Memo to the media: beware of pols pushing disease management as the new savior for health care costs. Their words should ring familiar to those who remember that managed care was supposed to do the same thing over a decade ago. Last year a researcher writing in the Annals of Family Medicine delivered an assessment which should find its way into any story on the subject:
There is no solid evidence yet that commercial for-profit disease management vendors will save money and improve care of chronic illness on a long-term basis. It is much more likely that the current enthusiasm among employers and insurers for outsourced disease management programs will end up as just one more policy failure, undermining primary care and delaying increasingly urgent health care reform.
Same story for information technology—another fuzzy concept touted as a cure-all for too-expensive medical care. Having all your medical records available electronically will let you see, graphically, whether you’re making progress lowering cholesterol; it can keep your doc from repeating diagnostic tests; it might help him or her spot potentially deadly drug combinations among the medications you are taking. But is it a panacea? It doesn’t seem so, at least not at the moment.
The Congressional Budget Office, a credible source, has also weighed in on this one. At a recent Washington health forum, CBO director Peter Orszag said that, while information technology could improve health care quality, it is not the cure-all solution for reducing health care costs. While savings are possible on a small scale, Orzag said that maximum savings and efficiency would require national adoption of health IT. It looks like the country has a long way to go before that will happen. The CBO report noted that, in 2006, only 12 percent of the nation’s doctors and 11 percent of hospitals had adopted health IT.
Health IT could also have detrimental effects for patients—effects that promoters don’t tout in press statements. On Monday, the Washington Post explored the dark side of all this free-floating health information. The Post offered a squirm-inducing angle on the topic: Big health information services companies like Milliman and Ingenix, a division of UnitedHealth Group (which owns mega insurance carrier UnitedHealth Care), are already collecting information from databases containing millions of Americans’ prescription drug records. Information companies use the data to create a sort of credit report for insurers and others who want to know how sick you are, what drugs you take, and so forth.
An entrepreneur who built one of the databases told the Post that an insurer “would be able to know that you have a high, near-intractable cholesterol problem” and could avoid a costly blood test. It also could mean that the insurer wouldn’t have to pay for the test. If the patient could avoid the test, that’s good—but what if the doctor ordered it anyway and the insurer refused to pay? Health IT has its pluses and minuses. Here’s pretty important minus: an insurer could also use the information to boot you out of the health plan. Here’s another: a drug company could try to switch you to a different medicine that helps build their market share. There are a lot of directions to go on stories about health IT, and journalists should look at the Post story as a good starting point.