Medical revolutions Featured

12:15pm EDT June 29, 2005

Let's face it -- we're in a health care emergency for which there is no single remedy. Employers are crying uncle, but health care's economic grip seems as tight as ever.

However, help is on the way, and it's right at our fingertips. E-tools are quietly revolutionizing how we integrate medical care, so employers, providers, employees and health insurers can work together to create a transparent, unbroken communication link.

It's no secret that employees are being asked to share more of the costs and responsibility for their health care, and for their health. Accordingly, there is an increasing need for consumers to be better-informed decision-makers. As consumers become more price-conscious, they are motivated to find ways to save money, and they need reliable information.

Computer software programs that can communicate diagnostic and educational materials to physicians and patients help managed care organizations intervene early and manage patients, and their diseases, better.

Let's use Joe, a new employee of Company X, as an example. Joe has insurance that covers catastrophic medical events and preventive care. He also has asthma. Because Joe is responsible for the cost of physician visits, he wants to avoid the doctor's office as much as possible.

Avoiding asthma attacks will not only make him feel better but will save money by keeping him out of the emergency room. So how does he find out more about his condition?

Many health insurers have, or soon will have, medically approved online libraries available to members like Joe to help research conditions and find practical ways to manage them. Even more compelling is the fact that Joe will be able to use interactive tools to communicate with his health insurer.

For example, he can complete an online health risk appraisal -- a survey that can help identify his risk for certain diseases -- and receive personalized risk information and suggestions for next steps.

Joe will also be able to go to his health insurer's Web site to change his physician, research medical quality data on area hospitals or check his account for status on his claims. In the future, Joe will be able to go to his health insurer's site to use a variety of financial tools that will help him see how much money he's spent on deductibles, for example, so he can track his medical expenses. These services are available 24/7, so Joe can get the information he wants whenever he needs it.

E-tools also offer secure portals to help physicians access up-to-date information such as co-pays, coinsurance and deductibles, and process claims more quickly, leading to more timely payments.

As a result, Joe's health insurer is able to provide better customer service because Joe no longer has to call every time he wants information, his physician has easier access to information she needs for processing payments and the insurer's staff has more time to handle complex issues and offer more substantive assistance to its members.

Company X is pleased because Joe is healthier. He knows how to manage his condition and hasn't had to go to the emergency room because of an asthma attack. He feels better at work and is more productive. And, because Joe is one of many employees who have used these tools, Company X sees an increase in the overall health and productivity of its work force.

Joe's physician is happy because he has fewer payment delays. He and his staff spend less time processing paperwork and can concentrate on what they do best -- providing quality medical care to their patients.

Last, but not least, Joe is engaged in his health care and is healthier because of it.

Laurie Westfall is chief operations officer for Care Choices, a nonprofit health care organization and a subsidiary of Trinity Health. Care Choices HMO is ranked first in Michigan for clinical excellence in health plans, according to the National Committee for Quality Assurance. Reach Westfall at (248) 489-6944 or westfall@trinity-health.org.