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Managing Sudden Conditions

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You know about the importance of managing the care of the 20% of health plan members who have chronic conditions and will generate 80% of an employers claims.

But what about the 2% of the employees who will develop a severe, acute health problem, such as cancer or severe trauma, and generate 20% to 30% of an employers claims?

One strategy is to supplement traditional disease management programs with acute-care management programs.

The big difference between helping patients manage chronic health problems and helping patients deal with acute-care issues is that its much, much harder to pinpoint who will fall into the dreaded 2%.

Of course, some will be workers who had trouble managing their diabetes or their blood pressure, but others might be young, healthy, thin employees who stepped off a curb at the wrong moment.

One of the best ways for an acute-care management firm to get the earliest possible warning of trouble is to position itself as a resource that can help employees who are facing urgent acute-care needs find the best possible doctors.

An acute-care management firm can work with third-party administrators, precertification companies, case-management firms and even stop-loss vendors to make sure all parties focus on achieving superior medical outcomes while holding down costs.

Getting an expert physician to consult with the treating physician can go further toward making sure the treating physicians are getting the best possible advice.

One reinsurer that tried an acute-care management service found that the program helped 63% of the participating patients avoid unnecessary surgery.

is executive vice president, business development, at Best Doctors Inc., Boston, a company that develops acute-care management programs. He can be reached at [email protected].

Reproduced from National Underwriter Edition, April 15, 2005. Copyright 2005 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.


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