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Monday, November 24, 2003
MAINE VOICES: CRAIG S. RUSSELL
Dirigo will work if it manages demand
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Dirigo's goals of lowering the cost of health care, improving quality and providing access to all Mainers are admirable, but many wonder if the program can work. Our experiences delivering health care through our nationwide network of medical contact centers lead us to believe that Dirigo can be successful and a model for other states to follow. That would require that the program appropriately manages demand so that Mainers have access to care without draining our health care resources. Managing demand does not mean reducing access. It means educating people how to seek the appropriate level of care at the appropriate time. With the exception of catastrophic incidents such as a car accident, health care is largely consumer-driven: You are the one person who has control of why you seek health care and when. But people don't seek care solely based on symptoms, but also on their perception of the severity of the symptoms. That's why it's important to give individuals access to decision-support resources and qualified medical professionals, early in the decision-making process. Providing health care information and advice to the public through a 24/7 telephone helpline is a proven approach to managing the appropriate use of health care resources. Registered nurses can sort calls by severity, guide patients to sources of information about their health issues and options and provide a network of support to patient communities, all while reducing inappropriate or unnecessary visits to health care facilities. Consider the case of a new mother with a croupy baby. Rather than choosing care at an emergency room - the most costly resource - a telephone nurse could educate her about her child's condition and coach her how to ease her child's breathing by taking her into a steamy bathroom. Not only does the mother avoid the cost of care, she has gained valuable experience on how to treat her child. Combined with advice on symptoms to watch for that should trigger advanced care, this mother now has the skills to evaluate her child's health, a trusted resource to rely on, and information she can use to manage her child's care. On average, 62 percent of the callers to our nurseline service who intend to go to the emergency room, after speaking with a nurse, seek alternate options such as self-care or scheduling a primary-care visit. And the 38 percent of patients with symptoms that justify an emergency room visit are urged to do so in an expedited fashion. Ninety-eight percent of our callers say they are satisfied and nearly 94 percent would use the service again. And more than 60 percent feel more confident and prepared to interact with their doctor. Half of all callers are referred to an alternate level of care, including self-care, and close to 20 percent are able to avoid a physician visit. Between 90 percent and 97 percent of callers are satisfied with the telephone service, citing reduced anxiety about their condition as a primary benefit. Such services can address chronic diseases and public health issues such as diabetes, smoking and obesity by providing information on preventive care and teaching self-management skills. Dirigo can use a variety of communication options including telephone nurse services, community workshops and classes, online information and direct mail to reach out to the entire population. Dirigo will attract a lot of national attention. Many states will look to us to see how we provide access to all without overwhelming our health care delivery network or breaking our budget. By properly managing demand and carefully tracking results, Maine will be able to measure consumer satisfaction, patient outcomes and economic impact.
- Special to the Press Herald
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