Employers, Health Insurers Increasingly Use Care Managers To Review Physicians' Treatment Plans, Ensure They Conform To Evidence-Based Practices

Another level of health care for those working for companies providing insurance...you could be seeing a "Care Manager" on the scene next...physicians as well may have this new layer of patient care to deal with at the office as well. As the article states, the physician should be the one who should be ultimately in charge...Care Managers will also be looking cost items as well, since the incentive for care managers is to also manage cost and their work is usually connected to the amount of money paid for health care through the insurer. Care managers...are they managing care or cost? BD

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.

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).