healthcare third party vendor
June 9, 2010 6:25 PM   Subscribe

Health care management: who / what is ITA partners and do I need them? My health insurance provider has passed my info on to a third party vendor. The third party vendor offers optional extra services. Is the third party on my side? Should I accept or reject them?

I have recently been diagnosed with cancer (good outcome expected but a lot of work needed).
I have Guardian insurance through my employer. Guardian passed my information to a third party vendor called "ITA Partners" Guardian says they do this with "large cases". Guardian says that ITA Partners makes sure that medical treatments for the patient are within approved standards of care. ITA Partners also offers a second service which is providing the patient with a nurse to talk to who checks in once per month. I told them I would think about it and today they have called me again to see if I want to participate in this second, optional service. The people I speak to at ITA Partners sound more like sales people than health care professionals. I am suspicious as to their role and whether I should be involved with them. The oncology practice through which I am getting my care already provides counsellors, patient navigators, support groups, etc. and the nurses are accessible and helpful. Is there any benefit to my being involved with ITA Partners and are there any risks? If they're employed by the Health insurance company can they really be pro-patient?
I'd also be interested to know whether anyone has any experience of this or a similar company and whether being involved with their optional extras is a benefit or a risk.
Thank you
posted by anonymous to Health & Fitness (2 answers total)
First of all, best of luck with your treatment and I hope you feel better very soon.

Your employer has made a number of benefits available to you. One of these is what's called a wrap-around benefit for people diagnosed with ongoing illness. You have identified this company as ITA Services. This organization is most likely under a Business Associate Agreement with your health plan and employer to offer these services. I understand your hesitation to engage with ITA Services considering your diagnosis and the thought that this information may somehow be used against you. However, in most situations, employers do not see individually identifiable data about a person's health condition--they would see aggregate data. An exception would be if your employer's plan is self-funded, meaning the employer is paying the claims. The employer sees the claims and could potentially identify employees by putting the pieces together. However, I do not think Guardian, your health plan provider, is a TPA and it looks like this is a fully insured plan.

Employers hire companies like ITA Services (or disease management or wellness companies) to try to get a handle on costs. In your situation, this means that ITA Services would work with your physician team to make sure that the guidelines for treating your cancer are followed. Evidence-based guidelines are the gold standard in medicine and the typical process is to try to evidence-based guideline-derived treatment first before trying any "experimental" or outside of the box treatments which may cost the health plan (and later the employer) more. I'm not familiar with ITA Services, but I'm certain that they will engage a physician and/or oncology RN case manager to be in contact with both you and your oncologist to monitor the treatment plan--in an effort to keep costs down. Some of this will include contact with you and your family, to provide referrals to resources you may need, but the focus of this is risk management and trying to provide the correct care for you to reduce costs (and complications that could increase costs further).

Just for disclosure purposes, I am a former employee of a major disease management program, but did not work on the oncology side. My sense is that a small number of patients will really benefit from these services from a patient support side, but that the employer will reap most of the benefits because of the cost savings. I don't think it's wrong for an employer to try to get employees to enroll in programs like this, because they do have risks to mitigate in order to preserve the benefits offerings. But, if you are pleased with your oncology practice, and confident in the practice's ability to manage your cancer, make referrals to the resources you may need (everything from rehab to psychotherapy to dietary to physical therapy to smoking cessation, etc), then you can always politely decline participation. It's definitely worth asking your physician about this, since the physician will be in contact with ITA Services as well.

As an aside, I have a relative who had leukemia recently. Since she wasn't covered by an employer's health plan, her treatment was covered by Medicaid and she was treated in a large teaching hospital (which was the proper and best place for her to go). She spent weeks and weeks in the hospital about 50 miles from her home. During the course of her treatment, she experienced a stroke and then optical nerve compression which has continued to affect her vision months after treatment ended. She also had to have a shunt placed. My point is that cancer doesn't always go as planned and that complications can arise quickly and without warning. I think for this case it would have been very beneficial to have a third party involved to monitor treatment plans to try and prevent some of these complications. I know she also had problems communicating with her physicians, but that was a function of the doctors and the hospital, not Medicaid. If she had a third party monitoring her case, maybe her outcome would have been better.
posted by FergieBelle at 6:57 AM on June 10, 2010

I suggest you ask your oncology team about their experiences with intermediary groups like ITA. They sound a lot like a buffer that will act to minimize your insurer's payout liability.

Personally, I'd start asking your insurer questions like
"If my primary care team and the ITA team disagree on a treatment, which team's opinion carries more weight when it comes to approval of payment?" In other words, is it the case where, if you go with the ITA recommendation, you get full coverage, but, if you go with your primary team's recommendation, the costs are only covered to 20%?
"Will ITA share back to the insurer any other personal health information that may not be germane to the current treatment? In other words, will I have to wave HIPAA confidentiality when I contract with ITA (via those open-ended clauses like "allow sharing of information with trusted partners")?"

Insurers are relying on these sorts of cost-control intermediary services for a whole range of health issues. We've gotten pressure to use them for both mental health treatment as well as allergy treatment. In the case of the mental health intermediary, the stated purpose of the intermediary was to consult on the issue of medication. However, the representative absolutely refused to state, either by voice or in writing, that behavioral details that may come up in the discussions they may have with my son's counselor would not be passed-on to our insurer. Just flat-out refused to make that assurance. This despite repeated homilies about their independence from the insurer, HIPAA laws, etc. etc.

In the end, and despite their assurances of being independent, groups like ITA work for the insurer. And, while minimizing cost is an admirable and necessary goal, I remain skeptical of these groups. Again, ask your oncology team about their experiences with such intermediaries.
posted by Thorzdad at 9:15 AM on June 10, 2010

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