As corporate wellness programs mature and begin to demonstrate cost savings, managed-care organizations are right behind with their own wellness program, demand management.
Jim Otis, vice president of research and development of the Oakton, Va.-based Center for Corporate Health, draws a distinction between wellness and demand management programs. Wellness programs comprise lifestyle management, smoking cessation, stress management and weight reduction. Demand management programs have all those services, and they counsel consumers on making healthcare decisions when illness or injury occur.
"Demand management recognizes that although it is a good idea to keep people healthy, somebody has to get sick," Otis said. "So, the next logical step is to educate consumers about decisions they make after they get sick and help steer them toward appropriate usage."
Betsy Horton-LeForge, director of health promotion at San Diego-based Sharp HealthCare, believes that demand management programs offered at the provider level have certain advantages over corporate plans.
"While corporate wellness programs reach just the workers, if you focus on promoting wellness through the providers you can potentially reach the whole family," Horton-LeForge said.
Recent studies have begun to prove the cost-effectiveness of demand management.
A two-year study sponsored by Wisconsin Education Association Insurance Group and conducted by the Center for Corporate Health tested the effectiveness of a 24-hour nurse counseling hotline and self-care education. One group of 24,000 members received a self-care manual and newsletter, while the second group received both the self-care program and access to the nurse counseling hotline.
The study concluded that the more extensive nurse counseling and self-care program saved more ($4.75 per dollar invested) than the self-care-only program ($2.40 per dollar).
A telephone survey conducted by Aetna Health Plans also studied how a nurse counseling hotline impacted utilization.
According to David Feffer, Aetna's assistant vice president for health enhancement, families who used the service saved about 1.1 ambulatory visits per year. At an average cost of about $85 per visit, Aetna estimates a return of up to $3 per dollar invested in the counseling program.
A nationwide survey of 241 HMOs conducted earlier this year concluded that 93% of plans offer enrollees a healthcare newsletter, while 58% provide a telephone health counseling service.
Of the HMO plans without demand management programs, half said they planned to offer a newsletter within the next year and a quarter said they had plans to add telephone counseling services. Otis sees the growing emphasis on preventive health and self-care as natural steps in the evolution of managed care.
"A lot of effort has gone into provider managing, supply-side managing," Otis said. "Well, now the same kind of focus is going toward consumer (decisionmaking)."
"Managed care has gone through managing the supply side of care. Employers can't control delivery of care but can control their employees. So I think the two are naturally evolving toward each other, merging together," Feffer said.
Otis feels that the new frontier in demand management programs lies in outpatient care.
"There's a growing emphasis on health prevention and managing ambulatory care. How much more can you squeeze out of inpatient bed-days per 1,000 (patients)? Discretionary ambulatory use-it's largely unexamined and unmanaged," Otis said.