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New
Medicare Law Boosts Chronic Care
The
New York Times A diabetic in The goal of this heightened monitoring is to
prevent a medical crisis that could send the patient to the hospital. Such
coordinated care for people with chronic illnesses such as diabetes, heart
disease and high blood pressure is the focus of disease management
programs, which got a big boost in the Medicare law signed by President
Bush last week. It is these patients who consume most health care dollars. The government hopes to enroll as many as
400,000 older people with chronic conditions in these programs. By
involving the patient, physicians, pharmacists and other providers in
commonsense steps to improve patient health, the government seeks to limit
costly hospital stays. ``We want to prevent diabetics from becoming
dialysis patients,'' said Rep. Nancy Johnson, R-Conn., a leading supporter
of including disease management in Medicare. The chronic care effort, plus a new Medicare
physical and other preventive screenings, are a marked change in the
38-year-old government health care program for 40 million older and
disabled Americans. Traditionally, Medicare has paid for treating
illnesses, not preventing them. But the number of Medicare beneficiaries
with chronic conditions is large and growing, said Mark Miller, executive
director of the federal Medicare Payment Advisory Commission. Three-fourths of Medicare beneficiaries have
at least one chronic condition, and close to one-third have four or more,
Miller told a recent congressional forum. These people account for 80
percent of Medicare spending. Such numbers make the benefit of early
intervention indisputable, said Health and Human Services Secretary Tommy
Thompson. ``It is better for us to start managing diabetes, hypertension,
asthma and other conditions before they get exacerbated,'' Thompson said.
``It will save us money in the long run.'' Programs in place on a small scale are
demonstrating savings, proponents of disease management say. At Aetna Inc., 3,000 people with chronic
heart failure are in a disease management program that has produced a 17
percent drop in costs and a 32 percent reduction in hospitalizations,
according to John W. Rowe, the company's chairman and chief executive
officer. Among obstacles to making the programs work
smoothly are persuading people to enroll and coordinating care among a
dozen or more doctors who may be treating patients with several illnesses. ``Particularly in the elderly population,
you have an increased level of suspicion and of people being set in their
ways,'' said Christobel Selecky, chief executive of Lifemasters of Irvine,
Calif., a private disease management company. The Medicare program will select up to 10
regions of the country that cover a total of about 4 million clients, said
Stuart Guterman of the Centers for Medicare and Medicaid Services. Using
recent medical claims, officials will try to concentrate on about 40,000
people in each region who could most benefit. The government will contract with private
companies, which will sign up patients and take charge of coordinating the
care. The new push for chronic care is a boon for Lifemasters and others
that use nurses and in some cases computers to facilitate frequent
communication with patients. The companies must show a drop in health
care claims by an amount at least equal to their fees, or the companies
will have to repay the government, the law says. Disease management companies had combined
revenues of $600 million last year and are growing rapidly as the
population ages, said Selecky, who also is president-elect of the Disease
Management Association of America. Lifemasters, which works with 300,000
patients around the country, runs a disease management program with the
State Teachers Retirement System of Ohio. For more than a year, James
Williams, 61, of If the numbers are too high or low, ``they
call the next morning to see how I am, and they also notify my doctor,''
Williams said. ``To me, it's another form of accountability.'' In addition, a Lifemasters nurse calls
Williams the first and third Friday of every month to talk about his
health, he said. In a program involving several hundred
veterans in ``It's a daily check in,'' said Steve Brown, chief executive of Health Hero Network of Mountain View, Calif., maker of the computer. ``It's something that breaks the cycle of isolation and crisis. You can have a huge impact if you just provide people with continuity of care.'' Copyright
© 2002 Global Action on Aging |
