HMOs Fill Domestic Violence Void with Physician Education
Certain high-profile industries, especially healthcare, have taken some image knocks for being too bottom-line oriented. But smart companies know that survival into the millennium will require balancing financial success with a human face.
A handful of health plans is debunking the myth that profit is king by addressing domestic violence with a community outreach model that combines early detection initiatives with counseling services. Although marketing and PR didn't spearhead these efforts, these are the kinds of programs communicators should be pitching to their employers to preserve brand reputation.
The program is the brainchild of Victims Services, a New York-based advocacy organization for domestic violence victims that helps more than 120,000 abused women each year. Victims Services is working with Aetna U.S. Healthcare, the Health Insurance Plan of Greater New York (HIP) and Oxford Health Plans to teach physicians to identify early signs of domestic violence.
As a motivation to physicians to be proactive about domestic violence, Aetna, the first health plan to launch the program three years ago, is offering continuing medical education credit (CME) and increased reimbursement compensation of.005 percent to its physicians.
Participation can amount to an additional $420 per month in a doctor's pocket. In addition to physician-training, the program provides health plans with outreach services, including:
- Physical and mental health screening/intervention protocols for battered women;
- Immediate referral and follow-up procedures; and
- Patient education materials on domestic violence.
The cost to these health plans to add domestic violence services to their standard coverage is under $.10 per member per month, according to Terri E. Pease, Victims Services' project coordinator.
Although physicians are well positioned to interrupt the cycle of domestic abuse that affects 3.9 million women each year, they often feel uncomfortable broaching the subject with patients.
"Doctors feel like they are opening Pandora's box where domestic violence is concerned because there is no pill they can prescribe for it," says Pease. "So we are educating them on care management [immediate counseling] as the solution."
Taking the Lead
Aetna's relationship with Victims Services began when Aetna sales representatives pursued offering insurance coverage to the organization's 600-plus employees. In their initial meeting a few years ago, Victims Services' administrators asked Aetna what it was doing about domestic violence. Caught off guard, Dr. Richard Bernstein, Aetna's senior medical director for New York, asked what the health plan should be doing.
This led to the two organizations developing a five-credit CME course in which more than 4,000 physicians have participated.
Aetna is training its physicians to identify subtle symptoms of abuse like headaches, dizzy spells and fatigue. In addition, physicians are encouraged to incorporate domestic violence questions into standard patient questionnaires (in English and Spanish) and to provide brochures on shelters and counseling services available in the community.
The key to encouraging physician involvement is to highlight domestic violence as a local issue affecting their patients, says Pease. Once they understand how their early intervention efforts can make a difference, the feedback is positive. Compelling statistics include:
- Battered women are major consumers of medical services, accounting for 14 percent to 28 percent of all women seen in ambulatory care settings and 23 percent of those seeking routine prenatal care.
- Between 22 percent and 35 percent of women who visit hospital emergency rooms are there for symptoms related to ongoing abuse.
Filling the Research Void
Although the healthcare industry acknowledges domestic violence as a major health threat, Victims Services isn't doing a successful job demonstrating the cost-savings and positive patient outcomes for managed care organizations which do domestic-violence intervention.
In the absence of quantitative data, the decision for a health plan to get involved has to be based on the belief that it's the right thing to do, says Dr. Bernstein. Many health plans - which have to pay close attention to the bottom line - don't believe they can afford to take that leap of faith.
There are now some research initiatives underway - funded by healthcare organizations like Aetna, the Robert Wood Johnson Foundation and the American College of Obstetrics and Gynecology - that will allow Victims Services to focus on evidence-based outcomes. A key research challenge is the way in which domestic violence is reported.
There are no diagnostic codes for it, which makes tracking the medical costs extremely difficult. Pease says that Victims Services is in discussions with the National Committee on Quality Assurance (NCQA) on how managed care plans can integrate domestic violence services into their standard coverage.
(Aetna, Dr. Richard Bernstein, Besty Sell, 212/512-0714; Victims Services, Terri Pease, 212/577-1369)
Equipping the Doctors with Information
To educate physicians about the prevalence of domestic violence within their practices, Victims Services, a New York-based advocacy organization, debunks the common myths about abuse:
- Domestic abuse only occurs among the lower class. This is a common misperception-domestic violence cuts across societal lines, socioeconomic status, race and sexual orientation.
- Domestic violence is only punching and kicking. In actuality, domestic violence can take many forms, including psychological, emotional, sexual, financial and physical abuse.
Source: Victims Services