Physiatry Practice Management Resources

"It's exciting to watch these sites develop," says Dr. Molly Joel Coye, president of the Health Technology Center, a nonprofit research organization in San Francisco. "They promise a way of improving quality of care and satisfaction for both physicians and patients, and there is solid evidence of their positive impact."

Numerous companies now offer a variety of on-line disease management formats. Some are in addition to longstanding telephone services; others are being created by Internet entrepreneurs specifically to address this new wrinkle in patient care. All focus on one or more chronic illnesses such as diabetes, asthma, chronic obstructive pulmonary disease, depression and congestive heart failure.

Executives at established disease management companies are adding Web services for several reasons, says Dr. Steven Locke, associate professor of health sciences and technology at the Massachusetts Institute of Technology. For one thing, Web-based disease management satisfies a perceived demand from consumers for personalized service and a perceived demand by health plans to offer such services.

In addition, the Internet offers a cost-effective method of delivering information and influencing patient behavior in the direction of improved health through enhancement of adherence and compliance.

"I haven't seen any published data that shows cost savings directly attributable to the Websites," Dr. Locke says. "But I'd bet that a company that didn't have plans to integrate the Web into the traditional clinical services it was providing would find itself having a lot of difficulty competing for business from health plans."

To help patients manage chronic illnesses, prevent acute episodes and stay out of the emergency room, disease management organizations track patients' vital signs and symptoms, offer information and education, provide telephone contact with nurse practitioners and communicate with physicians. Health insurance companies, managed-care organizations and large physician groups offer members free access to these disease management programs.

Aetna recently chose LifeMasters Supported SelfCare (www.lifemasters.com) in Irvine, Calif., and American Healthways (www.americanhealthways.com) in Nashville to provide enhanced disease management services to more than 30,000 Aetna members with congestive heart failure.

"Our experience has taught us that targeted interventions and education can play a significant role in improving the quality of care and quality of life of members who are living with this condition," says Dr. William C. Popik, chief medical officer at Aetna.

LifeMasters launched its comprehensive disease management program by telephone and fax in 1996 and, since 1998, has been adding Web components. About 15 percent of its 50,000 members access the Web. Casual visitors can view the site's offerings and benefit from its educational aspects, but interactive features are reserved for registered members.

"We built the Website for the future," says Christobel Selecky, CEO. "As the baby boom generation ages and gets chronic diseases, we're going to be managing them more on-line than in traditional ways."

Meanwhile, since Spring 2001, Willard Cook, 63, of Woodburn, Ore. has been entering information into the LifeMasters System via telephone keypad. The information is recorded in a computerized patient record and reviewed by nurse Lora Burger who calls Mr. Cook weekly to answer questions and keep him motivated.

"The nurse at LifeMasters told me what each of my medicines was doing," Mr. Cook says. "I've changed my eating habits, I'm exercising and I'm paying attention to my weight."

Mr. Cook's physician, Dr. Thomas Wright, an internist in Hubbard, Ore., says LifeMasters facilitates communication with his patients.

"Sometimes I find out that patients had unstable angina and I wonder why they didn't call," Dr. Wright says. "For an interventionist, that's frustrating. [LifeMasters] makes patients more aware of symptoms about which they should call me."

American Healthways, with 385,000 patients in its programs, recently added two on-line tools. "CareSteps" collects information on current diseases, behavioral patterns and family history from health plan members. Patients receive immediate feedback including customized care plans and lists of questions to discuss with their physicians.

"We provide the physicians with the same lists so they aren't surprised," says Robert Stone, executive vice president. "They can get them on-line or by fax."

A second Web application, "eResident," collects 5,500 pieces of information about each patient in the American Healthways program. Data on a patient's medicines, recent lab values and hospitalizations, among other basic items, are culled and sent by e-mail to the physician the night before a patient's appointment.