Insurelane Insurance Blog

Blue Shield of California has developed an improved case management program for patients with serious health conditions. The new program is called patient-centered management, or PCM.

PCM is a more comprehensive approach to case management than many other case management programs. Highly trained nurses are assigned to educate patients, help them understand their conditions, and discuss all of their treatment options. Patients are also provided with extensive care coordination, along with pain management and end-of-life care.

A study measured the effectiveness of PCM, finding the program reduced healthcare costs and improved the health of patients with cancer or neurological degenerative diseases.

The study compared PCM with traditional case management. One group of patients received usual case management and traditional practices. Another group of patients received PCM. Results revealed patients who received PCM had fewer health complications associated with their conditions — and 38% fewer hospitalizations.

Patient satisfaction was also greater with PCM.

“As a cancer patient I have had challenges and burdens unimaginable,” said a 50-year-old program participant. “The [PCM] program has actually made me want to fight that much harder. My care manager was in constant contact and pulled me through all the obstacles a cancer patient must endure.”

It was one of the first studies to show tangible evidence that better case management can both improve the health conditions of patients and reduce overall care costs. The study found a 26% average overall reduction in costs because of PCM — as result of fewer hospital admissions, fewer days in the hospital, fewer emergency room visits, increased home care, and increased hospice care.

The reduction of costs of PCM amounted to $18,599 per patient compared with usual case management.

“We’re very pleased that this study validates our commitment to provide members with more effective, more personalized care,” said senior medical director for Blue Shield of California, Andrew Halpert, M.D.

“This program makes it easier for members to obtain the appropriate treatment and helps our efforts to control healthcare costs for all of our members,” Dr. Halpert added.

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Monday’s New York Times features an article on the rising number of middle class people without health insurance.

It’s been widely reported that there are almost 47 million Americans without insurance. Less well-known is that more than a third of those people make more than $40,000 a year, according to studies by the Employee Benefit Research Institute.

The Times cites this statistic as one of the reasons that a national healthcare solution is part of the agenda for many politicians in the upcoming presidential election. Three of the major Democratic contenders — Senators Obama, Clinton, and Edwards — have all proposed variations of a universal healthcare system.

Senator Clinton championed a universal healthcare plan during the first term of her husband President Bill Clinton. The idea proved unpopular in the early 1990s. In the decade since, rising healthcare costs and increasing numbers of people without insurance have given the idea new life in American politics.

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A new article looks at health insurance coverage in Massachusetts, and finds “both a way forward and a warning” in how that state attempted to provide near-universal coverage to all its residents.

The article, written by Jason Szep and published by Reuters, reports that almost 105,000 of Massachusetts’ poorest residents are now enrolled in a health insurance program. That number represents roughly 25% of the number of people without health insurance when the law requiring health coverage for all residents took effect last April.

The law requires any uninsured individual living above the state poverty line to buy their own health insurance plan. Uninsured people who don’t buy a plan face a tax penalty.

After the law was passed, many other states began planning their own versions of it. California has already begun pursuing a similar law.

The law has its critics, though. Many claim that the law does not address the needs of people with incomes that put them above the poverty line, but leave them too financially strapped to comfortably afford insurance. Others point out that for some people, the tax penalty for not buying insurance can be as little as $150 — a fraction of the cost of buying insurance.

Some critics have raised doubts about using the law as a national model. Before passing the law, Massachusetts had a high percentage of residents already insured — roughly 93%. In Texas, the state with the highest percentage of uninsured residents, only 74% of people have health insurance. Massachusetts residents also have a relatively high median income: $82,561 for a family of four according to the U.S. Census Bureau, compared with a national median income of $65,093.

“It’s hard to know whether it will work as a national model in part because we don’t yet have any experience with how successful this reform plan in Massachusetts will be,” said Jennifer Tolbert, a policy analyst at the Washington-based Kaiser Commission on Medicaid and the Uninsured.

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