Employee Health management
Sitting in rows of small cubicles talking politely with clients through their telephone headsets, the casually dressed workforce at a call centre outside Atlanta could be selling insurance or double glazing. In fact, they are trained nurses, checking on the condition of patients with chronic diseases such as cancer and diabetes.
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The nurses work for Matria Healthcare, one of the biggest providers of a service called disease management, which aims to reduce the healthcare costs of large companies by making sure employees are receiving effective treatment for chronic illnesses.
Coca-Cola, Continental Airlines and IBM are among more than 60 US companies that have hired Matria to manage chronic disease in their workforce. Sick employees receive regular phone calls from Matria nurses checking whether they are taking the correct medication and making any lifestyle changes recommended by doctors.
“Our nurses become a mentor and a coach to help people make the right health choices,” says Pete Petit, Matria's chairman and chief executive.
Disease management is one of the fastest-growing parts of the US healthcare sector as companies struggle to control surging health insurance premiums. US health costs have increased by an average of 12.5 per cent every year since 1997, reaching 15 per cent of gross domestic product nearly one-third higher than any other country. Much of the burden falls on big companies that provide health insurance for employees. General Motors alone spent $5.2bn (￡2.74bn) on healthcare last year.
Nearly two-thirds of US health spending is caused by chronic disease. The costs are inflated by the failure of many patients to follow prescribed treatments, causing unnecessary sick leave and hospital stays.
“Half of people with chronic conditions do not stick to their treatments,” says Tad Stahel, Matria's senior vice-president of operations. “This creates unnecessary suffering for patients and unnecessary costs for employers. We aim to reduce both.”
In the first year of its contract with Matria, IBM, the technology group, reduced healthcare costs by 4.5 per cent, saving $25.2m. Spending on those chronic diseases targeted by Matria fell by more than 14 per cent.
Matria specialises in managing five of the most expensive diseases diabetes, respiratory disorders, heart disease, cancer and back pain. Customers can choose which conditions they want the company to tackle, depending on which are most prevalent among their workforce.
Disease management risks being viewed by sceptics as a form of Big Brother-style snooping. But Matria does not disclose information about individuals to their employer. “Our customers are not focused on individual cases,” says Mr Petit. “The aim is to bring down the average cost of treating chronic conditions.”
Participation in Matria's programmes is voluntary, but 80 per cent of targeted employees choose to take part. “People love to talk about their health,” says Mr Stahel. “Most people are glad of the support.”
Mr Petit insists that disease management is not intended as a substitute for doctors. “We don't provide medical advice or diagnosis,” he says, “just factual information about recommended treatments and lifestyle.”
Matria's nurses make report cards giving details of the employees' treatment and setting targets for them to work towards, such as increased exercise or lower blood pressure.
“We're not trying to get between the patient and the physician,” says Mr Stahel. “We send a copy of the report card to the employee's physician and most welcome the additional information.”
Mr Petit says disease management is still in its early stages, with less than 15 per cent of US companies having adopted the service. However, among the biggest listed companies he estimates the uptake is approaching 90 per cent.
Al Lewis, executive director of the Disease Management Purchasing Consortium, which advises companies about disease management, says that demand for the service has been growing at 20 to 25 per cent for the past six years.
Matria's revenues from disease management increased by 80 per cent to $52.4m last year and its Nasdaq-listed shares have tripled in the past two years.
Mr Petit says that his next step is to expand beyond disease management into disease prevention. Already there is demand from customers for broader health and wellness programmes that aim to reduce the incidence of chronic conditions by tackling causes such as unhealthy diets, smoking and substance abuse.
“The immediate cost savings come from managing existing diseases,” he says. “But once you have those stabilised, the next question is what we can do about those employees who are heading down the path towards chronic disease.”
Pharmaceutical companies are also embracing disease management. Pfizer and Schering-Plough, for example, have both hired Matria to help patients learn how to use drugs more effectively.
