Personal Health Management

Reprinted with permission, Managed Healthcare, July 1996.
(Second in a two part story. Part One)

Although employers and other purchasers still regard price as the most significant criterion in choosing a health plan, the time will come when costs are lowered to their bare minimum. Consequently, when prices can't be lowered any more without incurring significant financial losses, providers and plans will have to focus on value strategies to differentiate themselves from the competition.

In the following equation, V = Q/P, value (V) is defined as the relationship between quality (Q) and price (P). In other words, the higher the price relative to perceived quality, the lower the perceived value.

The value equation, in addition to showing the inverse relationship of cost and value, also shows the direct relationship between quality and value.

As cost competition continues to increase in health care, an irreducible minimum cost level eventually will be reached.

When this occurs-and it already has in some markets-the delivery of increased value will occur primarily through increasing the quality of care delivered without adding cost In addition to helping control costs, personal health management (PHM) programs improve the quality of care delivered as perceived by consumers and providers (mainly via increased satisfaction) , and health care plans and payers (via improved system performance measurements).

This happens in several ways. First, consumer access to information and advice is improved. Without a PHM program, patients get information and advice by calling their provider or insurance plan with a question. Then they wait for a response.

Alternatively, they may generate a list of questions for a provider visit (and leave feeling rushed and unheard), or call their providers office directly and receive advice and information from an office staffer (often with little medical expertise and other pressing responsibilities).

In contrast, PHM programs provide 24-hour, immediate access to trained personnel whose sole task is to provide triage advice, medical information and care advice for specific health problems, also offering user-friendly audio text (usually with mail or fax-out capability) for medically reviewed health information and plan- or institution-specific questions.

Satisfaction skyrockets

In one pediatric PHM program based in Denver more than 97% of parents were satisfied with the service overall. They also were more satisfied with the PHM program than they were with their children's primary care provider in terms of response time and the quality of information. In addition, 99% of the participating pediatricians were satisfied with the service The use of dedicated personnel and standard audio-text ensures: that callers receive timely, comprehensive and consistent advice and information, usually tailored to health plan and provider specifications:

• improved access to providers for medically necessary evaluation and treatment; and
• less inappropriate utilization, which increases costs and decreases access for those needing care.

Triage, as practiced in PHM programs, leads to the delivery of care at the right time, with the right resources, in the right location. That translates into physicians and other care providers seeing patients who need urgent evaluation and treatment in a timely fashion, while the less sick receive appropriate advice, information and follow-up instructions.

Finally, providers and staff are relieved of the burden of telephone inquiries, allowing them to deliver more focused care.

The physician satisfaction in the Denver program was a reflection of the satisfaction of the parents and the vastly decreased number of parent calls received. The calls that were received were appropriate and required the physicians' attention, which they were able to give without worrying that another call was waiting.

Who benefits from PHM programs?

For consumers, health care quality translates into satisfaction with their personal care provider and health care plan. PHM programs clearly improve satisfaction.

PHM programs improve providers' productivity and focus and increase their patients' satisfaction and quality of life. Payers and plans assess quality by monitoring patient satisfaction, access, utilization, clinical indicators and other measures developed by organizations such as the Joint Commission on the Accreditation of Health-care Organizations and the National Committee for Quality Assurance.

They are discovering that comprehensive PHM programs improve many performance measures by increasing access, utilization management and patient satisfaction through education and triage.

The delivery of value in health care, as defined by the value equation, clearly is enhanced by PHM programs, which offer both cost control and improved quality. Within a very short time, participation in PHM programs will be an expectation for patients, providers and plans.

Early adoption of this innovative approach to value delivery in health care will extend benefits to all participants.

by Ian R. Lazarus Reprinted with permission of the author. Mr. Lazarus may be contacted at irl@creative-healthcare.com