Toward Population Health Improvement

Tracey MoorheadPresident and CEOMay 21, 2008

What Did Disease Management Originally Mean?

Healthy/Low Risk At Risk High Risk ChronicDisease

Complex &Catastrophic

Chronic Condition

Management

Healthy/Low Risk At Risk High Risk ChronicDisease

Complex &Catastrophic

Chronic Condition

Management

Population Risk Segments

Industry Today

Healthy/Low Risk At Risk High Risk ChronicDisease

Complex &Catastrophic

Chronic Condition

Management

HealthCoachingWellness

Programs

Intensive Case Management

Healthy/Low Risk At Risk High Risk ChronicDisease

Complex &Catastrophic

Chronic Condition

Management

HealthCoachingWellness

Programs

Intensive Case Management

Population Risk Segments

“DM” is an Outmoded LabelPopulation Health Spectrum

Rebranding

DMAA launched rebranding initiative early 2007Objective: accurately reflect scope of membership and industry and recognize:

Limiting nature of “disease management”Expansion of services and providersEvolution of health care team concept

Refining our Vision

All stakeholders in the health care continuum are aligned toward

optimizing the health of populations.

Our GoalsPromoting population health improvement to:

Raise the quality of health careImprove health care outcomesReduce preventable health care costs

Through the Care Continuum:Health and wellness promotionDisease managementComplex care coordination

Population Health Improvement

Central care delivery and leadership role of the primary care physician.

Critical importance of patient activation, involvement and personal responsibility.

Patient focus and expanded care coordination capacity provided by wellness, disease and chronic care management programs.

Three core components:

Population Health ImprovementAims to improve population healthReduces health inequities among population groups.Recognizes influence of multiple physical, environmental, socioeconomic factors.Improves a population’s total physical, mental, social well-being by managing the individual.Gives individuals tools to make choices for better health and, in turn, reduce preventable medical expenses for population

A Changing LandscapeGrowth of prevention, wellness initiatives.Advances in program design and rise of behavioral health.Expanded role for health IT and need for interoperability.Recognition of threat posed by chronic conditions in an aging population.Shortage of health care providers: nurses, general practitioners, geriatricians.

What’s at Stake?Looming Part A Trust Fund insolvency in 2019.Health care to consume entire GDP in 75 yrs.Chronic conditions proliferating.PCP, nursing shortages regionally, and worsening.U.S. business competitiveness, wages undermined.Offshoring trend related partly to high health cost.1st American generation to have lower longevity than their parents?

ChallengesDemonstrating valueAligning incentives and reimbursementsPatient engagement and trustCoordination of all providers

Foundations of PHIPhysician EngagementPatient EngagementEvidence-based care advocacy

Strategic Approach toHealthcare

Integrating Population Health Strategies

Not competitive with or replacement for MHPopulation health strategies, technologies, expertise and systems complement physician-led care models

NCQA PPC-PCMH

Additional revenue likely required for Medical Home to work as envisioned

RUC recommendationsMedPAC

NCQA PPC-PCMH9 Elements for Recognition

Access and CommunicationPatient Tracking and RegistryCare ManagementPatient Self-Management SupportElectronic PrescribingTest TrackingReferral TrackingPerformance Reporting and ImprovementAdvanced Electronic Communications

Population Health StrategiesSupport practitioner-patient relationship.Utilize plan of care across continuum.Offer resources to fill gaps in patient health literacy, knowledge, timeliness of treatment.Assist physicians and groups with limited resources for care coordination.Support evidence-based processes.

Supportive Industry RoleAddress scalability concernsSupport healthcare providers in new rolesAssist with outcomes evaluations – clinical and financialLend experience in practice redesign efforts –culture, process, etc.

DMAA and PhysiciansPhysician Engagement Committee

Population Health Improvement Principles

PHI Strategies White Paper

Physician Satisfaction Survey

Patient-Centered Primary Care Collaborative

DemonstratingValue

DoesDisease Management

Save Money?

Typical Questions Posed

Implied question: Do programs always work for every condition in every population?“Work” means short-term savings, ROI.Assumes that DM is a monolithic intervention, similar to drug or procedure.

Better question:Do PHI ProgramsImprove Quality

and Deliver Value?

A More Useful Perspective?Does PHI ever work for any condition in any population?Which outcomes are impacted and in what sequence, over what timeframe? How are various PHI programs different?How do those differences affect results?How important is personalization of PHI?How important is collaboration with MDs?

“Squeezing the Bookends”

The DMAA Method

Single Standardized Approach for All DM Outcomes

DMAA Outcomes

Project

DMAA Outcomes

Project

Existing Spectrum of DM Outcomes Measures/Methods

More Casual More Rigorous

Narrower Spectrum of DM Outcomes Measures/Methods

More Casual More Rigorous

Achieving Optimal Balance

“Suitability” “Acceptability”

RigorPrecision

ReplicabilityEvidence-based

Bias, ConfoundersCausal Association

Experimental Design

CostTimeEase

SimplicityAccessibilityTransparencyDiverse Users

Outcomes GuidelinesVolume I, released December 2006Focused on evaluating financial outcomes.Responded to gap in consistent evaluation methods in disease management.DMAA convened numerous stakeholders in transparent, consensus-driven process

Outcomes GuidelinesVolume II, released September 2007.

DMAA collaborated throughout with leading quality, accrediting organizations—NCQA, URAC, Joint Commission.

Guidelines praised for sound methodology.

Next Steps/Current WorkVolume III- September 2008.Continue partnership with NCQA to expand, refine disease-specific clinical measures.Operational definitions, measures with URAC.Work toward standardized selection criteria.Refinement of current guidelines to compare performance across programs.Describe measures for wellness evaluation.

Medicaid InnovationsMedicaid initiatives well-developed and widespread.Increasing innovation.Numerous success stories—Florida, Wyoming and Georgia, among many others.Programs demonstrate a positive return on investment and improved care.

Medicare as LaboratorySpecial Needs PlansMedicare Health SupportMedicare Care Coordination DemonstrationCare Management for High Cost BeneficiariesSenior Risk ReductionMedical Home Demonstration

Market Continues to GrowValue proposition evidenced by dramatic industry growth in past decadeHealth Plan penetration >90%Employer and Medicaid growth >50%International adoption growing rapidly - value perception independent of nationalityEmployers overcome any doubt about short-term direct health savings with indirect health benefitsBuyers seem satisfied with value of their experiences

PHI OutlookFuture remains bright for population health.Studies continue to build clinical and financial case for PHI.Need for chronic care solutions on national stage—PFCD, IOM geriatric report, others.

Learn MoreDMAA: The Care Continuum Alliance

www.dmaa.org(202) 737-5980

Sept. 7 to 10, 2008 . Westin Diplomat Resort & Spa . Hollywood, FL