tag:blogger.com,1999:blog-9181810725696409953.post5754531471979867891..comments2024-03-17T04:20:11.083-04:00Comments on The Population Health Blog: Should Health Insurer Coverage Be Conditional On Participation In Disease Management?Jaan Sidorovhttp://www.blogger.com/profile/05072456803925863874noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-9181810725696409953.post-81110792263808020612012-01-05T21:43:03.863-05:002012-01-05T21:43:03.863-05:00I have thought of the same, however, with readmiss...I have thought of the same, however, with readmissions.<br /><br />If a patient is offered an evidence based intervention to reduce their chances of returning to the ER in <30 days, and they refuse it--after an informed discussion, is the hospital liable?<br /><br />Patient has capacity, but bad judgement. Its going to occur.<br /><br />Brad<br />relevant citation:<br />http://blogs.hospitalmedicine.org/SHMPracticeManagementBlog/?p=2671Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-42003588115583149422012-01-05T09:36:26.763-05:002012-01-05T09:36:26.763-05:00Big Chewy Pretzels makes a good point: the physici...Big Chewy Pretzels makes a good point: the physician needs to be involved in the referral process and can work with the patient to make it happen. I'd agree but point out that in the real world, despite extensive outreach to physicians with lots of buy-in, that the otherwise supportive docs generally neglect to refer. That can be overcome by P4P, which I've referred to in a prior lifetime, as a patient referral "bounty."<br /><br />And speaking of the real world, HealthPoints' description is especially telling.Jaan Sidorovhttps://www.blogger.com/profile/05072456803925863874noreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-61477092657876935942012-01-05T09:30:39.222-05:002012-01-05T09:30:39.222-05:00From HealthPoints:
The questions raised here are ...From HealthPoints:<br /><br />The questions raised here are important and well put. Our company management team previously ran the care and disease management program at one of the largest health insurance companies in the country. One (of the many) challenges we found with the programs provided there - which limited the program impact to a narrow slice (of already motivated!) individuals - was the Opt-In structure. In this case, a large portion of the telephone nursing staff’s job was “selling” the program to health plan members. Despite much time and effort, the sell rate (and thus program enrollment rate) was still very low. Experiences of the team piloting opt-out services captured a much higher portion of the population. <br /><br />This one step of moving from an opt-in to opt-out structure won’t solve all the issues raised here, but was found to be an effective way to increase program reach into the population.Jaan Sidorovhttps://www.blogger.com/profile/05072456803925863874noreply@blogger.comtag:blogger.com,1999:blog-9181810725696409953.post-48500782719868658132012-01-03T19:26:10.211-05:002012-01-03T19:26:10.211-05:00My comment was getting lengthy so I cut it back. H...My comment was getting lengthy so I cut it back. Hopefully it still makes sense.<br /><br />To me, the way to achieve this is by making DM a core component of primary care and eliminating the opt-in or out issue. The intensity of DM protocols are based on what the patient and provider jointly determine is best. <br /><br />This is a situation where partial efforts, such as an insurance company demanding DM on a portion of the population or paying a bit extra to primary care for some additional services, fail. Success requires jumping in with two feet and aligning the interests of the employer, the patients, and the primary care providers. <br /><br />I'd argue that the payment model needs to be aligned so that PCP is contracted directly with populations (e.g. self-insured employers) to avoid the issue of trying to get PCPs to perform DM services on a small sliver of the population.Eric Pagehttps://www.blogger.com/profile/01935321073090256445noreply@blogger.com