PREVENTIVE CARE: HMOs’ Proactive Approach May Save Money
In the final segment of his series on the future of American health care, NPR's Frank Browning this morning took a look at managed care organizations' attempts to use preventive medicine to help the bottom line. Browning paid particular attention to Kaiser Permanente as a paragon of an HMO devoted to preventive care, noting that Kaiser is the only HMO to screen for hemochromatosis, a rare blood disorder. Dr. Vincent Fuletti, Kaiser's director of preventive medicine, said the HMO calculated that whereas diagnosing one patient with hemochromatosis costs about $1,100 and lifetime treatment costs about $6,000, "an undiagnosed case would probably cost us lifetime about $46,000." This justification "touches the core controversy around the term 'managed care,'" Browning said. While many HMOs began with an effort to prevent "disease as a way to save both money and lives," only Kaiser and a few others are still taking that approach, he said. Most HMOs simply reduce payments to providers and restrict care and "call that 'managed care.'"
The Next Frontier
Kaiser is also progressing toward another innovation in preventive care -- evidentiary medicine. Peter Jun, executive director of Kaiser's Managed Care Institute, says medical care can be cheaper and more effective by implementing findings from clinical and epidemiological research into the everyday practice of medicine. For example, based on a study of its own patients, Kaiser developed a recommendation that all patients over 50 should be screened for colo-rectal cancer every ten years. Nurse practitioners were trained to administer the test, and in one year, Jun said, Kaiser went from screening about 5,000 members to 60,000. But because many HMOs have higher turnover than Kaiser, they cannot conduct the kind of outcome research on their own patients upon which evidentiary medicine is based. Phil Lee, founder of the University of California's Health Policy Institute, said, "Most managed care plans in this country are really a variance of fee-for-service, solo practice medicine, and as such, we have not taken advantage of the integration that can occur with a group practice." Further, too much of the managing occurs "at the health plan level, instead of the doctor-nurse delivery level." Lee said an integrated approach, especially one in which patients begin to purchase their own plans, would include recommendations for healthy living, as well as regular screenings supplemented by active treatment when necessary. Browning concludes that the new approach rests on two assumptions: "That the medical consumers are well-enough educated to understand the choices before them, and that they have enough money to afford sound, basic coverage" ("Morning Edition," 3/4).