Doctors devise plan to treat chronically ill

May 15, 1994|By Patricia Meisol | Patricia Meisol,Sun Staff Writer

For years, managed care companies have built their profits by signing up the healthy and erecting roadblocks to keep away the sick. Now a group of doctors at Johns Hopkins proposes to make money on just the opposite: a plan for people with chronic ailments.

They want to test the theory that specialists can provide better care at lower cost for people who are chronically ill than generalists who shuffle them around the health system in search of treatments as their disease progresses.

"Where who gets cared for is a very important issue in this reform," said Christopher D. Saudek, an authority on diabetes and director of the School of Medicine's Clinical Research Center.

He and colleagues have targeted four common recurring diseases -- diabetes; musculoskeletal problems, including arthritis and back pain; chronic heart disease; and affected psychiatric disorders. They want to offer a four-year pilot plan to large employers starting as soon as December to provide complete care for up to 800 people.

As with many managed care plans, the doctors would agree to treat patients for a pre-set monthly fee. It's up to them to figure out how to provide the best care for the price. Dr. Saudek's cohort in this project is Gerard F. Anderson, an expert in hospital finance and management at the School of Hygiene and Public Health, who will be in charge of assessing the risk.

The experiment is being watched closely by Hopkins administrators. They have to sign off on it, after assuring themselves the project won't lose money.

The cost for this plan will be much higher than the average, but by using specialists the doctors hope to cut back on unnecessary tests and medications. Moreover, the first point of contact will be with a specialist nurse working under standards established by the faculty; the nurse will determine further referrals.

The advantage to employers is threefold: they will know their costs upfront; rate increases will be slowed and, if it works as the doctors predict, care will be better and patients will lose less time from work.

If it works, the plan could become a national model for academic medical centers. At minimum, it could expand the role of specialists at Hopkins and help big employers manage costs.

"We should carve out our niche to include chronic diseases," Dr. Saudek said. "Hospitals need to change, and not hang onto their old paths. This is one of the trials or experiments."

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