Managed Care - December 2008 - (Page 29)

dealing with 15 different companies handling 15 different diseases. We’re looking for a single point of care,’” WellPoint’s Latts said. Attached to the medical home concept is the controversial view that it will save the health system money. “The medical home has the potential to contain health care costs, particularly by reducing hospital admissions, ER visits, and inappropriate specialist visits,” said another speaker, David Brumley, MD, medical director for health management at Blue Cross Blue Shield of Massachusetts. At the heart is a mandatory electronic medical Kaiser Permanente keynoter, Paul Wallace, MD, record that can be shared by all who provide care. medical director for health and productivity man“Some practices won’t be able to afford, and agement programs, said, “Paying for the medical won’t want to hire, a full time registered nurse,” said home is a zero sum game — there is no cost savMoorhead, head of DMAA. “There is a lot of techings.” nology associated with disease management, so Still, other speakers were reserved. “It’s a promdoctors may want to outsource that piece of the ising but untested model,” Latts said. “It will take a while to assess,” added keynote speaker Gail Wilensky, PhD, an economist, health policy expert and former MEDPAC chairwoman. No matter whether it saves money, “it’s just good primary care,” said Sharon Glave Frazee, PhD, vice president for health informatics & research at Take Care Health Systems, the Walgreens subsidiary that sets up employer and retail clinics. One physician representing Emblem Health, New York (parent of GHI and HIP) who asked not to use his name said his company has a Medical home panelists at the DMAA: The Care Continuum Alliance forum. medical home project. “I don’t know From left to right: moderator Jaan Sidorov, MD; Paul Wallace, MD, of Kaiser that the medical home has proven itPermanente; Lisa Latts, MD, of WellPoint; and Ricardo Guggenheim, MD, of self,” he said. “We don’t know the McKesson Health Solutions. costs or limitations. For a managed care company, the question is who gives me the medical home.” better return on investment.” Kuraitis agreed. “Ultimately we may find out a nurse can achieve just as good or better results than a disease management company,” he said. “Right Physician push back now, though, it would be difficult for physicians in The Emblem doctor said that his company had general to develop the analytical tools, the inforencountered significant physician pushback when mation technology tools, and the behavioral techit came to sign up doctors, something Kuraitis had niques that the disease management industry has anticipated. “Early adapters are entrepreneurial and developed over the past 10 years.” willing to try new things. They are not representaEnabling physicians to outsource disease mantive of the doctor on the street,” he said. agement may require changes in the industry. WellPoint’s Latts articulated other troubling is“Physicians are telling us, ‘We don’t want to be sues. “Our customers are saying we’re already pay- A shared licensed practical nurse who fields phone calls, conducts triage, orders medical equipment, and manages the insurance paperwork and referrals, and • A registered nurse who fields the physician’s clinical phone calls, conducts chronic disease management, diabetic counseling, weight teaching, and other preventive care (or this function could be farmed out to a disease management company). • DECEMBER 2008 / MANAGED CARE 29

Table of Contents Feed for the Digital Edition of Managed Care - December 2008

Managed Care - December 2008 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor ICD-10 Offers Huge Opportunity, Challenge Part D at a Crossroads Plans Can Weather the Financial Crisis DM vs. Medical Home? Tackle Prediabetes Reasonable Approach to Morning Sickness Formulary Files Tomorrow's Medicine Outlook

Managed Care - December 2008

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