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
Click here to read
details about clinical improvements methods developed by the
Institute for Clinical Systems Improvement (ICSI). An article in the
York Times further describes the ICSI project.
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!
PHYSICIANS WELCOME INCREASED ROLE FOR THE INTERNET
"Survey on Internet Use by Medical
Health Technology Center, Pricewaterhouse Coopers, Institute for the
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
Physicians identified six
Internet-enabled services as "essential" for future success:
Purchase of medical office products
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
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?
PRODUCTIVITY -- THE LAST FRONTIER FOR DEMONSTRATING DISEASE
MANAGEMENT (DM) EFFECTIVENESS
Only On Medical Costs Vastly Underestimates True Costs Of Employee
Integrated Benefits Institute (IBI),
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
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
"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
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.
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.
States can build disease management
programs to overlay their Primary Care Case Management (PCCM)
programs to better integrate and manage chronic illness for the
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
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
HEALTH CARE IT FOR A NEW ADMINISTRATION
to the President: Transforming Health Care Through Information
President's Information Technology Advisory Committee, February 2001
1) Lack of an accepted national
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
2) Federal research infrastructure
3) Medical records privacy legislation
4) Support for bioinformatics training
5) DHHS capacity-building
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
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
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.
INCLUDING BHT SPEAKERS
The Symposium On
Advances In Chronic Disease Care
May 9-11, 2001
Palm Desert, CA
May 18-19, 2001
2001: Expanding The Practice of Medicine Through Telecommunication
June 3-6, 2001
Fort Lauderdale, FL
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.
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
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