Patient-specific program offers multiple benefits
Program emphasizes clinical care, not costs
It has saved Merrill Lynch & Co. over $6 million in direct medical costs for high-cost cases over a period of five years. It has helped the rate of large claims (more than $50,000) at the financial services company steadily decline, and has dropped medical costs per employee to about $3,600 — well below average for a company that size.
"It" is a unique approach to employee health care that has been adopted by companies such as Marriott International Inc., Sears, Roebuck & Co., and Circuit City Stores Inc., covering a total of 700,000 individuals.
This approach is being pioneered by New York City-based ActiveHealth Management Inc. The company’s mission is to give doctors timely, patient-specific information so they can make better clinical decisions.
Founded in 1994, the company was renamed ActiveHealth in October 1998. "We’re a unique player; we don’t do what others do, but we make the things they do a whole lot better," explains Charles Blanksteen, vice chairman of ActiveHealth. "Our systems sit on top of the others. We help them find cases where there has been clinical oversight, a gap in care, a treatment missing or a test that should be given, or medications that shouldn’t have been given in combination."
ActiveHealth employs an extensive data management system. "We acquired a company called Health Data and Management Solutions in Cleveland," notes Blanksteen. "We scrub [organize] all the data that come in from lab companies, like tests and values, and drug companies — names, dosages, histories — and health plans and disease management programs. All of the data are organized and put through our warehouse so we can access it to find the people with diseases and get them into the right program." This high technology, says Blanksteen, is backed up by "people power" — 50 professors of medicine.
"The big problem with chronic disease management is that you can’t find the people; the false positives are brutal," says Blanksteen. "Then, if you do find them, you have to tune your wellness and disease management efforts to both the main disease and the comorbidities. Without that, compliance is so limited."
ActiveHealth has no intention of taking the place of managed care organizations. "By definition we are trying not to replicate what the current system does so well," he says. "They handle the dollar part; they’re quite able to manage the money, the resources, the modality of care. We follow and track the patient through clinical means, not through fiscal means. You don’t have to spend a lot of money to find what you need. It also means that as the patient progresses and regresses, we follow them and adjust interventions. Many other programs are static; ours gives us the ability to manage emerging comorbidities."
One of the key tools ActiveHealth offers is a private health record. "We prepopulate it with your information and then we redo it," says Blanksteen. "To do this in real time is very key to compliance. You must find the patient, find out what’s wrong, but third, you need an infrastructure so that multiple people can look at same thing at the same time. And the patient can be clued in with very real information in real time, as well."
The programs typically are run by nurses and physicians, each of whom have computer systems they use for patient tracking. "We offer an Internet browser system [they can access]," Blanksteen explains. "In other systems, the case manager, the medical manager, and the utilization manager all have their own systems that don’t talk to each other, so they miss the clinical part altogether."
Interfacing with other vendors
Typically, when ActiveHealth becomes involved with a company, the employer will ask the health plan and the care management process to link up with them.
Has Blanksteen seen resistance on the part of HMOs, who traditionally have strived to limit utilization? "Initially, the difficulty we have is the same you face with any new technology: The response is, We do that,’" Blanksteen observes. "Then we show them the system, and they say, Oh.’
"Once they see we’re adding a whole new dimension to what they do, we have a friend," he continues. "For example, nurses use their clinical judgment, but it’s applied to asking whether the person is in the right setting. Their clinical judgment is, do they need to be there? Our is, is the care they are getting correct?"
Blanksteen asserts that 99% of ActiveHealth’s recommendations are not debatable. "If a post-MI [myocardial infarction] patient is not on an ACE inhibitor, they should to be," he notes, "but half the people in country are not."
By its very design, the ActiveHealth system will save money, Blanksteen notes. "Most patients will get the right care eventually," he concedes. "But it’s a lot less expensive to do it right the first time."
One of the main problems with the health care system is that care is not standardized, he notes. "You can have the same symptoms in two patients five feet away from each other in the same hospital, and they will not get the same care," he asserts.
Instead of retrospective utilization review, the ActiveHealth system seeks to stop a problem before it starts — before, as Blanksteen puts it, "the horse is out of the barn. We are on a completely different time frame.
"Now, you could wait for a diagnosis of diabetes," he continues. "You could treat it when it can easily be controlled, or when it’s really dangerous and there are a whole lot of comorbidities. We’ve discovered a way to find those people in time to help them."
It doesn’t take much to save a whole lot of money, Blanksteen notes. "A very small number of patients go wrong, but one half of 1% of the patients are responsible for 25% of the costs. In the corporate setting, if we find the right people, it will really pay off."
• Charles Blanksteen, ActiveHealth Management Inc., 95 Madison Ave., New York, NY 10016. Telephone: (212) 651-8200.
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