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Managed Care Has the Power to Improve Health, but Unwilling to Pay the Price

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Jan. 14, 2000 (Eugene, Ore.) -- Managed care plans aren't living up to their potential when it comes to helping members change unhealthy behaviors, according to a just-released report from the Center for the Advancement of Health (CAH), a Washington-based nonprofit organization. Nearly half of U.S. premature deaths and as much as 70% of all health care spending are linked to consumer habits such as poor nutrition, lack of exercise, and alcohol and substance abuse, but few plans routinely use effective strategies to promote behavior change, the report says.

"We were pleasantly surprised to learn there is widespread recognition within managed care about the critical importance of behavior in improving health outcomes," says CAH executive director Jessie Gruman, PhD. "However, they have had trouble figuring out which interventions are truly effective." While most health plans do offer services to help members manage chronic disease or improve health behaviors, often they simply hand out brochures and pamphlets, a method that rarely leads to sustained, long-term change.

Health Behavior Change in Managed Care: A Status Report is based on a 1999 survey of HMO medical directors in five states and the District of Columbia, interviews with purchasers, and a review of scientific literature on consumer behavior change. "We did find a new recognition of the importance of chronic disease," says Gruman. "Unfortunately, much more attention is focused on managing existing chronic diseases than on preventing them in the first place." Management services for chronic disease are usually offered at no extra cost, while efforts to prevent disease (through improved diet, exercise, smoking cessation, or similar programs) are usually offered off-site, with extra fees.

While purchasers also recognize the importance of behavior change, they rarely negotiate for specific services, because they expect comprehensive care to include effective methods for controlling risky behaviors and managing chronic disease.

After surveying the available literature on behavioral risk reduction and disease management, certain themes emerged, the report states. "All effective interventions include some form of review and collaborative planning discussion between primary care provider and patient."

The report notes that common elements of effective discussions between primary care providers and patients include a brief personalized review of health status and risks; collaborate decision-making and priority-setting about what to do; mutual development of a treatment plan, including referral to specific behavior change support services if needed; and an arrangement to follow up on the patient's progress.

At present most managed care organizations are not doing systematic outreach to all their at-risk members. But "plans that are institutionally committed to population-based care can potentially do this," Gruman tells WebMD. "We have computers, and health plans know who their members are, so we have the technological ability."

HealthPartners Inc., a Minneapolis-based plan with 800,000 lives, is one plan that has the kind of effective programs Gruman is talking about. For example, the plan identifies diabetic patients through claims and lab data, then routinely shares data on elevated HbA1C levels with physicians. The doctors plus specially trained diabetes resource nurses work with each patient to develop a plan, says Linda Roe, director of care system integration in HealthPartners' Center for Health Promotion. The plan may include referrals to group or individual nutrition counseling, and/or to phone-based counseling in weight management, physical activity, or stress management.

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