Medicare changes to boost firms - East Valley Tribune: Business

Medicare changes to boost firms

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Posted: Tuesday, September 7, 2004 6:52 am | Updated: 5:21 pm, Thu Oct 6, 2011.

NASHVILLE, Tenn. - Bonnie Brailey started working as a nurse 42 years ago, wearing a starched white uniform and changing bedpans in a hospital.

Now she works in a Nashville call center, caring for patients by telephone. She makes sure they’re taking their medicine and reminds them about doctor appointments.

‘‘One-on-one rapport — it’s a great opportunity for teaching and answering questions,’’ said Brailey, who works for Nashville-based American Healthways, the largest disease management company in the country.

Disease management — which monitors chronically ill patients in hopes of preventing serious complications — is one of the fastest growing sectors in the health care industry. The idea is to spend money now on prevention and avoid spending more later on emergency care for people with diabetes, asthma, congestive heart disease and other chronic conditions.

Disease management is on the verge of further expansion as government and insurance companies give it a serious look to see if it will reduce the amount of money they have to pay on doctor and hospital visits.

The Medicare law enacted last year will launch 10 chronic care programs for Medicare patients by the end of 2004. The pilot projects, each involving 15,000 to 30,000 people, are supposed to last three years.

‘‘The idea to bring disease management to Medicare would be a big opportunity’’ for the industry, said Brook O’Neil, senior research analyst of Dougherty & Co. in Minneapolis.

The larger disease management firms — like American Healthways and Matria Healthcare of Marietta, Ga. — are in the best position to win Medicare contracts, he said. Other major companies likely to win the Medicare contracts are LifeMasters Supported SelfCare of Irvine, Calif., and CorSolution of Chicago, said analyst Glenn Garmont of First Albany Corp. in New York.

Still, while the business is growing, O’Neil warned there are no guarantees yet

that disease management will help the government and insurers save money.

‘‘Some say it’s not safe to spend more up front in an effort to save more money long term,’’ he said. ‘‘That’s the biggest argument.’’

But Bernie Horn, policy director for the Center for Policy Alternatives, a Washington-based advocacy organization, said disease management is a great idea even if it doesn’t save money.

‘‘The primary reason has to be to make the patients better,’’ Horn said. ‘‘There’s not enough information to prove that it will work. In theory it will save money. . . . This should be done, but not with the purpose to save money.’’

Disease management nurses use computers linked to patients’ medical records. They make sure patients are getting proper care, talking about symptoms and keeping medicine regimens.

Most American Healthways patients are elderly people who don’t mind the calls, said Sam Lewis, a clinical operations manager for American Healthways. Sometimes they are eager to speak to nurses because they have no one else to talk to about their illnesses.

‘‘It’s like (having) a best friend that knows something about your sickness,’’ Lewis said.

At first, the nurses call to build a rapport and make sure patients are being honest about their condition. Other calls that follow are health assessments, depression screenings, scheduled care checks and appointment reminders.

Some patients with more serious illnesses, like heart disease, have a monitoring system in their home that reports their weight and blood pressure daily.

Jacqueline Pitts of Nashville suffers from heart disease and has been in the home-monitoring program for about five years through Cigna HealthCare. When Pitts first started, she didn’t think she would be able to comply with the program’s demands; there were times she wouldn’t tell the nurses about some of her symptoms because she felt they couldn’t do anything about them.

That has changed: ‘‘You build a personal attachment with the ones that call. . . . I feel that if there was anything wrong they would really catch it,’’ Pitts said.

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