2004-07-15 00:00:00

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This post was written by Melanie

Even though managed care rates are increasing at slightly slower rates, the industry is still bracing for double digit increases in HMO and PPO rates in 2005, according to early results of the annual Milliman and Robertson survey. Final results will be published in October.

The industry will undoubtedly continue to turn to other methods to control these rising rates, including disease management, predictive modeling, consumer driven healthcare. During Controlling Healthcare Costs in 2004: A Three-Pronged Approach,an audio conference hosted by the Healthcare Intelligence Network in February of 2004, Lora Hedin, Senior Director, Product Management, HealthPartners, Alexandria Schweitzer, Assistant Vice President Consumer Driven-Health Care, Tufts Health Plan and Jim Woodburn, MD, MS, Major Account and Corporate Medical Director, Blue Cross Blue Shield of Minnesota, described how these strategies were working in their organizations.

Hedin said their organization is working toward creating a traditional marketplace where the consumers, buyers and providers of a product are aligned appropriately. Cost-shifting gets the consumer’s attention. By educating members on price and quality differences, it drives members into the most efficient, effective providers or makes them share in the cost.

Liberty by Tufts Health Plan is a second-generation consumer-driven health plan that combines the best of consumer-driven healthcare with the best of managed care, Schweitzer said. The plan provides incentivesto control discretionary spending and protects against less controllable expenses. It also provides members with a variety of tools to help members become better consumers of healthcare, including online health content, and audio library, a symptom checker, a nurse advice line, HRAs and decision support tools.

Anecdotal evidence confirms that the plan helps members behave like active consumers and adopt healthier lifestyles. Data confirms that the plan components reduce high-cost utilization, lower costs for controllable expenses and increase members’ preventive activities, Schweitzer explained.

The disease management program at BCBS of Minnesota began in March 2002 and now provides disease management programs for 17 conditions. The combination of the 17 conditions impacts between 12 and 15 percent of a commercial population, accounting for between 40 and 45 percent of total claims expenses.

The care support program was implement by stage, Dr. Woodburn said, with diabetes and heart program starting in March 2002 and the 11 extended conditions beginning in June 2002. Enrollment in the program was triggered by claims data. Overall, there was a 11 percent decrease in ER visits and a 14 percent drop in inpatient admission. The intervention was most effective for members with heart conditions ?????????????????? ER visits were down by 10 percent and inpatient admissions were down by 46 percent.

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