Disease management programs have the potential to improve care and reduce the costs of chronic illness. However, certain characteristics of the disease management marketplace may cause concern. Disease management in the United States, whether outsourced to a corporate vendor or performed within a commercial health maintenance organization, largely takes place within the for-profit healthcare sector.
Dr. Jack Charles Schoenholtz, Distinguished Life Fellow of the American Psychiatric Association, a Fellow of the American College of Psychiatrists, and a clinical professor of psychiatry and behavioral sciences at the New York Medical College, is the author of “The Managed Healthcare Industry–A Market Failure,” a book that examines the history of healthcare reform.
Dr. Schoenholtz says, “As a physician, I was inspired to write the book as far back as the 1980s, and wrote many articles and features about managed care. Those, and the healthcare-deconstructing events between 2001-2008, required a book to show how healthcare turned into ‘wealthcare’ for big insurers and managed-care companies. The so-called ‘healthcare industry’ is not a cohesive group. It, and the ‘disease management’ (commercial managed-care) group are largely adversaries. People with diabetes would find that commercial ‘disease management’ only locks them into high-cost, higher-priced, ‘carved-out’ care.”
Dr. Schoenholtz explains that “carved-out” care means “a healthcare delivery and financing arrangement in which certain specific healthcare services that are covered benefits (e.g., behavioral healthcare) are administered and funded separately from general healthcare services. The carve-out is typically done through separate contracting or subcontracting for services to the special population.”
So what does “wealthcare” mean for people with diabetes?
As more funds are dedicated to disease management, less will be available to pay primary care physicians. For the tens of millions of Americans enrolled in health maintenance organizations, a fixed amount per patient is divided among hospitals, physicians, and ancillary and other services. Dollars carved out for disease management firms are not available to primary care physicians. These physicians will be forced to see more patients to earn the incomes they are used to, allowing them less time to care adequately for patients with chronic diseases. Disease management firms will accumulate the knowledge of how best to manage patients with chronic diseases, while primary care physicians may increasingly lose these skills.
Dr. Schoenholtz believes his work will show readers how the country can reduce expensive healthcare costs for employers while still upholding promised benefits for employees. By weaving political, social, and economic information together, this book offers a comprehensive and readable approach to this ongoing debate.
Source: Bodenheimer, T., Disease management in the American market. BMJ. 2000 February 26; 320(7234): 563-566.