United's New Approach: Good PR or Better Patient Care?

Christine Wiebe

Disclosures

May 22, 2000

In This Article

Establishing a Safety Net

Perhaps the greatest potential for change lies in the patient advocacy part of United's new program, most of which occurs outside the visit to the doctor's office, which could explain why so many physicians are still unfamiliar with the program.

"The focus of care coordination is on how can we improve the care of the patient," said Dr. Hawkins. Many patients fail to comply with a physician's prescribed plan of care, he explained, such as filling prescriptions or following a diet. "If no one is checking on that and evaluating that, then there are patients who fall between the cracks."

Under the care coordination program, United patients are contacted before any scheduled hospitalization to discuss the upcoming procedures, Dr. Hawkins said. Discharge planners and nurses try to identify patients' recovery needs, he said.

In one recent example, a home care nurse contacted a patient who had undergone total hip replacement surgery and was having difficulty getting to her follow-up appointments, Dr. Hawkins recounted. The patient explained that the only way she could bypass the front steps to her house was to hang on the screen door, swing out past the steps and then drop onto the lawn.

"We felt fairly comfortable that that was not part of the treatment plan the doctor had prescribed," Dr. Hawkins said. United nurses arranged for physical therapy in the patient's home, he said, and they are looking at community resources to develop a long-term plan.

Nationwide, services established under United's "care coordination" program have resulted in contacts with 90,000 members, a significant portion of its 8 million enrollees, said Dr. Georgiou.

"We involve the physician when we notice a care gap," said Dr. Hawkins. Sometimes the gap is due to a physician not complying with established practice guidelines, such as prescribing beta-blockers for patients who have had a heart attack, he said. In those cases, the physician receives a "reminder" from the health plan, in addition to a clinical profile every six months that compares individual practices with established norms.

In addition, physicians receive reports from United about care gaps that are due to patient non-compliance, such as failing to fill prescriptions. Alabama physician Dr. Folmar said he welcomes those reports and follows up with patients who are overdue for pap smears or other exams. But he also views those reports somewhat critically, such as the recent mammogram reminder he got for a patient who had undergone double mastectomy.

Other physicians are less receptive to the idea of "partnering" with a health plan on patient care issues.

"If they tell me a patient didn't fill a prescription, what am I going to do about it?" asked Barry Webb, MD, a family practitioner in Cincinnati. He says he already makes a conscientious effort to communicate with his patients to determine their needs, and doubts that an insurer can make much difference.

"In an ideal world it might lead to better patient care," he added, "but in the world we live in, I'm not sure it would work."

As for any cost savings, United decreased staffing nationwide by 18 percent last fall when the new program was initiated. Dr. Georgiou said it was too early to draw any conclusions about the program's impact on overall utilization, except that the numbers look "promising."

Regardless of the program's short-term cost savings, some analysts have argued that focusing on quality measures rather than utilization not only produces better outcomes but also results in long-term savings - a goal the managed care industry has not aggressively pursued, particularly with high membership turnover.

"The industry was quicker to go the straight cost route," said Erich Kirshner, spokesman for the Colorado Foundation for Medical Care, a peer review organization. "It's a little easier to measure the number of times a doctor sends patients to specialists than it is to look at diabetes management," he said.

But like other patient advocates, he is optimistic that United's new approach could signal a change in managed care's philosophy.

"There's a growing awareness that your patient is my patient tomorrow, and if we don't all do a better job of managing the health care delivery for these patients, then we'll all pay the price," he said. "As an industry it makes sense to look more closely at that."

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