America's Best Health Plans
Managed care doesn't have to be cold and uncaring. The highest-ranking plans have a positive attitude.
Patients have access to their medical records online as well. Jodie Danowsky, 35, was able to confirm last year that she was pregnant--with Emma, now 3 months old--by checking her results online even before the Geisinger nurse had a chance to call. Winifred Reakes, 59, logs into her patient record to help her remember the details of a recent doctor's visit. "Sometimes when they explain stuff in the office, you forget," she says.
Coping with chronic illness. Care for people with chronic conditions--ongoing illnesses such as diabetes, heart failure, asthma, and hypertension--accounted for 83 percent of all healthcare spending in 2001, according to a recent Johns Hopkins University study. By 2030, half the population will have one or more of these illnesses, the study found. A good disease management program teaches patients how to monitor their condition and prods them to manage it themselves. For 15 years, Charles Coffman was able to control his diabetes through diet alone. But when that strategy began to fail four years ago, the 57-year-old mayor of Bloomsburg, Pa., started working with a disease management nurse at Geisinger. Coffman knew chocolate cake wasn't good for him, but through his nurse he learned that potatoes and bread could make his blood sugar spike, too. The nurse also worked with his wife to develop healthful meals she could cook for them both. Now Coffman sees his nurse every six weeks for a check of his blood sugar, blood pressure, and weight and to look over his feet for sores. The results have been gratifying. "I'm not on insulin right now, and I probably still have my legs because of this program," he says.
Managing medication. An oft-cited Institute of Medicine 1999 report charged that medication errors cause up to 100,000 in-hospital deaths each year. Harvard Pilgrim Health Care believes outpatient errors may cause even more. So the plan offers to send a pharmacist to doctors' offices to sit down with patients on more than five medications to review their prescriptions and talk about side effects, drug interactions, and the like.
The transition back home after a hospital stay can be confusing, so the health plan also routinely calls patients three days after discharge to review their medications. Judith Frampton, the plan's vice president of clinical quality programs, cites a patient who was found to be taking not only the drugs she'd been prescribed when she was discharged but those she was on before she was admitted as well. "That's a very dangerous situation, and who knows when it would have been discovered," she says.
Informing consumers. The rise of consumer-driven healthcare has prompted health plans to intensify their efforts to make information more available to consumers about the cost of services and help them evaluate the quality of care provided by doctors and hospitals. Cost information has been particularly elusive. But in a pilot project now underway in Cincinnati, Aetna plan members can go online and find out the cost of their medical care for 25 common office procedures.
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