Allergists Tackle Managed Care Issues

To preserve their patients' choice to seek specialist care for allergies and asthma, the American College of Allergy, Asthma and Immunology is working with Public Communications Inc. to mobilize a "Managed Care Liaison Council" (MCLC) to talk facts and figures with HMOs and other managed care organizations.

The stakes are high. More than 50 million people currently are enrolled in managed care organizations. Armed with the best available research that documents the outcomes and cost-effectiveness of care by an allergist, an MCLC team of physicians was trained, and are being dispatched to meet with major managed care groups, HMOs and insurance companies. Packets of information have been mailed to many others.

Feedback secured from meetings has been very positive with managed care representatives receptive to hearing the allergists information. Some of the MCLC meetings made an impact that extended beyond the initial appointment with members assisting the managed care organizations in evaluating treatment protocols, facilitating training programs and working on quality assurance committees.

Several hundred copies of the outcomes documentation have been requested in response to the managed care organization mailing. One organization, Blue Care Network, an affiliate of Blue Cross/Blue Shield in Southfield Michigan, has utilized the documentation as the basis for a pilot pediatric asthma education program for 200 of its physicians.

To preserve their patients' choice to seek specialist care for allergies and asthma, the American College of Allergy, Asthma and Immunology is working with Public Communications Inc. to mobilize a "Managed Care Liaison Council" (MCLC) to talk facts and figures with HMOs and other managed care organizations.

Allergists are uniquely qualified to provide the best care to asthma sufferers, and allergists want to be a part of the delivery of that care.

At issue is:

• the patient's direct access to an allergist
• opportunities for allergists to participate in managed care organizations
• preservation of fee-for-service as a payment option
• prevention of restrictive formularies

The stakes are high. More than 50 million people currently are enrolled in managed care organizations. Armed with the best available research that documents the outcomes and cost-effectiveness of care by an allergist, an MCLC team of physicians was trained, and they are being dispatched to meet with major managed care groups, HMOs and insurance companies. Packets of information have been mailed to many others.

In preparation for the campaign, the College conducted surveys of both specialty associations and managed care organizations. Through interviews with national medical specialty groups, the College found that most are very concerned about managed care issues and some were devoting attention to member education and legislation. But few, if any, were talking directly to managed care organizations.

In contrast to this, the College's survey of medical directors in 22 major managed care organizations found that most want to have information about outcomes and costs of treatment of asthma patients.

Armed with the best available research that documents the outcomes and cost-effectiveness of care by an allergist, an MCLC team of nine members was trained and dispatched to meet with major managed care groups, HMOs and insurance companies.

A variety of program components and tactics are being used to achieve the campaign's objective:

Outcomes Documentation. A review of scientific literature was conducted for clinical studies to document superior outcomes and cost-effectiveness of care by an allergist. The studies were summarized in a compendium, The Role of the Allergist in the Cost-Effective Treatment of Asthma, which is being used as a leave-behind after MCLC meetings with managed care organizations. The compendium also contained the College's Guidelines for Referral.

Training. The MCLC members took part in a two-day training program to analyze managed care issues, understand newly developed data on outcomes of care and cost savings, and role play meetings with managed care representatives. A training manual for the managed care initiative was developed to provide MCLC members with meeting guidelines and key message points.

Visuals. A slide presentation and tabletop flipchart presentation based on the outcomes documentation that showed that allergists achieve better outcomes at less cost were produced for MCLC members to use in meetings with managed care organizations. Key message points to accompany the visuals also were provided.

Appointments. Initial appointments were scheduled with the managed care organizations located in the home markets of the MCLC members. After local meetings were completed, MCLC members began traveling to nearby major markets to meet with additional managed care organizations. The program has expanded to include allergists in markets that have not been reached by MCLC members.

Managed Care Organization Mailing. The outcomes documentation was distributed with a cover letter from the College president to medical directors at approximately 547 HMOs and 765 PPOs. The letter offered the managed care organizations the opportunity to order additional copies of the document through the College.

In the first seven months of the program, MCLC members had appointments scheduled with 27 managed care organizations representing 3.7 million covered lives. The MCLC members reported that managed care representatives have been very receptive to hearing how referral of asthma patients to allergists can help achieve better outcomes at less cost. The organizations also were interested in the College's Guidelines for Referral.

Some of the MCLC meetings made an impact that extended beyond the initial appointment with members assisting the managed care organizations in evaluating treatment protocols, facilitating training programs and working on quality assurance committees.

Several hundred copies of the outcomes documentation have been requested in response to the managed care organization mailing. One organization, Blue Care Network, an affiliate of Blue Cross/Blue Shield in Southfield Michigan, has utilized the documentation as the basis for a pilot pediatric asthma education program for 200 of its physicians.