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LOUISVILLE, Ky. -- An especially intensive disease management program may hold the key to conquering one of employers' most expensive and recurrent costs: workers' and retirees' heart conditions.
The program already has yielded impressive results for Humana Inc., and it will be rolled out in somewhat different form to United HealthCare Corp. nationwide. Both are team efforts taken together with a disease management company, Buffalo Grove, Ill.-based Cardiac Solutions Inc. The program is open to health plan sponsors as well.
Humana and United HealthCare's programs involve nurses, acting as disease managers, forming close relationships with heart patients to coach them into practicing healthy activities, such as maintaining proper diets and staying on drug regimens.
The payoff for Louisville-based Humana, which began the program in 1996, was a 61.1% reduction in inpatient health care costs and a 57% drop in hospital admissions for all conditions, Cardiac Solutions Vp Cornelia Tilney said.
But some benefit managers said the program makes sense for Medicare recipients, though it may not result in direct savings for most employers.
Humana and Cardiac Solutions tracked 1,915 HMO members who had experienced at least one previous hospitalization for congestive heart failure.
The system Humana used, a proprietary Cardiac Solutions program called Multicare, entails these features:
* Intensively trained nurses who act as disease managers and work to form close relationships both with the patients and their physicians.
* Education and coaching of patients to motivate them to eat properly and take medicine.
* Coaching on other services, such as physical therapy, counseling and home health aid.
* '"Humanizing activities," such as postcards to patients' homes, home visits, supportive telephone calls and special attention to weight changes and salt intake.
"This isn't just a nurse picking up the phone and checking in on the patient; this is a very complex, intricate technical program," Ms. Tilney said.
Programs such as Humana's and Cardiac Solutions' would appeal not only to HMOs but to plan sponsors with large populations of retirees, as well as those with many older current workers with heart conditions, she said.
"We're just starting to call on these employers," said Ms. Tilney. "Some of them are interested in contracting out for programs such as this. . .If you're a very large, national retailer with many 25-year-old females, it may not make sense, but if you're an IBM and have many older males, a program like this makes a great deal of sense."
The only expense to rise in the Humana program was prescription drug costs, which rose by roughly two-thirds. That was expected, Ms. Tilney said, because patients were taught by disease managers the importance of taking drugs as prescribed.
The Humana program's results were "really quite stunning," said Dr. Richard Vance, the HMO's vp for population health improvement.
"In the last seven to eight years, there has been the promise of programs that can deliver but rarely those that demonstrate savings of money and better health (for participants)," he said. "There have been smaller studies with other diseases, (but) this. . .requires skills. This is something you have to gain by experience."
The rise in drug costs that accompanied the program was anticipated and even welcomed, he said. "Disease management programs like this realize the main driver to hospitals is the failure of management of proper pharmaceutical care," he said.
Minnetonka, Minn.-based United HealthCare Corp. said in September that it, too, planned to join with Cardiac Solutions to try to reduce the cardiac-related expenses of its work force. United HealthCare tried a small pilot program in North Carolina and found that hospital admissions dropped by about 40% and emergency room visits dropped 73% over a 12-month period.
The North Carolina program, which involved 148 employees with heart problems, also included close monitoring of patients, encouragement of smoking cessation, lowering of cholesterol, better diet and other lifestyle changes for current workers.
One benefit manager said programs such as Humana's probably would save Medicare the most money, as that program is the most common payer of benefits to cardiac patients, who typically are older or retired.
Alan Peres, manager of benefits strategy of the Chicago-based Amer-itech Corp., said that, on a cost basis, such a program is more appealing than trying to fight heart disease at the primary level -- attempting to prevent a first occurrence of a heart attack.
But he said most employers would not see a direct return if the program were helping only Medicare patients.
"If you work on Medicare patients, Medicare reaps the patients' benefits -- we don't reap the Medicare benefits," Mr. Peres said.
Richard Dreyfuss, director of compensation and benefits of Hershey, Pa.-based Hershey Foods Corp., said of Humana's program that "the premise is reasonable" and called it the "second generation of case management."
Considering that workers' cardiac problems are undoubtedly a significant cost to Hershey, he said Hershey might consider integrating such a program with its existing HMOs and third-party providers, especially if a contractor took the risk.