Dr. VanderLaan

Thursday, 29 April 2004 06:21

Integrating benefits

In today's competitive business environment, loss of productivity due to employee disabilities is a growing concern.

The strong desire to retain employees and the high cost of replacement workers are important drivers behind growing employer interest in integrating medical and disability benefits. A Mercer Human Resource Consulting study found that companies spent 15 percent of payroll on employee absence in 2002.

In addition, chronic diseases are on the rise in the United States. According to the American Diabetes Association, almost 17 million people in the United States have diabetes, yet about one-third don't even know they have the disease.

Researchers have estimated that diabetes cost the country $132 billion in medical expenses and lost productivity in 2002.

Return to productivity

By combining health and disability data to get an overall picture of a patient's health, physicians can help their patients remain healthy and productive. An integrated health and disability management approach can't necessarily prevent disease, but it can help a patient manage the progression of the disease and open up new options for workplace accommodations.

Here's an example. Bob, a 41-year old employee who works at a manufacturing plant, has a nonwork related injury and visits his doctor. His doctor determines that he's having lower back pain, says he should be out of work for a week, prescribes a muscle relaxant and anti-inflammatory medicine, and recommends physical therapy.

When Bob files his disability insurance claim, he agrees to join the integrated health and disability program and signs an authorization allowing the medical and disability staff to share information about his condition.

Over the weekend, Bob complains of frequent urination, thirst and hunger. He becomes disoriented, passes out and is admitted to the emergency room. His attending physician discovers that Bob is suffering from diabetic ketoacidosis and has very high blood sugar.

Bob's wife calls his disability insurance specialist and explains that Bob was taken to the hospital due to disorientation. She does not mention diabetes to the disability specialist. However, the disability insurer requires a statement from the attending physician and contacts the doctor's office.

The nurse tells the disability specialist that Bob was admitted to the hospital in a diabetic coma. The disability specialist explores the matter further and discovers a history of depression (a common, co-existing condition) and the new diagnosis of diabetes.

At this point, the disability specialist can continue with approval of the disability claim, and because Bob has previously granted permission to share information between his medical and disability case managers, she also makes a referral to the medical case management team responsible for Bob. When Bob is discharged, he is still experiencing lower back pain and is a newly diagnosed diabetic, so his doctor advises him to remain off work for four more weeks.

In the meantime, his medical case manager has also received a referral from the hospital. The medical case manager refers the case to the insurer's behavioral health and diabetes disease management area for follow-up.

In this scenario, Bob would get case management assistance from a care team that reviews his case in its entirety, develops a common plan to understand the link between his depression and his diabetes, and synchronizes the efforts of the medical and disability staff to help him return to work earlier than otherwise expected.

This holistic management approach focuses on the root causes of absences that generate health and disability claims. It links health effectiveness to functional outcomes, return-to-work and work/life issues. The total health model also enables employers to measure the value of health care products, at least partially, by their impact on productivity. Dr. Burton VanderLaan is a board-certified oncologist. He serves as regional medical director for Aetna and is responsible for quality and utilization activities for a 16-state region. He is a member of the board of governors and a past president of the Institute of Medicine of Chicago, and has served as a member of the board of trustees of the Illinois Hospital Association. He also is a fellow of the American College of Physicians. Reach him at (312) 928-3580 or VanderlaanB@aetna.com.

Thursday, 26 February 2004 09:43

On the cutting edge

Recent employer surveys revealed that health insurance premiums increased 13.9 percent in 2003 -- the third straight year of double-digit increases. Yet employers today are benefiting from innovative technology offered by health plans to get a better return for their employee benefits dollar while helping to maintain or improve their employees' health.

These technologies frequently use current or historic data, including predictive modeling and the use of data to improve quality and safety, to identify individuals at risk.

Predictive modeling

Health plans that use predictive modeling are increasingly able to identify individuals who are predicted to have a costly or adverse health event, such as a hospital admission or emergency room visit. Carriers can then develop insightful and accurate reports from their large databases providing information about such high-risk individuals.

This information may be provided to a treating physician, who can work with the individual on early prevention and detection programs or other steps that can offset or prevent more serious health issues. Alternatively, it may be used to get the individual involved with a disease management program. Overall, it can help improve an employee's quality of care and reduce costs for both the employee and the employer.

Quality and safety

Leading health benefits companies are investing in helping to improve the quality and safety of medical care. Through sophisticated data-mining programs, data can be collected, combined and analyzed to create meaningful information that physicians can use to improve clinical quality and patient safety.

