And the supports they choose - whether increased home health services or training for a family member to operate a suction machine or involvement with a community support group - will be far less expensive than placement in a nursing home or repeated hospitalizations typical for people with serious illnesses. In fact, one study comparing two groups of seriously ill patients showed that costs were 30 percent less for the group that actively participated in health care decisions.
If the potential of managed care to actually improve the delivery of health care to Medicare beneficiaries is to be realized, the focus has to shift - from avoiding "risk" and controling costs to empowering patients and coordinating the care they need. Health plans should start by providing individualized education and face-to-face support to the patients with the greatest needs, that small percentage of people with serious or chronic or terminal illnesses whose Medicare costs are extraordinarily high.
Medicare managed care plans cannot prosper by erecting barriers to cost-effective care or applying cookbook medicine, but only by operating as flexibly and creatively as possible. As Dr. David Levy, an expert in designing and implementing coordinated care programs for high-risk patients, told the Senate Aging Committee recently, "No two patients with serious illnesses ever want to be treated in exactly the same way - but given information and support patients, and their families, can and do make the 'right' treatment decisions for themselves."
Today, coordinated care programs that provide for medical, social and other needs while respecting the patient's wishes and decisions are more the exception than the rule for elderly people with serious illnesses. If managed care is to help improve Medicare, and better meet the needs of our aging population, that will have to change.
Douglas Peddicord, Ph.D., is senior policy analyst with Washington Health Advocates. He writes from Columbia.
Pub Date: 11/01/98