WEST CHESTER, Pa. -- Nick Polidore, a state gymnastics champion
with bangs, dimples and baggy blue jeans, would seem as robust as
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
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
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. …