Insurers Use Disease Management Programs to Cut Costs
To control costs associated with treating chronic conditions, health insurers are increasingly turning to disease management programs, the Hartford Courant reports. Insurers' growing interest in disease management has "spawned a whole new industry," with nearly 150 disease management companies operating nationwide. According to Al Lewis, executive director of the Disease Management Purchasing Consortium, the value of disease management contracts rose from $81 million in 1997 to $366 million last year, with that figure expected to reach $491 million this year. Through disease management programs, which are voluntary, contractors use techniques such as educational mailings, home visits by nurses and "in-home monitoring techniques" to reduce costly emergency room visits and hospital stays. While disease management programs "have been around for years," insurers are not only enrolling the "sickest consumers," but also "people in various stages of disease." To determine which consumers are good candidates for disease management, insures such as Aetna and Cigna "mine their claims data, looking at diagnosis codes and what drugs patients are on," and then ask consumers and their physicians to fill out questionnaires about their conditions. While the insurers and contractors generally will not discuss the cost savings that result from management programs, Lewis said that vendors "typically promise ... savings of 5% to 10%." Dr. William Popik, the new chief medical officer at Aetna, said, "It's a perfect example where you can improve the quality of health care our members are getting, the quality of their lives and reduce health care costs at the same time."
The Courant reports that many consumers participating in disease management programs appreciate the extra attention from their insurer. Some doctors, however, believe that the programs interfere with the doctor-patient relationship. Dr. Steven Wolfson, medical director of Yale Cardiology Network, said that 90% of the group's physicians "refused" to fill out a management contractor's questionnaire. He added, "What [insurers are] basically doing is building on another level of complexity to the whole system and removing more dollars from where they belong -- the health care system." The Courant reports that insurers "flinch at such accusations," saying that they obtain physicians' permission before enrolling patients in disease management and try to work with doctors. Dr. Victor Villagra, Cigna's national executive for medical strategy and health policy, said that disease management may not end up saving insurers money in the end but will prove beneficial to patients. "We're perfectly prepared to accept the notion that cost of care will go up because we're doing the right thing," he said (Levick, Hartford Courant, 5/28).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.