Laboratory News

Companies Now Funding Care Managers to Review Doctors’ Treatment Plans

Doctors now have someone else looking over their shoulders watching treatment plans.  Growing numbers of large corporations are utilizing the services of care managers or integrated-health managers, reports the Wall Street Journal.  These services essentially review doctors’ treatment plans to make sure they conform to evidence-based practices established by medical standard-setting bodies.  Care managers may choose to nix certain drugs or procedures, but they may also expedite a surgery or suggest alternative and less invasive treatment when it makes more sense to do so.  Nationally, there are more than 200 care managers in place.

Early reviews by employees of companies using care mangers are mixed.  Some employees report that care managers can be invasive, making unwanted and repeated phone calls.  Another complaint is that care managers can be rigid and can fail to take into account differences among individual patients.  Meanwhile, other employees credit care managers with expediting clinical services such as surgery when required. They also note that care managers often assist with getting insurance companies to pay for things that would not typically be covered, such as help in quitting smoking. 

One employer, Hess Print Solutions, went so far to entice employees to enroll in their care manager program from Quantum Health  by offering a discount on health care co-payments.  Hess also introduced on-site wellness and other programs. Together, these programs have helped Hess keep employees' share of health-plan premiums level for the past three years.

Some care managers, such as Best Doctors, Inc. , also provide medical second opinions.  Best Doctors has a network of 50,000 medical specialists who review case files looking for wrong diagnoses and ineffective treatments, particularly for life-threatening illnesses and injuries.  They save large employers an average of $2 to $3 per month per employee.

For example, EMC Corp, had Best Doctors review 37 cases.  14% of them had a change of diagnosis and 89% a change of treatment.  Best Doctors has provided EMC employees with 107 referrals to specialists and hospitals in 2007.  Best Doctors typically saves money for employers by recommending less invasive procedures that require fewer days of hospitalization and less recuperation.

If care managers become more common in large companies, at some point it is likely they will begin looking at how physicians order unnecessary and/or inappropriate laboratory tests.  This will be particularly true for chronically ill patients.  In some cases, however, care managers may order additional laboratory tests as medical records are reviewed and second opinions are established.  If any of our readers have seen the effects care managers first hand, we would love to hear about it.  Drop us a line at schristensen@darkdaily.com or rmichel@darkdaily.com.

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