GUEST COLUMN
Disease management: Think you can’t afford it?
By Steven Sutor
Health care premiums are rising at an average rate of 7% to 10% annually, with the probability of a PPO premium gain of 36% between 1998 and 2000. Meanwhile, the labor market is tight. Your challenge: Reduce the cost of care without imposing an additional monthly financial burden on hard-to-find and harder-to-replace employees. There are a number of ways that employers across the country are trying to do this — increased deductibles and office visit copayments, emergency department surcharges, and increased drug benefit co-payments. However, these are fiscal Band-Aids and are still an irritant to employees. But you "know" you can’t afford to bring in a disease management health and wellness program that might attack the root issues: health-related behaviors. The return on investment isn’t there . . . or is it?
There are disease management (DM) companies and organizations out there that will try to wow you with technology, data capture, and the complex nature of managing disease among your employees. But, like the Wizard of Oz, much of what they claim as essential to DM is so much smoke and mirrors. I should know; I run a disease management education company.
It isn’t often that we can take a negative and twist it into a positive. One negative you can’t change is the rising cost of health care. You don’t have the time or the resources to take on what even the federal government can’t seem to chip away at. But when you localize that negative — understand what increased health care costs mean to you and your employees — you can turn it into a positive. In fact, if you find you have to increase office visit and pharmaceutical copayments and add surcharges for unnecessary or inappropriate emergency room use, you can still come across as something of a hero to employees. Through an appropriate DM program, you offer employees the strategies and skills to move toward healthier, low-risk behaviors, and a way to get around utilization of the services that incur the surcharges. You help reduce their health care spending and improve their health-related quality of life. In short, you become a hero to your employees and to your CFO.
It is important to acknowledge that we all act as our own primary care provider. Americans spend more than $30 billion annually out-of-pocket on self-care. From aspirin to acupuncture, we use our own diagnoses as our first line of defense. Offering employees germane methods of improving self-care is a logical step toward reducing inappropriate, costly use of the health care system. And "costly" doesn’t just refer to dollars. When patients do not comply with treatment methods for chronic disease (noncompliance is a very risky form of self-care) this has a significant negative impact on quality of life for the patient as well as the family and employer. When you couple that with the results of a 1997 study by the New York Business Group on Health that determined that patients trusted health-related information obtained in the workplace more highly than from any other source — including their primary care physician! — you have a potent force for change.
Studies have shown that patients given an interactive self-care tool, such as a journal, use the health care system less, but actually self-report as being healthier. In addition, their retention of information increases as much as 60% with an interactive tool compared to verbal instructions from the doctor. A 1999 study at the State University of New York, Stony Brook, School of Medicine, demonstrated that when patients with asthma and arthritis wrote about their stressful life experiences, they experienced less health-related stress and actually reduced the severity of the symptoms of the disease.1
Therefore, an effective work-based DM program might be as simple as distributing a health journal. As adults, we take a "What’s in it for me?" attitude about acquiring new skills, so employees should have some input into any new program. Employees should first be made aware that the company is developing the journal, and then, through a survey or a committee, be consulted as to what they might want in a journal and how they envision using it. Upon distribution they should be shown how to effectively use a journal so that it has personal value and integrates easily into their relationships with their doctors.
If you choose to document the effectiveness of the journal, you can easily survey employees and collect comparative health data. This evidence might be used to gain premium reductions or new DM initiatives through your organization’s health plan.
Another important study, conducted by the American College of Preventive Medicine, showed that when a primary care physician spent about three minutes discussing smoking cessation with patients who smoked, 10.7% quit.2 Taking that further, the study indicated that with about 10 minutes of talk, almost one in five patients (18.7%) kicked the habit. Harnessing this powerful information, the smart employer will offer smoking cessation counseling on-site in small groups or one-on-one with a health care provider. Smoking cessation offers a long-term benefit, but similar studies have shown a reduction in other at-risk behaviors when the patient is briefly counseled in a way that acknowledges the patient’s perspective: "What’s in it for me?"
Talking to doctors
Similarly, a pilot program in south central Pennsylvania indicates the power of linking the employer and the provider. This program, the Franklin County Coalition, brings together employers and physicians associated with the Cumberland Valley Hospital to provide a valuable continuum of care, acknowledging and respecting the sometimes confusing dual role of patient/employee in cases of injury and disability. The dialogue exists to make each side of the health care equation aware of the other’s perspective. Included are issues such as the availability of graduated back-to-work programs, loss of intellectual capital, balancing clinical recommendations with workplace needs, and how the patient/employee, family, and community benefit in this type of initiative.
As we have seen, you can make some big changes through disease management — without having to allocate a big budget. Physician counseling for three minutes helps one in 10 smokers to quit. Exchanging viewpoints with community physicians reduces short- and long-term disability. Writing about stressful life situations reduces the severity of symptoms in chronic disease. No masterful information management systems, no problems with patient confidentiality, no extensive — and expensive — reviews of prior claims data. Just the heart and the art of medicine, applied in the right way at the right time for the employee and the employer. Localized problems, localized solutions, and a real return on investment. An excellent twist on DM in the workplace.
[Editor’s note: Steven Sutor is president of Adventa Health Education LLC, in Baltimore. Adventa provides disease and population management programs to managed care organizations, pharmaceutical firms, integrated hospital systems, and employers. The firm has successfully informed and educated thousands of providers and patients, changing behaviors and creating better health outcomes while reducing unnecessary utilization and expenditures. Sutor can be reached at (410) 468-4488, or via e-mail at: [email protected].]
References
1. Smyth JM, et al. JAMA 1999; 281(14):1304-1309.
2. Fiore MC, et al. Smoking Cessation Clinical Practice Guideline. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services; 1996.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content