WEST CHESTER, Pa. -- Nick Polidore, a state gymnastics champion with bangs, dimples and baggy blue jeans, would seem as robust as any other 11-year-old. But he has asthma, so ragweed or a simple cold can propel him to an emergency room, gasping for breath.
Once, an asthma attack would keep him in a hospital for a day or two. But since his family doctor, Brandt S. Loev, took up disease management, a system for controlling chronic conditions like asthma, the big emergencies have stopped -- and so have the big bills to his mother's health insurance company.
Disease management sounds familiar, even common-sensical. On each office visit, Loev checks Nick's breathing and health completely and then an aide teaches him how to avoid attacks, how to use inhalers, how to test his lungs himself with a simple bedside device the clinic gave him. Once upon a time, this is what managed care was supposed to do: cut costs by keeping people healthy. Instead, health management organizations and insurance companies concentrated on cutting costs, especially by reducing doctors' fees. But now that those methods have played out and in many cases profits evaporated, some health care organizations are looking to better medical practice as an answer. The new remedy is managing chronic diseases, which account for 60 percent of medical costs in the United States. "The next phase has to be managing care better and disease management is another word for that," said Uwe S. Reinhardt, a health care economist at Princeton University. The movement is breeding as many as 300 companies that contract with health maintenance organizations and employers to supervise the care of people with chronic diseases. The revenue of these companies is expected to double over the next year, to $348 million, said Al Lewis, a broker who negotiates contracts for the companies with health maintenance organizations. Among the 1,000 HMOs that belong to the American Association of Health Plans, at least 150 are collaborating with the American Diabetes Association in a 10-year disease management program that aims to reduce blindness and foot amputations among diabetics by 40 percent and kidney failure by 30 percent. One leader in the movement is the University of Pennsylvania Health Center, which offers management programs for 20 chronic conditions through its 85 clinics in and around Philadelphia, including Loev's clinic in West Chester. In September, it licensed VHA, a group of more than 1,200 nonprofit hospitals, including Columbia Presbyterian in New York, to use its programs. "Everybody's talking about it," said Dr. Joseph Carver, disease management medical director for Aetna U.S. Healthcare, which has enrolled nearly 59,000 members in programs that include those for managing congestive heart failure and low back pain. "Everybody says they're doing it." But disease management is still a small part of health care, and it is not clear whether it will gain wide acceptance among doctors, some of whom belittle it as "cookbook medicine. …