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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


Some Physicians to Be Paid for Online Consults

Managed Care Matters

Containing Costs While Maintaining Quality


from Drug Benefit Trends®
Posted 02/03/2003

Blue Shield of California plans to begin paying HMO- and PPO-contracted physicians for providing online consultations beginning in the first quarter of 2003. At press time, the plan had not decided how much physicians would be paid.

The decision follows release of a study conducted by a Stanford University researcher and funded by Blue Shield of California, San Francisco, and ConnectiCare Inc, an HMO based in Farmington, Conn. ConnectiCare is not paying physicians for online consultations at this time.

In the study, physicians were paid $20 per online consultation involving minor, nonurgent matters. Using a secure messaging system developed by RelayHealth Corp, Emeryville, Calif, physicians and patients were able to communicate about refills, laboratory results, appointments, and referrals.

Health care spending for office visits by the treatment group averaged $1.87 less per member per month (PMPM) compared with spending for office visits by the control group. Study results indicated that Web visits cost insurers $0.33 PMPM, a net savings of $1.54 PMPM. If savings are extrapolated for the 2 million members of Blue Shield of California, the insurer could potentially save more than $3 million a month.


Of the physicians who participated in the project, 63% said they were likely to continue using the RelayHealth service and 56% said they preferred to handle patients' nonurgent health care needs via the Internet versus at the office.

The study involving members of Blue Shield of California and ConnectiCare was conducted by Laurence Baker, PhD, assistant professor, department of health research and policy, at Stanford University. Baker analyzed and compared the health care spending patterns of 2274 patients in the treatment group who had access to the RelayHealth Service with those of 3390 patients in a control group. Claims for the 2 groups were reviewed for the 12-month period before the RelayHealth service became available and for an 11-month period ending February 28, 2002, during which the service was available.

Participating physicians interviewed in the November 25 issue of AMNews reported a high degree of satisfaction in being able to offer online consults, saying that the online system allows them to be paid for advice previously dispensed over the phone at no charge. It also saves time for physicians and their staffs by shifting requests for referrals, refills, laboratory results, and appointments from the phone to the Web. An online system provides better documentation of what was said and when as well.

Ninety percent of adults who use e-mail would like to be able to communicate with their physicians online in order to ask questions when no visit is necessary (77%), make appointments (71%), refill prescriptions (71%), and receive results of medical tests (70%). The more affluent persons are, the more likely they would be willing to pay for this service. As for how much patients would be willing to pay, the average response was just over $10 a month as a fixed amount, or nearly $7 each time they sent an e-mail.

Containing Costs While Maintaining Quality

from Drug Benefit Trends®

Mailed Promotions Cut Physician Visits for Arthritis Patients but Not Others

The use of mailed health promotion materials, such as handbooks and personalized questionnaires, improved the overall health of patients with arthritis and resulted in fewer visits to physicians' offices. However, use of health promotion materials did not benefit patients who have diabetes or hypertension.

These findings are from a study led by Diana L. Dally, PhD, of the Kaiser Foundation Health Plan of Ohio and published in the November-December issue of the American Journal of Health Promotion.


Outpatient visits for persons with arthritis who received the health promotion materials decreased an average of 4.4 visits over a 30-month period compared with a control group of patients with arthritis who did not receive the same materials. The 4.4 fewer visits translated into a net savings of more than $20,000.

The number of outpatient visits by diabetic patients who received similar mailings did not differ significantly from the number of visits by diabetic patients in the control group. The number of visits by patients with hypertension who received health promotion mailings actually increased an average of 2.89 visits over the 30-month study period compared with a control group.

The overall health status of the arthritis group who received the mailings also improved significantly, while the overall health of patients in the diabetes and hypertension groups did not change, according to the study authors.

Dally and colleagues suggest that mailings and other similar interventions may have a greater impact on conditions that greatly impair function, such as arthritis, than on conditions associated with less severe functional impairment, such as hypertension.

The researchers tested the effectiveness of home mailings with 593 members of the Kaiser Permanente of Ohio managed care plan. Half of the members in the study received regular mailings of personalized questionnaires, individual feedback on their returned questionnaires, health education materials specific to their medical condition, and a health information handbook at regular intervals throughout the study. Members in the control group received only condition-specific health education materials at the end of the first year of the study. Study participants were aged between 18 and 64 years and had chronic arthritis, diabetes, hypertension, or some combination of these conditions that caused them to seek outpatient care at least 11 times each year over a 2-year period.

Containing Costs While Maintaining Quality

from Drug Benefit Trends®

Physicians Say Medicaid Prior Drug Approval Is Seriously Flawed

The vast majority of physicians responding to a poll say that prior drug authorization required by Medicaid programs may potentially lead to less than optimal treatment, more emergency department visits, and may even place patients' lives at risk. Physicians also received a vote of confidence from the general public.

The survey of 315 primary care physicians and 2464 adults was conducted online by Harris Interactive. Results were released November 15 at the American College of Allergy, Asthma and Immunology (ACAAI) annual meeting.

More than 9 (92%) of 10 physicians agree that "requiring prior authorization is bad policy for the simple reason that it takes the decision of what is the most appropriate medication for a patient in an emergency situation out of the hands of their physician -- the individual in the best possible position to determine what is best for a given patient in a given situation."

Nearly all primary care physicians feel that prior authorization has a substantial impact on the overall health of patients who need acute care or rescue medications (92%) and that patients won't have access to the best available treatment (95%).

In addition, more than 9 out of 10 primary care physicians agree that "even if prior authorization might make sense for medications to treat chronic conditions, it doesn't make sense for acute care or rescue medications where many patients will not have such medication on hand when an emergency arises and will therefore have no time to seek prior authorization."

Among adults surveyed, 90% of respondents say they prefer that treatment decisions stay with their physicians.

"For people with life-threatening diseases, such as asthma, delaying prescribed treatment can have devastating consequences," says Bob Lanier, MD, president of ACAAI. "This is very clear to the medical community and population at large, as reported in this survey. This ought to be clear to the government, insurance companies, and MCOs as well."

Containing Costs While Maintaining Quality

from Drug Benefit Trends®

Medicare Targets Smoking in 7-State Pilot Program

The Centers for Medicare and Medicaid Services has launched a pilot program in 7 states to help determine the best ways to get seniors to quit smoking. The states are Alabama, Florida, Missouri, Nebraska, Ohio, Oklahoma, and Wyoming. The announcement was made November 21 to coincide with this year's Great American Smokeout Day. Results of the study will be available in 2005.

The program will test the effectiveness of various combinations of smoking cessation strategies with seniors, including counseling in person or over the phone, and the use of nicotine patches, a prescription smoking cessation drug, and educational materials.

Medicare beneficiaries who enroll in the study will receive free smoking cessation therapy, which may range from physician counseling to use of medications. Smoking cessation therapy is normally not covered under Medicare.

Medicare beneficiaries in the 7 named states who smoke and want to quit can call a toll-free number (866-652-3446) to find out if they are eligible to participate in the study. Once enrolled, beneficiaries will be assigned to one of the study options being offered and will have access to these services for 1 year from the time they enroll.