|
Send
this issue to a friend
|
|
The Managed Care Insider eNews
Volume 4 Number 1
January 2002
Welcome to The Managed Care Insider eNews.
You are receiving this because you have subscribed; the eNews is never sent unsolicited.
Subscribe/unsubscribe information can be found at the end of this eNews. The
Managed Care Insider eNews is published, copyrighted, and owned by The Scheur
Management Group, Inc. (SMG), http://www.scheur.com and
is distributed monthly, free to subscribers. If you wish to forward this edition,
you may do so only if the edition is forwarded in its entirety. No reproduction
of any part of this publication is permitted without the express permission of
the publishers.
----------------------------------------------------------------
The focus of this issue of The Managed Care Insider eNews is on cost-cutting
measures in developing in-house disease management programs. MCOs can use newly
available database applications to build cost-effective member tracking systems.
Read on and, as always, please email your comments to insider@scheur.com.
----------------------------------------------------------------
Disease Management's Little Known Secret
by Paul R. Reich, M.D.
A health plan was shocked to learn that the cost saving from its currently out-sourced
congestive heart failure (CHF) disease management program was reduced from 74%
to a mere 14%. As a result, the Medical Director was instructed to bring the
program in-house.
How hard could it be to take a cardiovascular nurse and bunch of educational
brochures and newsletters, and duplicate the functions of the out-sourced disease
management program for 500 members? This Medical Director soon found that the
problem was not developing the program's content, but rather keeping track of
the members in the program. Not only tracking their clinical data and their progress,
but also sending them enrollment letters, telephone reminders and packages of
information became a nightmare to contemplate.
All of a sudden it was clear that the major attraction of an out-sourced program
was the member tracking application used by the vendor. How does a plan considering
in-sourcing its disease management program obtain or develop a member tracking
system?
First to consider are outside vendors who have developed robust tracking systems
that are for rent, so-called application service providers or ASPs for short.
These companies use the Web and are accessed by plans, or even members, through
Web browsers. These services can be expensive, but they provide a means for plan
disease managers to store member demographics and track progress through the
program. Some enable devices in the member's home to collect and report body
weights and blood pressure, and quiz patients concerning their clinical status.
They require plans to extract from their claims databases member and provider
information and load it into the servers that maintain the Web tracking system.
They can be limiting to plans that wish to send their own brochures and newsletters,
or integrate with an automated telephone reminder system.
A second solution is to build one's own tracking system using newly available
database applications. In the past it has been very expensive to build these
tracking systems with multiple functions and capacity to track large numbers
of individuals. The cost of highly trained programmers and licensing fees for
programs such as Oracle have severely limited plan development of these systems.
Less expensive database applications such as Microsoft's Excel, Foxpro or Access
have either limited capabilities or inability to share data among large groups
of case or disease managers.
Underneath most IT manager's radar screen is a program called Filemaker 5.5 which
is easily programmed by health care professionals willing to invest time in learning
how to configure its screens. At a low cost it can be loaded on a PC with Microsoft's
Windows 2000 Professional operating system and shared by up to 250 users. The
functionality that can be created in such a disease management tracking system
is very impressive:
- It stores demographics, benefits and the member's personal physician network
with contact information.
- Nurses use stored assessments that, for example, stratify members into different
levels of acuity, measure quality of life, or calculate salt intake.
- They track the members' standard of care activities. For example, in diabetes,
the dates of eye and foot exams and Hb A1c determinations.
- Laboratory results, obtained either from contracted laboratories or from self-reporting,
are not only stored, but can be charted.
- Drug data from the plan's pharmacy benefit manager is easily retrieved along
with any other clinical data needed by the disease manager.
The software allows for a "tickling" function whereby all disease managers
are linked and may "tickle" for their enrollees telephone reminders,
fulfillment center requests for educational materials, dietary consultation from
a registered dietician, referral to case management, or follow-up nurse phone
calls. Each morning their "To Do" list is printed and serves to guide
their daily activities. A fully functional report writing module is easily created
that allows the staff to produce management reports at the click of a button.
These reports can be used to balance nurse caseloads, track any billable costs
or support the disease management program's need to report outcomes.
Health plans that wish to develop their own disease management program should
consider gathering a nurse with experience in managing patients with the disease
to be managed, an IT person familiar with simple networking functions and a Filemaker
5.5 programmer. Working together, this team should be able to produce a disease
management program at minimal cost that can "touch" thousands of members
and coordinate the activities of the up to 100 disease managers. Filemaker 5.5
programmers are available in every metropolitan area at www.filemaker.com.
Scheur Management Group has a fully functional and tested system and the expertise
to implement it in your plan. Now, there's the secret, so no excuses for not
participating in the disease management revolution.
----------------------------------------------------------------
About the author: Paul R. Reich, M.D., SMG's disease management development consultant,
creates customized computerized disease management programs in CHF and Diabetes
for health plans. He believes that each health plan, each geographical area,
has its own nuances which must be addressed specifically to its needs. Dr. Reich's
career spans 23 years as a practicing physician and eight years as a physician
executive for Harvard Pilgrim Health Care, one of the leaders in health care
innovation and care quality in the United States. Dr. Reich can be contacted
at preich@scheur.com.
----------------------------------------------------------------
Sites and Sounds on the 'Net
In keeping with this issue's focus on disease management, we present the following
sites that cover this area.
DM in-house or outsource? Managed Healthcare Executive provides discussion at http://www.managedhcare.com/dm501.html
A disease management forum is offered at http://www.sapien.net/dm/
View and search free the Case Management Resource Guide at http://www.cmrg.com/
The Disease Management Association is located at http://www.dmaa.org
Healthcare Intelligence Network offers free reports (registration required),
including "The Top Six Challenges in Disease Management" at http://www.hin.com/freeindx.html
The Case Management Society of America offers nurses and case managers networking
opportunities at http://www.cmsa.org/
----------------------------------------------------------------
Speaking Engagements
April 25, 2002
Indianapolis Association for Healthcare Quality
Location: TBA
Topic: "Resuscitating Managed Care"
Speaker: Nancy K. Belle
If you are interested in contracting either Barry Scheur or any SMG/Oath associate
for your organization, please contact Nancy Belle at nbelle@scheur.com.
----------------------------------------------------------------
End of The Managed Care Insider eNews,
Volume 4, Number 1.
Scheur Management Group (SMG) is one of the most experienced specialized healthcare
operations management and business revitalization consulting firms in the country.
Our expertise is in time-sensitive analyses, strategic business and market planning,
operational re-engineering, and communications, as well as implementation of
start-ups, expansions, and new products. The firm's clients cover the spectrum
of insurers, managed care organizations, physician groups, integrated delivery
systems, hospitals, employers, governmental entities, vendors, and other providers.
Contributing to this edition is Paul R. Reich, M.D. Editing and Research by Judith
Jaffe. Production Coordination by Nancy K. Belle.
TO SUBSCRIBE: visit http://www.scheur.com/smghome.nsf/webcontent/ezine.html or
send e-mail to insider@scheur.com with the word SUBSCRIBE in the subject and
name, email, company, title, and country in the message.
TO UNSUBSCRIBE: send email message to insider@scheur.com with the word UNSUBSCRIBE
in the subject.
Please take a minute to visit our eNews page at http://www.scheur.com/smghome.nsf/webcontent/ezine.html for
archives, subscriber information and to RATE our ezine.
Get up-to-the-minute health care news on-line at www.scheur.com
|
