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E-CareManagement News

June 22, 2000


Senior Analyst James Ackerman of Friedman, Billings, Ramsey & Co. has authored an excellent analysis of emerging e-care opportunities, a full 34 page report (dated June 1, 2000) and a 2 page summary. 

The analysis includes discussion of (1) wireless, handheld physician automation tools, (2) home-based patient monitoring/disease management and (3) medical risk management by payors. A few highlights from the summary:

There are four key factors driving the widespread penetration of the Internet in healthcare. These include:

1) Spiraling costs and the imperative to find operating efficiencies.

2) Growth of healthcare consumerism and self-education.

3) Introduction of wireless technologies as a means of accessing and communicating patient information.

4) The necessity to utilize technology to reduce the prevalence of medical errors.

The onset of the e-care age promises to alter the landscape of the healthcare industry -- patients will be enabled to better monitor their health, physicians will have more resources at their disposal when practicing medicine and payors will finally have a credible means for "managing care." The benefits to the healthcare industry will be two-fold: 1) improved care outcomes and 2) reduced costs.


In 1997 Congress created the Medicare+Choice (M+C) program. M+C was an attempt to bring expanded managed care and care management options to Medicare beneficiaries.

Three years later, however, the program is struggling. Many private plans have withdrawn from Medicare or reduced the geographic areas in which they offer service.

The Health Insurance Association of America sponsored a white paper examining the M+C program. The paper was authored by Bruce Merlin Fried and Janice Ziegler.

The white paper identifies three fundamental changes as the cause of the program's decline:

  • Change in payment formula
  • Increases in regulatory costs and burdens under M+C
  • Increased risks associated with serving as a government contractor
  • The authors recommendations include a series of measures to stabilize the program:

  • Increase payments to Medicare HMOs to keep up with medical inflation.
  • Reduce the administrative burden and expense of M+C.
  • Require HCFA to implement risk adjustment in a budget neutral manner and direct HCFA to explore alternative mechanisms of assessing health risk status.

    WebCriteria develops and presents industry indices of websites based on an "objective comparison of the user experience and accessibility".
    ...and the envelope please....rankings among health care provider web sites are:

    1. Kaiser 
    2. Mayo Clinic 
    3. McKesson 
    4. Medtronic 
    5. Amgen 
    6. Bristol-Myers Squibb 
    7. Columbia HCA 
    8. Humana 
    9. Johnson and Johnson 
    10. WebMD 

    And just how did WebCriteria reach their conclusions


    An article in the British Medical Journal reviewed 32 studies on patient satisfaction with interactive video telemedicine applications (p. 365). "Firm conclusions are limited by methodological difficulties, but it would seem that the patients found teleconsultations acceptable; noted definite advantages, particularly increased accessibility of specialist expertise, less travel required, and reduced waiting times; but also had some disquiet about this mode of healthcare delivery, particularly relating to communication between provider and client via this medium."

    Another study published in the April, 2000 issue of the Mayo Clinic Proceedings explored telemedicine applications in primary care for geriatric patients. Participants in this small pilot study were pleased with the experience they had with telemedicine.

    The Ad

    The emergence of the Internet as a tool in disease management has created a sense of both opportunity and confusion among management teams. Recently, several clients have asked BHT to develop and present a customized, 1 day workshop -- "State of the Art in eDM Strategy and Applications". Please call or write if we can assist you in seizing opportunities or clarifying the chaos.


    Mathematica Policy Research has published "Care Coordination and Medicaid Managed Care: Emerging Issues for States and Managed Care Organizations" (Adobe Acrobat required).

    The study presents several key points:

  • Care coordination programs take time to develop but can be put in place even after a state has implemented Medicaid managed care.
  • For the Medicaid managed care population, care coordination must be broader than simply expanding case management to include referrals for social services.
  • Creative problem-solving, through advocacy, is emerging as an important new role for care coordinators.

    The May 15, 2000 issue of Internet World features five articles relating to various aspects of e-health.

    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 (  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 © 2000, Better Health Technologies, LLC. All rights reserved.

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