Another source of demand is the public sector. Ohio's state government, for example, has recruited Matria to manage diabetes and asthma among public employees. Nan Neff, benefits administrator for the state, says that the aim is not only to reduce costs but also to increase productivity. “A healthy workforce is a productive workforce,” she says.
Potentially the biggest buyer of disease management in future could be the federal government. The Department of Health recently launched three regional pilot programmes for users of Medicare, the public health system, raising the prospect of huge contracts if the service is adopted nationwide.
However, Matria and its handful of competitors such as American Healthways and CorSolutions are not alone in having recognised the potential of disease management. Big health insurance specialists, such as UnitedHealth Group and Cigna Healthcare, are also starting to offer the service and some analysts believe they could eventually force the smaller companies out of the market. “Health plans see [disease management] as a way to deepen relationships with customers,” says Mr Lewis.
But Brooks O'Neil, analyst at Dougherty & Company, says that the health insurers are “far behind” Matria and its peers because their skills lie in processing claims rather than managing care. He predicts that insurers and pharmaceutical companies may eventually seek to build disease management capability through acquisition with Matria an obvious target.
Uptake of disease management outside the US has been patchy. “Some places, such as Singapore, are moving into it very quickly,” says Mr Lewis. “But many countries have privacy rules and healthcare payment systems that make it difficult.”
But Mr Petit has little doubt that, in the US at least, disease management is here to stay. “Companies spend lots of money making sure their IT systems and supply chains work efficiently, but they have not paid much attention to how employee health affects their business,” he says. “That is starting to change.”
企业开始 “流行”疾病管理
在亚特兰大之外的一座呼叫中心里，穿着便装的员工坐在一排排小隔间里，通过电话耳机礼貌地与客户交谈着，他们像是在推销保险或双层玻璃。但实际上，他们是受过训练的护士，正在检查癌症或糖尿病等慢性病患者的情况。
这些护士为Matria Healthcare公司工作，该公司是一种被称为疾病管理服务的最大提供商之一。疾病管理服务的目的是，通过确保员工的慢性疾病得到有效的治疗，从而降低大公司的保健成本。
