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By M.L. Baker  |  Posted 2004-11-24 Print this article Print

At Anthem (Blue Cross and Blue Shield licensee in nine states), the 11 percent of health plan members with chronic conditions incur 43 percent of health care costs. To see how effective intervention programs could be, the company compared 13,000 patients who were either involved in an intervention group or not. Anthem tracked whether patients with congestive heart failure weighed themselves daily, whether patients with diabetes monitored their blood glucose levels and received cholesterol screenings, and other measures. All in all, the studies found that patients in the intervention group went to the doctor and the emergency room less often. Another study by Health Management Corp. on tens of thousands of patients calculated an 11 percent savings for patients enrolled in a disease management program, or a return on investment or a savings of $2.84 for every dollar spent.
However, Nussbaum admitted that one reason the program was cost-effective was because patients remained in the programs long enough for the savings to accrue to the patient.
Partners Glaser said that insurance companies are reluctant to sponsor programs unless the payoff comes within a short period of time, like a year or two. Otherwise, a patient is likely to switch health plans, and the benefit of a companys investment would go to a competitor. In other words, its not in an individual insurance companys best financial interest to help a healthy 30-year-old become a healthy 60-year-old. But this would most definitely save Medicare money, and the idea that CMS (Centers for Medicare and Medicaid Services) should provide financial incentives to promote healthy lifestyles crops up regularly in discussions of who should pay for what in health information technology. The deficit will certainly discourage such spending, but last week health IT czar David Brailer said CMS planned to move quickly toward reimbursing doctors for programs that keep senior citizens healthy. However, that does not necessarily cover directing 20-year-olds into smoking cessation programs, and IT will not necessarily be a component. Still, any disease management program will almost certainly require IT to find eligible patients, said Glaser. And if CMS moves in this direction, the insurance companies are likely to follow. "The big payers wait to see what the feds do," he said. Check out eWEEK.coms for the latest news, views and analysis of technologys impact on health care.

Monya Baker is co-editor of's Health Care Center. She has written for publications including the journal Nature Biotechnology, the Acumen Journal of Sciences and the American Medical Writers Association, among others, and has worked as a consultant with biotechnology companies. A former high school science teacher, Baker holds a bachelor's degree in biology from Carleton College and a master's of education from Harvard.

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