Managed Care - December 2008 - (Page 30)

ing you for disease management; we don’t want to pay twice.” What’s more, doctors are uncertain how to make their offices into medical homes. “In all of our locations where we’re doing medical home pilots, docs are saying, ‘you have to help me transform into a medical home.’” A done deal? The conference unveiled many medical home cheerleaders who produced studies indicating its benefits. Frazee, of Walgreens Take Care Health Systems, demonstrated through a self-insured employer pilot that patients signed up for, and stuck with, disease management programs longer if they were part of a medical home. The concept may be a locomotive without brakes. “The medical home is sweeping the country as the next saving grace,” says Wilensky. The National Committee for Quality Assurance has constructed a framework for certifying medical homes, calling it, “an antidote to a fragmented system.” The concept has garnered support from the Association of American Medical Colleges, coalitions of business leaders, consumer groups, and others. Medical home supporters point to a number of medical studies, including one in the Annals of Internal Medicine that demonstrates that a strong primary care infrastructure is a common denominator of high-functioning health systems in developed countries. Kuraitis adds: “This could be the next big thing or this could fail. There are no guarantees.” MC In other seminars The medical home was just one of many topics discussed at the DMAA conference A recent study of 87 patients conducted at Kaiser Permanente Riverside Medical Center using cell phone technology developed by BeWell Mobile Technology revealed that using mobile phones to send HIPAA-compliant encrypted messages to disease management enrollees boosted diabetic adherence rates by an average of 83 percent, indicating that the cell phone helps to change behavior. “We know this stuff works, unless you are truly impaired,” said Peter Boland, PhD, BeWell’s director and a member of MANAGED CARE’S editorial board. Reminders told patients to enter their blood sugar results, which were then sent to case managers, and told them to watch their carbs and exercise. Kaiser attained striking results within 14 weeks. “The sicker you are, the bigger the impact,” says Boland, calling cell phones in disease management a disruptive technology because they deliver care in a new way and threaten to reduce the number of call centers, but only if patients agree to pay for phone data plans that encompass the extra text messaging required, a problem for Medicaid patients, and, only if the patients did not start to treat the messages as nuisances. “It has exciting potential but it was a small sample,” said Steele Stewart, an actuary at BlueCross BlueShield of Kansas City, adding, “After how many messages are you going to start ignoring them?” Researcher Neil Goldfarb of the department of health policy at Jefferson Medical College in Philadelphia gave a $500 incentive to 53 mostly large, self-insured employer groups, and 37 large commercial health plans to participate in a study to determine why there is limited coverage of obesity when there is a “heat wave of obesity” and a prevalence of obesity interventions. Only 32 percent of plans thought bariatric surgery was effective, while 46 percent of employers thought it was. Some 76 percent of plans thought their policies were appropriately restrictive. Goldfarb agreed there is no intervention that works well. In addition, Goldfarb said there is a growing employer movement to increase the price of high-fat food, such as French fries, and to subsidize the cost of salads in on-site cafeterias. BlueCross BlueShield of Kansas City is an example. BCBSKC also has “Wellness Wednesdays,” where the cost of a healthy option, like salmon and green beans, is $1.99 when a normal meal might be $5.99. Ninety-two percent of health plans and employers offer one or more disease management programs; by 2010, 97 percent will offer them, according to the DMAA’s first market survey of members, initially released last fall. Of more than 200 DMAA members surveyed, 114 responded: 22 were health plans, 35 were employers and third-party administrators, and the balance were disease management companies. Though the top programs supported by health plans are for diabetes, coronary artery disease, and heart failure, the programs most supported by employers are diabetes, asthma, and coronary artery disease. Most disease management companies believe physicians see them as interfering with their provision of care and, perhaps as a consequence, are not inclined to encourage patients to enroll. 30 MANAGED CARE / DECEMBER 2008

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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