X-post from health related finances

Just in case…


This is interesting. Thanks for sharing.

Clearly, people with chronic conditions do better and have fewer hospitalizations if they follow their prescribed program. The problem is that many people are “non-compliant,” especially if they have multiple chronic problems that make personal care almost a full-time job.

A friend of mine, an obese diabetic bechelor who eventually lost both his legs, also had pulmonary fibrosis and heart issues. He was very disorganized and would have lost his health insurance if I hadn’t dug through piles of his un-opened mail while he was hospitalized and then begged his estranged older brother to pay the premium. (Which he did with ill grace after his wife told him to.)

My friend was non-compliant and always waited until the last minute when he phoned DH and me to take in his dogs since he needed to be hospitalized immediately. I used to scold him and say, “If you aren’t feeling well, go to the doctor. Don’t wait until you are at death’s door and need to be hospitalized.” But he wouldn’t do it.

My friend was a very intelligent lawyer and author but simply didn’t take care of himself. His last hospital stay, when he coded but was revived, lasted 78 days. When he died at home at age 62 the sheriff’s deputy didn’t find any insulin bottles.

We adopted his surviving dog.

My friend’s health care probably cost millions of dollars. Would having constant follow-up as you described have led to better health outcomes? Maybe.

I don’t even know if this service is available in our rural area. I wouldn’t know how to ask for or access it.


Would having constant follow-up as you described have led to better outcomes

Well, the Chronic Care Management procedure codes probably wouldn’t. They were actually designed to reimburse offices for the increased burden of non clinical care that folk with multiple co morbidities inevitably inflict on practices and, given that insurance reimbursement is trimmed to the bone as it is, end up being a major financial drain.

Here’s the downside…showing that there’s no such thing as a Good Idea that can’t be misused. I first came across this a few years ago when we still had husband’s employer provided plan as our medical coverage. For 2 or 3 months, we got a bill for something like $25 from out PCP’s office for this and I couldn’t understand what it was for. It was this CCM and our insurance was paying…the $25 was a copay. On further questioning, the care coordinator informed me it was for my husband’s chronic conditions…and rattled of 2 or 3 quite serious issues none of which existed. I made a big fuss and the bills stopped. I didn’t take it far enough as these spurious conditions remained on his medical record. I only found out about it when we transitioned to Medicare and, for our supplemental insurance, UHC accessed his PCP records and what was there actually doubled his premiums!

Quite apart from what I consider insurance fraud, my husband’s medical records contain diagnoses that are wrong.

So, I’m bumping this thread primarily because I answered my own question…I now have experience of Chronic Care Management and the difference it makes to me is exactly what I expected (but for one unexpected reason) Email prompts to constantly update my care profile with daily weight measurements, blood glucose reading, BP measurements etc…the sort of thing that I do/have done (blood glucose excepted) and why I’m not part of the demographic this is aimed at. Probably 90% the results of the obesity epidemic. Manifestly, I’m not going to respond to this e-intrusion into my life.

I decided to sign up for it because the extra income from a minimal user such as myself will go some way to subsidise the disproportionate costs incurred by the Usual Suspects…much like my medical insurance over the past 3O or so years and my National Insurance contributions and taxes did back in England.

Shouldda known better…except that I’ve discovered an error on my medical record that I’m going to have to deal with. I assumed that my recent discovery of coronary artery disease and what’s now being called dyslipidemia along with my paroxysmal Afib were the two chronic conditions that made me legitimately eligible for this programme. Well, right alongside those two, seems that “hypertension” is down there. This, in spite of never ever having a BP reading even close to 120/80 in the office! I’m treating it as an error created by the CCM software that these companies that advertise so heavily to promote the financial value to offices…possibly by using an algorithm that looks at medication as an identifier for disease? I’ll judge by the response when I call to sort it out with the CCM coordinator.

I think that’s explained it because I can see a potential for this making a financial impact for anyone who unwittingly opts into this (quite apart from medical implications)…and not just Medicare beneficiaries! A heads-up on flaws in my reasoning/dodge 'splaining gratefully accepted. I’m sure the companies involved “educate” the staff who deal with this how to field questions.

1 Like