report advises that "Common chronic conditions should serve as a starting point for the restructuring of health care delivery." 

Have your management team, board, or physicians wrestled with the potential upside and downside implications of ever-increasing chronic disease? Do you have a strategy in place?

More than 70% of medical costs relate to chronic conditions. Grab hold of the planning process by scheduling a Strategy Workshop with Better Health Technologies. "Chronic Disease Management as a Bridge between Clinical and Business Strategies" is a customizable workshop available for your organization. Faculty for this workshop are Harry Leider MD, MBA and Vince Kuraitis JD, MBA

Call or email to be placed on our summer/fall calendar. Contact
Vince Kuraitis at (208) 395-1197 or vincek@bhtinfo.

PORTRAYING DIGITAL HEALTH COMPANIES

"The Digital Health Company: Threat or Opportunity? Implications for the Health Plan Market"
First Consulting Group, FCG Doghouse, February 2001

This paper explores the emergence of the Digital Health Company and what it means to the health plan market. It is organized in eight sections:

1) Market Environment
2) Defining the Digital Health Company
3) How Will It work?
4) Attributes of the Consumer Experience.
5) Market structure and Players
6) Innovative Models
7) The Competitive Threat
8) The Competitive Response

What's a "Digital Health Company"? Four elements form a unifying theme:

  • Marketing Itself as a Departure from Managed Care - Each player focuses on the health financing and administration space, and has developed a unique strategy that promises to cap or reduce costs.
  • Taking the Employer off the Hook - Each entrant aims to simplify the demands on employers by migrating administrative and financial responsibility to consumers.
  • Positioned to Capitalize on Defined Contribution - Defined contribution has drawn the attention of the financial markets even though it has yet to be embraced by the employer community. Looking to capitalize on this interest, Digital Health Companies market themselves as the beneficiaries of a migration toward this model.
  • Placing the Consumer First - The business model of the Digital Health Plan places the consumer at the heart of the strategy.
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  • LESSONS FROM FLORIDA MEDICAID DM CONTRACTING
  • "Contracting for Chronic Disease Management: The Florida Experience"
    Center for Health Care Strategies, Inc., March 2001

    Some key findings:Developing new models of Medicaid managed care, such as disease management programs, may give new options for states that face health plan exits.
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  • States can build disease management programs to overlay their Primary Care Case Management (PCCM) programs to better integrate and manage chronic illness for the Medicaid population.

  • Chronic Disease Management offers opportunities for states to better integrate and manage chronic illness for Medicaid beneficiaries.
    States can and should exercise creativity and flexibility in the bidding and contracting process for innovative chronic disease management programs.
    The disease management industry is responsive to state-sponsored programs serving Medicaid beneficiaries.

  • Moving from demand management to disease management may require different relationships with physicians.

  • Physician participation is critical to success.

  • States should consider mandatory enrollment in chronic disease management programs.
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  • PERSPECTIVES ON HEALTH CARE IT FOR A NEW ADMINISTRATION
  •  
  • "Report to the President: Transforming Health Care Through Information Technology"
    President's Information Technology Advisory Committee, February 2001

    Key Findings:

    1) Lack of an accepted national vision
    2) Critical long-term issues not addressed
    3) Decision-support systems needed
    4) Too few bioinformatics professionals
    5) Reliance on outside innovations
    6) Department of Health and Human Services issues

    Key Recommendation Areas:

    1) Pilots and Enabling Technology Centers 
    2) Federal research infrastructure
    3) Medical records privacy legislation 
    4) Support for bioinformatics training 
    5) DHHS capacity-building 

    EXAMINING THE IMPORTANCE OF LINKING PRIMARY CARE AND DM

    "Primary Care for People with Chronic Conditions: Issues and Models"
    University of Maryland Center on Again, National Chronic Care Consortium, March 2001
    Click here for Press release or Full report.

    The use of new primary care models to manage care for the chronically ill can play a significant role in reducing and preventing the debilitating consequences of illness, can help consumers navigate an increasingly complex health care system and can begin to address the fragmented nature of how care is paid for.

    UNINSURED PATIENTS WITH CHRONIC CONDITIONS RECEIVE INADEQUATE CARE

    "Getting Less Care: The Uninsured with Chronic Health Conditions"
    Families USA, with support from the California HealthCare Foundation

    This report is the first to compare the health care received by insured and uninsured non-elderly people who have five common health conditions: heart disease, hypertension, high blood cholesterol, arthritis, and chronic back pain. The study documents that the likelihood of receiving medicine, doctors' care, or other treatment for these conditions differs greatly, depending on insurance status.

    CONFERENCES INCLUDING BHT SPEAKERS

    The Symposium On Advances In Chronic Disease Care
    May 9-11, 2001
    Palm Desert, CA

    Summit on Evidence-Based Medicine
    May 18-19, 2001
    Washington, DC

    ATA 2001: Expanding The Practice of Medicine Through Telecommunication Technology
    June 3-6, 2001
    Fort Lauderdale, FL

    DEMONSTRATING THE VALUE OF TARGETING HIGH COST & HIGH RISK PATIENTS

    "Targeting Beneficiaries Who Are Most at Risk"
    University of Maryland Center on Aging, National Chronic Care Consortium, February 2001

    In the short term, addressing the risk for high-cost care is a priority with the possibility of immediate reward for the network and high-risk consumers. Over the long term, risk identification will allow payers and providers to also begin to target low-risk groups in order to prevent decline and decrease the number of people who progress to chronic illness and disability. 

    Disclosure -- No clients were mentioned in this issue.

    E-CareManagement News is an e-newsletter that tracks a major change in health care and managed care—the paradigm shift from “managing cost” to “managing care”.  This e-newsletter is brought to you by Better Health Technologies, LLC (http://www.bhtinfo.com).  BHT provides consulting and business development services relating to disease management, demand management, and patient health information technologies.

    You may copy, reprint or forward this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 2001, Better Health Technologies, LLC. All rights reserved.

     

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