Managed Care Has the Power to Improve Health, but Unwilling to Pay the Price
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.
"When we look back five or ten years, we can see there has been substantial progress," Gruman says. "However, managed care has an incredible potential to make an impact on unhealthy behaviors that has yet to be realized."
HealthPartners' medical director, George Isham, MD, served on the CAH advisory committee for the study, which was funded by a $380,000 grant from the Robert Wood Johnson Foundation.