New Programs for Providing Proactive and Urgent Care

New Programs for Providing Proactive and Urgent Care

By Dr. Kenneth Rothaus

There have been many recent reports in the conventional media and internet about programs designed to decrease both, the incidence of primary admissions and the numbers of patients that get readmitted after a hospitalization.

Anthem Blue Cross ACO of California is one such organization. An ACO or accountable care organization links provider (read doctors and hospitals) reimbursements to two metrics: quality of care and reduction in cost of care for an identifiable population. The Anthem ACO identifies members of its PPO (preferred provider organization or network of hospitals and doctors contracted by the insurance company to deliver care) with two or more chronic diseases. The identified patients received a proactive team based medical care which resulted in a significant reduction in hospital admissions (7.3%), outpatient visits (2.3%), and a greater use of generic drugs (4.2%). The cost savings was almost 8 million dollars. The article implies that this presumably and more importantly also resulted in better health and quality of life for the patients

Both the Cleveland Clinic and Providence Health Care (also a west coast insurance provider) have announced 24 hour telemedicine medical visiting services at $49 and $39 per visit respectively. Such services are meant to treat patients with routine problems that often for lack of another option result in a visit to the emergency room or the doctors office. These problems can now be treated over the phone. The problems mentioned in the Cleveland Clinic press release included cough, abdominal pain, diarrhea, fever and headaches. Certainly patients with a long-term primary care physician will initially seek care over the phone and be successfully treated. The key point is that failure to improve or worsening of the symptoms will result in a prompt visit to see a physician in person.

One of the benefits of both of these programs are the cost savings that are generated for the insurance companies. As noted above, many patients already receive their initial care from their private physicians over the telephone. These physicians rarely charge for this service. If the insurance companies and hospitals are now providing the same service for a fee, how would you feel if your physician charged a fee for this service as well?