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Help in a Heartbeat : Phone Counseling Service Offers Alternative to ER Visits

November 21, 1996|DAVID OLMOS | TIMES STAFF WRITER

Here's one scene you won't see on "ER."

A new mother is near panic when her infant develops a fever in the middle of the night. Before heading to the nearest emergency room, she calls a 24-hour telephone information service staffed by nurses. After asking the mother a series of questions and using computers to tap into a list of physician-approved protocols, the nurse tells her that a trip to the emergency room is unnecessary. Just call the doctor the next morning if the fever persists, the nurse suggests.

It may not be as exciting as watching George Clooney struggle to save a child's life on the popular television show, but "telephone triage" is getting high ratings as a cost-cutting tool in today's hotly competitive health-care field.

A major player in this arena is Access Health Marketing, a Sacramento-area company that provides phone counseling services to hospitals, HMOs and, most recently, directly to consumers.

HMOs such as California-based Foundation Health and Blue Cross of California are adopting the idea to help cut down on costly emergency room visits. Medical researchers estimate that up to 50% of such visits aren't necessary, which means billions of dollars in excessive medical costs.

Emergency room visits are not only costly, they are also frequently a source of strife among HMOs, their members and hospitals. Typically, this occurs when an insurer denies payment for emergency room visits that it deems unnecessary, but which the patient--and often the hospital--considered necessary enough.

Thomas E. Gardner, Access Health's chief executive, says most people who go to emergency rooms could be treated just as well in urgent-care centers or by seeing their regular doctor the next day.

While some critics might see Access' business as just another way for HMOs to scrimp on care, Gardner stresses: "If the patient needs to be seen in the emergency room, we'll tell them to go to there." He stresses that his company assiduously avoids contracts with HMOs that "would put our personnel in the position of making decisions that trade off business considerations for health-care considerations."

While the company has primarily offered its Personal Health Advisor product through health plans and employers, it recently began offering a package of health counseling and information directly to consumers. The service is available by telephone, through the Internet and via fax at a monthly cost of $8.95.

Shopping for a Health Plan There's a lot of hoopla these days about HMO "report cards" and "quality surveys." Health-care gurus say we'll soon be using information about child immunization rates, cancer screenings and patients' opinions of their doctors to comparison-shop for health care the way we do for a car.

A few health-care organizations and large employers are beginning to collect and publish comparative information on health plans. But would employees bother to use such information if it were available?

A new national survey by the Henry J. Kaiser Family Foundation, a leading health-care charity based in Menlo Park, Calif., found that nearly 60% of Americans rely largely on the opinions of their doctors, family and friends when selecting a health plan. About the same percentage said they don't trust their employers to provide reliable information on the quality of health plans "because employers' main concern is saving money on health benefits."

Fifty-two percent of those surveyed said that, when choosing between two health plans, they would still choose one recommended by family or friends over one rated more highly by an independent review organization.

The survey also finds that comparative data wouldn't be of much use to the 45% of Americans who are offered only one health plan--and thus no choice--by their employers.

David Olmos can be reached at david.olmos@latimes.com

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