Employers, Health Insurers Use Care Managers To Review Physicians' Treatment Plans

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A growing number of employers and health insurers are using care managers, or integrated health managers, who"essentially audit an employee's health care and look for ways to both improve outcomes and save money," the Wall Street Journal reports. According to the consulting firm Deloitte & Touche, there are more than 200 care managers in the U.S. who provide "programs designed to save employers and health plans money by reviewing employees' health care claims and targeting high-cost cases for special management," the Journal reports.

Care managers often review physicians' treatment plans to ensure they are following established evidence-based practices and help coordinate care for people with serious illnesses. Based on the reviews, "the companies then may nix certain drugs or procedures," the Journal reports.

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Critics say that some of the programs "intrude into the private relationship between patients and their doctors and that they add yet another layer of bureaucracy, while saving money mostly by denying or switching specific drugs and procedures," according to the Journal.Other critics say that care managers can be inflexible and ignore differences between individual patients and the judgment of physicians and nurses.

Cecil Wilson, immediate past chair of the American Medical Association, said, "The patient's physician should ultimately be the one in charge,"adding that cost-saving should not be the main goal of care managers(McQueen, Wall Street Journal, 9/25).

Reprinted with permission from kaisernetwork.org. You can view the entire KaiserDaily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email. The Kaiser Daily Health Policy Report is published forkaisernetwork.org,a free service of The Henry J. Kaiser Family Foundation. 2007Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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