Health Care and Insurance and Technology

Advocacy firms finding business in confused patients: Health care complexities creating new industry

February 5, 2007

Duane Etienne's role as the leader of a local elder-care agency provides him the benefit of knowing how to navigate the intricacies of the modern medical maze more than most.

Yet, the 65-year-old admitted he still had trouble deciphering the fine print on his parents' insurance policies.

"It's just too complicated," said Etienne, president of the local CICOA Aging & In-Home Solutions. "I work this business every day, and it's complex for me. But I've got people I can go to, and that's what you want everyone to have: access to good information."

The complexities of today's health care system, coupled with the nation's aging baby boomers, is driving a trend toward simplifying the process for retirees-and their adult children. By 2030, 20 percent of the U.S. population will be at least 65 years old, according to the U.S. Census Bureau.

In the metropolitan area, a handful of startups have sprouted to offer health care guidance. And nationally, HealthNow New York Inc., parent of a few BlueCross BlueShield insurers in New York, in October became the first health insurance plan to include an advocacy service as a standard feature for its members.

But are these types of companies here to stay? Bob Miller, a senior consultant at Indianapolis-based Gregory & Appel Insurance, thinks probably so.

"As things get more and more complicated, more people will try to step up and fill the void," he said. "There's definitely a consumer demand for it, but it's a matter of whether enough will be willing to pay a price for it."

Managing health care

Launched in Indianapolis a year ago, My Health Care Manager LLC is looking to roll out a similar concept, as well as in several more locations. The company has plans to introduce its services to employers as an added benefit, and will open an office in Sarasota, Fla., on March 1.

The Sunshine State's burgeoning senior sector has My Health Care Manager CEO Alan Stanford eyeing a second location, in Naples, with plans to expand to a dozen cities nationwide within a year.

The 66-year-old Indianapolis native formerly was president of local computer and entertainment convergence firm Escient Technologies and, before that, an Ernst & Young partner specializing in IT.

"I've helped put million-dollar computer systems in, and it's not the same," Stanford said of his second career. "We are absolutely affecting people's lives. It is the most rewarding thing in my life."

My Health Care Manager seeks to help seniors and their caretakers make sense of a complicated system that may include everyone from insurance companies to home-health-care agencies to doctors and nurses.

The company in the Castleton area has nine employees, including nurses who interact directly with the elderly, gathering information such as the names and contact information of their children, the schedule of their prescriptions, and even the more everyday aspects of their lives.

My Health Care Manager uses proprietary technology to organize the data, simplify it to the essentials, and deliver it via reports to everyone with a stake in the senior's life. The result is that doctors are keenly aware of their peers' recommendations and orders. That's particularly important considering physicians normally spend just 10 to 15 minutes visiting with patients, Stanford said.

Members of My Health Care Manager receive a card for their wallets that contains vital information about their medical histories to make the admission process to a hospital easier.

Stanford estimated his company has helped 150 to 200 individuals. Members pay $840 to $2,500 for an initial assessment and $125 an hour for services. Monthly memberships range from $95 to $700.

While in its infancy, the emerging market of health care advocacy hardly has been tapped, Stanford said.

"There's room for everybody and every business model as long as they're competent," he said, "because the problem is so huge."

There to help

Judy Smith can relate. The 57-year-old former office manager of a local family practice group spent much of her day guiding patients through their paperwork and insurance claims.

So last spring, she started Health Care Advocates of Indiana Ltd., a service that helps any consumer, not just seniors, find health care providers or sort through medical bills to negotiate payment.

"We're simply trying to help them on their behalf, because the paperwork is just horrendous," Smith said. "We basically do the research."

If the supplement of a Medicare policy increases, for instance, Health Care Advocates will look over it and suggest discontinuing coverage that might be unnecessary, Smith said.

Members pay an annual fee to gain access to resources that might help them get reimbursed from an insurance company or simply locate a support group to deal with a health issue. Annual costs range from $80 for a single member to $179 for a family.

The company began signing up members in September, when it moved into downtown office space on North Meridian Street. Smith since has enrolled 30 people in the program and hopes to increase membership with the recent hire of a sales associate.

Her largest concern, however, is providing assistance to those who truly need it rather than making a large profit. In fact, she might seek not-for-profit status for a portion of the business.

"I'm not a person who is going to say no," she said. "I want to be able to help."

Indeed, Smith organized a fund-raiser for Amaya Hess-the toddler who was attacked and injured by a pit bull in May-without even knowing her family.

Spotting billing errors

Like Smith, Christine Lewis and Micki Wanzer are veterans of the medical profession-Lewis as a consultant for hospital and physician practices and Wanzer as a medical practice administrator.

Together, they founded Med Review Solutions two years ago as a medical costcontainment consulting firm that helps consumers and self-insured companies manage their medical expenses. One way of doing that is by exposing errors and overcharges they say are rampant in the health care industry today.

In one instance, errors accounted for half the charges billed to one client, Lewis said. And as more high-deductible insurance plans are introduced, consumers must become more diligent about tracking their costs.

Said Lewis: "It's a lot different when it's coming from your pocket."

She and Wanzer belong to Medical Billing Advocates of America, a Virginiabased consumer advocate, and receive training from the organization. The two have served roughly 30 clients but are working to expand their base by targeting the corporate sector.

They can audit third-party administrators for self-insured companies and perform work for probate and personal-injury lawyers who may have clients with a lot of medical bills.

For now, though, clients bring their bills to the partners "like taxes in a shoebox," Wanzer said. Initial consultations run $150 and services are rendered for $70 an hour. If a client is contesting a medical bill, Lewis and Wanzer will take a percentage of the amount ultimately saved.

"We've never not been able to save them money," Wanzer said.

Dr. John Barker, a solo practitioner on North Post Road who has practiced medicine for 31 years, thinks health care advocates are here to stay, especially given the growing complexities of the system.

"I would love to go back to the day when you see the patient, they pay their receipt, and they're on their way," he said. "But the insurance companies control everything today."
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