Policy Statement on Disease Management by Insurers
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MPPA Policy Statement on Disease Management by Insurers
Minnesota Physician-Patient Alliance believes that disease management by insurance companies rather
than health care providers reduces the quality of health care and violates patients'' privacy rights.
To date, disease management by insurers has not proven effective; researchers have concluded that disease
management by insurance companies has only a limited ability to control costs or improve quality.(7)
MPPA has the following objections to disease management by insurance companies:
- There is a fundamental conflict of interest between caring for patients and managing the cost of
their insurance. Insurers primary business function is to insure payment for health care. An insurer's
interest in managing the cost of care often conflicts with the interests of a caregiver to do what is
in the best interests of the patient. Therefore, when an insurer's disease management employee or
contractor gives medical advice to enrollees, patients have no assurance that this advice is in their
best interests or in keeping with that of their physician.
- Patients' rights to privacy are violated by insurance companies' disease management programs.
Insurance companies should have explicit consent for permission to share information about their
enrollee's health status with disease management contractors.
- Patients' recourse against bad medical advice is unfairly limited by insurance companies' disease
management programs. Individuals have limited rights to sue insurance companies. This is unfair to
patients and increases the risk that insurance companies may favor their own interests, or the
interests of a "population", over the interests of an individual enrollee or patient.
- Insurers usurpation of the disease management function adversely affects health care costs.
When doctors and hospitals were adequately paid to coordinate their own patients' care, there was not
the need to incur additional expenses to "assess the risk status of populations"; this was done on an
individual basis each time a patient was seen by a physician. Now, with funds diverted from providers
by insurance companies so that the insurance companies can provide their own disease management
functions, care is more fragmented. Fragmentation of care increases administrative costs, increases
the risk of medical error, and, in the hands of a stranger on a telephone, depersonalizes the care
that patients need and deserve.
- Insurers providing disease management diminish health care's continuity, timeliness, accessibility,
and personal compassion. When insurers supplant providers' ability to perform disease management by
directly delivering these services to their enrollees, physicians and hospitals lose in their ability
to manage the continuity and timeliness of care. Patients' relationships with their caregivers are
fragmented. As a patient's relationship with his or her doctor is diminished, so too is the quality of
their care. While there is some evidence that disease management by insurers enhances quality in
comparison to no disease management at all(8) evidence that disease management by insurers is superior
to physician or hospital care is non-existent (and counter-intuitive).
For these reasons, the Minnesota Physician-Patient Alliance recommends that insurance companies
should be prohibited from running disease management programs independent of physicians' care and
encourages reimbursement for disease management and care coordination services to doctors and hospitals.
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