By comparing data with treatment recommendations, errors and gaps in treatment plans can be discovered. Carriers can arm physicians with information that can be used to improve patient care and avoid adverse health events.

To illustrate, a review of medical, lab and pharmacy claims for Mr. Smith following his recent heart attack suggests he is not using a drug referred to as a beta blocker. Evidence-based standards indicate a beta blocker could help reduce his chances of having another heart attack. This finding may be communicated to his treating physician, who then can evaluate if he should be prescribed a beta blocker.

The bottom line

A carrier's ability to skillfully and accurately collect and integrate data is a powerful tool that can influence medical management, and overall patient management, in a positive and beneficial way. Employers looking to manage health care dollars should consider a carrier that is investing in innovative health care technology focusing on quality and safety. It could an important first step toward keeping your employees - and your bottom line -- in good health. Dr. Burton VanderLaan is a board-certified oncologist. He serves as regional medical director for Aetna and is responsible for quality and utilization activities for a 16-state region. He is a member of the board of governors and a past president of the Institute of Medicine of Chicago, and has served as a member of the board of trustees of the Illinois Hospital Association. He also is a fellow of the American College of Physicians. Reach him at (312) 928-3580 or VanderlaanB@aetna.com.

Tuesday, 27 April 2004 13:53

Integrating benefits

In today's competitive business environment, loss of productivity due to employee disabilities is a growing concern.

The strong desire to retain employees and the high cost of replacement workers are important drivers behind growing employer interest in integrating medical and disability benefits. A Mercer Human Resource Consulting study found that companies spent 15 percent of payroll on employee absence in 2002.

In addition, chronic diseases are on the rise in the United States. According to the American Diabetes Association, almost 17 million people in the United States have diabetes, yet about one-third don't even know they have the disease.

Researchers have estimated that diabetes cost the country $132 billion in medical expenses and lost productivity in 2002.

Return to productivity

By combining health and disability data to get an overall picture of a patient's health, physicians can help their patients remain healthy and productive. An integrated health and disability management approach can't necessarily prevent disease, but it can help a patient manage the progression of the disease and open up new options for workplace accommodations.

Here's an example. Bob, a 41-year old employee who works at a manufacturing plant, has a nonwork related injury and visits his doctor. His doctor determines that he's having lower back pain, says he should be out of work for a week, prescribes a muscle relaxant and anti-inflammatory medicine, and recommends physical therapy.

When Bob files his disability insurance claim, he agrees to join the integrated health and disability program and signs an authorization allowing the medical and disability staff to share information about his condition.

Over the weekend, Bob complains of frequent urination, thirst and hunger. He becomes disoriented, passes out and is admitted to the emergency room. His attending physician discovers that Bob is suffering from diabetic ketoacidosis and has very high blood sugar.

Bob's wife calls his disability insurance specialist and explains that Bob was taken to the hospital due to disorientation. She does not mention diabetes to the disability specialist. However, the disability insurer requires a statement from the attending physician and contacts the doctor's office.

The nurse tells the disability specialist that Bob was admitted to the hospital in a diabetic coma. The disability specialist explores the matter further and discovers a history of depression (a common, co-existing condition) and the new diagnosis of diabetes.

At this point, the disability specialist can continue with approval of the disability claim, and because Bob has previously granted permission to share information between his medical and disability case managers, she also makes a referral to the medical case management team responsible for Bob. When Bob is discharged, he is still experiencing lower back pain and is a newly diagnosed diabetic, so his doctor advises him to remain off work for four more weeks.

In the meantime, his medical case manager has also received a referral from the hospital. The medical case manager refers the case to the insurer's behavioral health and diabetes disease management area for follow-up.

In this scenario, Bob would get case management assistance from a care team that reviews his case in its entirety, develops a common plan to understand the link between his depression and his diabetes, and synchronizes the efforts of the medical and disability staff to help him return to work earlier than otherwise expected.

This holistic management approach focuses on the root causes of absences that generate health and disability claims. It links health effectiveness to functional outcomes, return-to-work and work/life issues. The total health model also enables employers to measure the value of health care products, at least partially, by their impact on productivity. Dr. Burton VanderLaan is a board-certified oncologist. He serves as regional medical director for Aetna and is responsible for quality and utilization activities for a 16-state region. He is a member of the board of governors and a past president of the Institute of Medicine of Chicago, and has served as a member of the board of trustees of the Illinois Hospital Association. He also is a fellow of the American College of Physicians. Reach him at (312) 928-3580 or VanderlaanB@aetna.com