目前，有60多家美国公司雇佣了Matria来管理他们员工的慢性病，其中包括可口可乐(Coca-Cola)、大陆航空(Continental Airlines)和国际商业机器公司(IBM)。患病的员工定期接到Matria护士的电话，检查他们是否正确服用药物，并根据医生的建议改变其生活方式。
“我们的护士成了导师和教练，帮助人们做出有利于健康的正确选择，”Matria董事长兼首席执行官皮特?珀蒂(Pete Petit)说。
疾病管理是美国保健业中发展最快的领域之一，因为各公司竭力想控制日益飙升的健康保险费用。自1997年以来，美国的健康成本平均每年上升12.5%，达到了国内生产总值(GDP)的15%，比其它任何国家都高出近三分之一。这个负担有很大一部分落在那些为员工提供健康保险的大公司头上。单是通用汽车(General Motors)一家公司去年在保健方面就支出了52亿美元（合27.4英镑)。
在美国的医疗支出中，有近三分之二是由慢性病所致。许多病人没能遵照医生开出的疗法，造成不必要的病假和住院，致使医疗支出膨胀。
“一半的慢性病患者不坚持接受治疗，”Matria负责运营的高级副总裁泰德?斯塔荷尔(Tad Stahel)说：“这给病人带来不必要的痛苦，也给雇主带来不必要的开支。我们打算减少这两种情况。”
在与Matria签约后的第一年，IBM的保健成本降低了4.5%，节省了2520万美元。在Matria专攻的那些慢性病上，开支下降了逾14%。
Matria专门从事5种花费最高的疾病的管理――糖尿病、呼吸系统紊乱、心脏病、癌症以及背部疼痛。顾客可以选择想让该公司对付的一些病状，这取决于哪些病状在员工中最为普遍。
疾病管理可能会被一些怀疑论者视为“老大哥”式的隐私窥探。但Matria并不向雇主透露其员工的个人信息。“我们的顾客关注的不是单个病例，” 珀蒂先生说。“它们的目的是降低治疗慢性病的平均成本。”
参加Matria的疾病管理项目是自愿的，但目标员工中有80%的人选择参加。“人们喜欢谈论自己的健康状况，”斯塔荷尔先生说，“大多数人对于能获得支持感到高兴。”
珀蒂先生强调说，疾病管理的目的不是取代医生。“我们不提供医疗建议或诊断，”他说，“只是提供有关推荐疗法和生活方式的实际信息。”
Matria的护士们制作了一些报告卡片，卡片上详细记录着雇员的治疗情况，并为他们设定了努力的目标，例如增加运动或降低血压。
“我们并非试图挡在病人和医生之间，”斯塔荷尔先生说，“我们把这种报告卡送一份给雇员的医生，而多数医生都对这些额外信息示欢迎。”
珀蒂先生表示，疾病管理目前仍处在早期阶段。不到15%的美国公司采用了这项服务。但他估计，在最大的上市公司中，已有近90%采用了这项服务。
Disease Management Purchasing Consortium为企业提供疾病管理建议，该机构的执行董事阿尔?刘易斯(Al Lewis)表示，过去6年里，对这项服务的需求一直在以20%至25%的速度增长。
Matria去年来自疾病管理的收入增长了80%，至5240万美元。过去两年中，公司在纳斯达克上市的股票价格已翻了3倍。
珀蒂先生表示，他下一个步骤是从疾病管理向疾病预防领域拓展。顾客已对更广泛的保健计划产生需求，这些计划旨在通过解决不健康饮食、吸烟和滥用药品等致病原因，来降低慢性病的发病率。
“直接的成本节省来自管理现有疾病，”他说，“但一旦使这些情况趋于稳定，下一个问题就是，对于那些正患上慢性病的雇员，我们可以做些什么？”
制药公司也在采用疾病管理。比如辉瑞(Pfizer)和先灵葆雅(Schering-Plough)，这两家公司都聘请了Matria，帮助病人学习怎样更有效地使用药物。
另一个需求来源是公共部门。如俄亥俄州政府就雇佣了Matria来管理公务员的糖尿病和哮喘。该州福利管理人纳恩?内夫(Nan Neff)表示，这样做不仅是为了降低成本，而且还为了提高生产力。“健康的员工才是生产力高的员工，”她说。
疾病管理未来最大的买家可能是联邦政府。美国卫生部最近推出了针对联邦医疗保险制度(Medicare)使用者的地区性试点计划，一旦这项服务在全国范围内采用，就有可能获得大额合同。医疗保险制度是一个公共保健体系。
但Matria以及American Healthways和CorSolutions等少数竞争对手并非是唯一意识到疾病管理潜力的机构。联合健康集团(UnitedHealth Group)和Cigna Healthcare等大型健康保险专业机构也已开始提供这项服务，而一些分析师相信，这些企业最终可能会将规模较小的公司挤出市场。“保健计划将(疾病管理)视为加深与顾客关系的一种途径，”刘易斯先生表示。
但Dougherty Company的分析师布鲁克斯?奥尼尔(Brooks O’Neil)表示，健康保险商“远远落后于”Matria及其同类企业，原因是健康保险商的技能在于处理保险理赔，而不是管理保健护理。他预测，保险公司和制药公司可能最终会通过收购疾病管理公司(Matria显然是个目标)，以寻求建立自己的疾病管理能力。
在美国之外，采用疾病管理的地区还是凤毛麟角。“新加坡等地正迅速进入这一领域，”刘易斯先生说，“但许多国家有隐私规定和保健支付体系，因而难以采用这一做法。”
但珀蒂先生几乎毫不怀疑，至少在美国，疾病管理将会普及。“企业花费大量资金来确保自己的信息技术系统和供应链有效运作，但它们尚未重视员工的健康状况对业务的影响，”他说，“这种情况已开始改变。”
