Phone Counseling Services Boom As Health Plans Seek To Curb Costs

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In the good old days, nothing came between physicians and their patients. Today, however, telephone-based nurse counseling, a relatively unknown yet booming service, is being positioned as a major point-of-entry to the health care system, according to a report in the American Medical News.

In rapidly growing numbers, health maintenance organizations, physician practices, hospitals and other health care providers are encouraging patients who have questions about their health to call these toll-free hotlines first, senior reporter Greg Borzo found. The registered nurses who staff the 24-hour phone banks don't give medical advice. They do provide triage, referral, education, support, advice about home remedies, counseling about treatment options and disease management.

Most phone-based nurse counseling is provided by about half a dozen independent companies that run national or regional phone centers. HMOs and other health care providers contract with these companies at $.50 to $1.20 per member per month, depending on the level and type of service offered. Subsidiaries of Aetna, Travelers and United Healthcare provide the service, too, primarily to their own members.

In each of the past two years, phone counseling companies have more than doubled their business to an estimated 13 million contracted lives, say industry watchers. They predict rapid growth into the foreseeable future.

In addition to toll-free call-in services, these companies typically offer enrollees self-help publications and telephone access to prerecorded information about hundreds of illnesses. Some conduct personalized research; others mail or fax enrollees health care information and make follow-up phone calls to go over the issues discussed.

Phone counseling was born in the mid 1980s and grew out of ask-a-nurse hot lines, which were used primarily by hospitals as a marketing tool. In its current form, phone counseling is part of a new approach to managed care known as demand management, Borzo found.

Until recently, managed care concentrated on the supply side, reigning in costs by clamping down on providers. Now it is turning to the demand side of the equation, pushing patients to lower-cost settings and encouraging better self-care.

"For too long, we've overlooked the vital role that individual patients play in the quality and outcomes of health care," says David Feffer, assistant vice president of health enhancement at Aetna Health Plans and cofounder of one of the first phone counseling companies.

"Demand management works because informed patients make better, more conservative and more cost-effective choices."

At present, only 5% to 30% of enrollees actually use counseling services during a year's time, but usage is expected to grow. Eventually, phone counseling, coupled with broader demand-management services, could play a significant role in health care delivery. For instance, six towns in rural Maine are developing a program that would funnel all primary care through nurses.

Counseling companies also are amassing potentially valuable data on patient needs and behavior that could help counselors and physicians improve care, so long as confidentiality concerns are addressed.

Many see government regulation ahead for this newly forming field, Borzo said.

American Medical News, published weekly by the American Medical Association, reaches more than 300,000 physicians, health care administrators, policy makers and other health professionals.

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