Fibromyalgia joins ranks.....

[Guest guest]

Fibromyalgia joins ranks of those conditions that are managed by

telephone case managers

The doctor gets a checkup Firms aim to cut medical costs by

`managing' diseases From US NEWS - online edition By Kim `My

doctor told you what? " Jean Faber of Verndale, Minn., was angry and

suspicious when a stranger called two years ago offering advice about

her bad back. The 43-year-old human resources consultant hung up

immediately and checked with her insurer. Sure enough, Blue Cross and

Blue Shield of Minnesota had hired a company to provide free advice

to members with bad backs, heart disease, and a host of other

conditions. So Faber gave it a try. Her nurse explained how drinking

more water and buying a better office chair could help her back,

details Faber's doctor did not mention. The nurse's advice, and

regular calls encouraging Faber to stick to her diet, have been life-

changing. Faber has lost weight, and her back no longer bothers her.

The nurse calls " are wonderful. It's kind of like having your mom

call. " Soon, Big Mother may be calling you, too. In the latest

attempt to reduce skyrocketing health costs, insurers and employers

have hired thousands of nurses to coach patients and doctors to

follow the standard protocols for each disease. " Disease management "

is one of the hottest ideas in health insurance because it promises

to improve patients' health while reducing employer and insurer

costs. But it is controversial, as some doctors and researchers

question whether the programs live up to their marketing hype and

whether they benefit some in the medical community at the expense of

others. On the rise. There is little question that the concept is

booming. What began as an attempt to reduce medical emergencies and

the hospital costs of people with a few expensive illnesses, disease

management now serves at least 2 million Americans with conditions

that include cancer, depression, fibromyalgia, and heart disease.

Offered by more than half of all employers and almost every major

private insurer, disease management is now a $750 million industry.

And the idea of micromanaging illnesses got a major boost last year,

when a Medicare reform bill called for trying out disease management

on approximately 4 million senior citizens. Industry leader American

Healthways, which called Faber, and other accredited disease managers

such as CorSolutions Inc. and LifeMasters, all have experienced

nurses call or meet patients personally every week or month,

depending on the patient's need. They also provide 24-hour nurse

answer lines, Web sites, and mailings. The companies employ

sophisticated computer programs that alert nurses (and the physicians

who want to check on their patients) to exactly what the standard of

care is for each disease and how each patient's care compares. The

computer reminds a nurse chatting with a diabetic, for example, that

the American Diabetes Association recommends patients check their

feet for sores every day because diabetics' poor circulation can lead

to festering wounds that result in amputation. The programs also

alert the nurse if a doctor hasn't followed the association's

recommendation that physicians check diabetics' feet at least once a

year. The computer prompts the nurse to fax or call in a reminder to

the doctor. Surprisingly, getting patients and doctors to follow

basic recommendations like these is a major accomplishment. A study

published in the New England Journal of Medicine last summer found

that nearly half of all Americans weren't getting the official

standard of care for their ailments. The leading disease managers

improve health by reducing the number of emergencies that require

hospitalization, says Al , a consultant who rates programs. The

reduction in hospital stays and emergency room visits helps the top

disease managers deliver to the insurer or employer guaranteed

savings of, typically, twice the $20 to $90 per patient per month

costs, he says. (Sicker and harder-to-reach patients cost the most.)

But despite these promised savings, the programs are not without

their critics. There is suspicion that the management companies

reward pharmaceutical firms since the programs encourage people to

take prescribed medications, which results in increased drug sales.

In Florida, Republican Gov. Jeb Bush has come under fire for giving

pharmaceutical giant Pfizer a no-bid contract to provide disease

management to Medicaid patients. The state says it made sure that the

nurses promote only good health and don't mention Pfizer products.

And so far, the nurses have helped patients while reducing their

medical costs, the state has found. But critics say it is no

coincidence that Pfizer's sales to Medicaid patients have also

skyrocketed. While saving Florida's Medicaid program $7.5 million,

Pfizer saw its sales of drugs to the state rise $20 million. " Drug

companies should not run disease management programs, " says Bernie

Horn, policy director for the Washington-based Center for Policy

Alternatives. " It is not in the best interest of patients. " Irate

docs. What's more, the frequent monitoring of doctor care by nurses

rankles physicians. Fleming, president of the American

Academy of Family Physicians, says he and many of his fellow general

practitioners are fed up with calls and faxes from poorly trained

nurses who are using a corporate script to question their medical

judgments. Fleming, who runs a practice in Shreveport, La., likes to

see his sickest diabetic patients every three to six months. He says

a disease management nurse hired by an insurer once told his patients

they did not have to see him for nine months. The nurse may sound

friendly and may only be giving advice, but he or she is hired " by

the same people who, a year ago, denied you care, " Fleming notes.

There's even some question whether the disease managers actually make

good on their promise to cut costs. Autumn Dawn Galbreath, director

of the disease management center at the University of Texas-San

, says her research has found that while disease management of

elderly heart patients " does make people feel better and live longer,

it doesn't necessarily save money. " Disease management companies say

that while they're still working out some of the kinks, such as

improving relations with doctors, they've had plenty of experience in

winning over skeptics. Count among them Pope, a Florida

cardiologist who initially thought nurses' calls were a waste of his--

and everyone else's--time and money. But after noticing that the

nurses were catching patient problems earlier than his twice-yearly

checkups, as well as keeping people adhering to their diets, he

became a convert, so much so that he quit his practice and signed up

as medical director for American Healthways. " If you are a better-

educated person about your disease, then you are less likely to use

emergency healthcare services inappropriately, " he says. Even more

important, the industry is winning over the skeptics who write the

checks. In Minnesota, Blue Cross and Blue Shield executives figured

they might improve their members' health when they started their

disease management plan in 2002 but estimated they would only break

even on the costs. But in just one year, and after reaching fewer

than 15 percent of the insurer's members, the nurses cut their

patients' emergency room visits by 18 percent and helped control the

blood sugar of the diabetics. Blue Cross says the program saved it

$36 million in medical costs the first year. If the nurses can keep

reducing costs as the program spreads, " the potential impact is

staggering, " says Bill Gold, the insurer's chief medical officer.