© copyright 2004 American Healthways 1 The Role of Disease Management in the Private Sector The...

© copyright 2004 American Healthways 1

The Role of Disease

Management in the Private

SectorThe Disease Management

Colloquium, Philadelphia, PA 1 p.m.

Robert E. Stone Executive Vice President



America’s Health Care ExpectationsAmerica’s Health Care Expectations

• To be cured

• To be cured right now

• To be cured for free



125

157

100

120

140

160

2002 2020E

$510

$1,000

$0

$400

$800

$1,200

2002 2020E

Americans with Chronic ConditionsIn millions

Medical Costs for Chronic ConditionsIn millions

Source: JPMorgan Disease Management Health Plan Survey

Growing Population and Costs


Something Important Has ChangedSomething Important Has Changed

• Did not have a macro economic effectDid not have a macro economic effect

• Had a credibility gap in value measurementHad a credibility gap in value measurement

• Had no quality standardsHad no quality standards

Historically, Disease Management Programs…Historically, Disease Management Programs…


Disease Management is now a strategic imperativeDisease Management is now a strategic imperative

• Outcomes continue to show significant clinical and financial improvements among the country’s chronically ill, impacting medical costs trends for health plans and self-funded employers.

• Standardized measurement methodologies are beginning to take shape.

• NCQA, URAC and JCAHO have established quality standards.

Today it’s a different story…


Employer Cost Containment StrategiesEmployer Cost Containment Strategies

10%

14%

6%

49%

54%

51%

24%

21%

24%

13%

9%

14%

4%

2%

5%

22% 44% 17% 8% 9%

0% 20% 40% 60% 80% 100%

Increased Cost Sharing

Consumer Driv en Plans

Tighter Managed Care

Very Effective Somewhat Effective Not Too Effective Not at All Effective Don't Know

Disease Management


Healthy ReturnsHealthy Returns

Health Plan ROI on DM Programs

25%

31% 31%

6%0%

6%9%

39% 37%

12%

0%3%

0%

10%

20%

30%

40%

50%

No Impact 0-50 51-100 101-200 201-300 300+

% of Plans % of HP Lives

Impact on Overall Medical Cost Trend, in basis points

6%

18%

29%

41%

6%3% 1%

42%

51%

3%0%

10%

20%

30%

40%

50%

60%

No Return 0-100% 100-200% 200-300% 300%+



From the Customer’s PerspectiveFrom the Customer’s Perspective

• Chief Financial OfficersChief Financial Officers see the macro-economic effect see the macro-economic effect

• Chief Medical OfficersChief Medical Officers see improved quality and clinical outcomes see improved quality and clinical outcomes

• Chief Executive OfficersChief Executive Officers see differentiation which translates into top see differentiation which translates into top line growth, customer retention and market leadershipline growth, customer retention and market leadership

• Employers Employers see reduced costs as a result of improved work force health see reduced costs as a result of improved work force health and productivityand productivity

• ConsumersConsumers see their way to a much better lifesee their way to a much better life

• GovernmentGovernment sees the promise and has taken action sees the promise and has taken action

Why Disease Management is relevantWhy Disease Management is relevant


Value Proposition Aligned with StakeholdersValue Proposition Aligned with Stakeholders

Improve health of populations,

Enhance patient satisfaction & care experience,

Enhance physician satisfaction & delivery experience,

Reduce total health care cost, and

Improve work force productivity

““Outcomes Improvement”Outcomes Improvement”


Both63%

Insource32%

Outsource5%

Insource26%

Both74%

DM Strategy by % of Covered Lives

DM Strategy by % of Plans


Parallel Group ComparisonsParallel Group Comparisons

4 /’97 4 /’98 4 /’004 /’99 4 /’01

Chicago

Kansas

DallasHouston

DenverMid-Atlantic

NashvilleFlorida

OhioTri-State

Control Site Intervention Site


Pre-Post ComparisonsPre-Post Comparisons

4 /’97 4 /’98 4 /’004 /’99 4 /’01

Kansas

Dallas

Houston

Florida

Tri-State

Baseline Period Intervention Period

Mid-Atlantic

Ohio

Chicago

Nashville

Denver


Quality Indicators: Parallel Group ComparisonQuality Indicators: Parallel Group Comparison

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

HbA1cTesting

ACEInhibitors

DilatedRetinal Exam

Microalbumin Lipid Testing Tobacco Use

Control 77.8% 34.2% 40.7% 24.6% 71.9% 17.1%Intervention 81.1% 39.9% 50.2% 39.6% 82.6% 11.5%

P < .24

P < .09

P < .007

P < .001

P < .001

P < .001


Quality Indicators: Pre-Post AnalysisQuality Indicators: Pre-Post Analysis

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

HbA1cTesting

ACEInhibitors

DilatedRetinal Exam



P < .19

P < .02

P < .001

P < .02

P < .001

P < .27


Cost and Utilization Changes Parallel Group and Pre-Post Comparisons


-30% -25% -20% -15% -10% -5% 0% 5% 10% 15%

Parallel Group Pre-Post

P < .001

P < .001

P < .001

P < .001

P < .001 P < .012

P < .001

ER Rate

Admissions Rate

Pharmacy

Overall Cost


Quality Indicators: Parallel Group ComparisonQuality Indicators: Parallel Group Comparison

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

HbA1cTesting

ACEInhibitors

DilatedRetinal Exam



P < .24

P < .09

P < .007

P < .001

P < .001

P < .001


Quality Indicators: Pre-Post AnalysisQuality Indicators: Pre-Post Analysis

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

HbA1cTesting

ACEInhibitors

DilatedRetinal Exam



P < .19

P < .02

P < .001

P < .02

P < .001

P < .27




-30% -25% -20% -15% -10% -5% 0% 5% 10% 15%

Parallel Group Pre-Post

P < .001

P < .001

P < .001

P < .001

P < .001 P < .012

P < .001

ER Rate

Admissions Rate

Pharmacy

Overall Cost


The Cohort StudyThe Cohort Study

• Compares a population with disease enrolled in the program to a reference population with similar disease not enrolled in the program– Study Population – Fully Insured members, excluding Public Programs, Atrium,

and First Plan– Reference Population – ASO (self-insured) members not eligible for care

support during year 1– Both Populations

• Continuously enrolled for 24 months (03/2001 – 02/2003)• Diseases identified by same algorithm• Members with the following age criteria

– Asthma, age 5-64– All other conditions , age 18-64

• All members have drug benefits


PhysicianOffice

PhysicianOffice

PhysicianOffice

PhysicianOffice

PhysicianOffice

PhysicianOffice

Guidelines

DataData

Savings Quality Productivity

Patients

Effective, Efficient Translation


DM Programs Currently in PlaceDM Programs Currently in Place

95%91% 91%

77%

50%

36%

14%

45%

100% 99% 94%

71%74%

48%

14%

65%

0%

20%

40%

60%

80%

100%

Cardiov ascular Diabetes Respiratory /

Asthma

Obstetrics Cancer Depression Chronic Pain Other



60%

45% 45%40%

20% 20%

0%

10%

20%

30%

40%

50%

60%

70%

Limited Finances MemberNoncompliance

Limited ROI Data TechnologyChallenges

CustomerDisinterest

Other

Challenges to Wider AdoptionChallenges to Wider Adoption


The Next Frame


Thank You!

Date post:	16-Jan-2016
Category:	Documents
Upload:	janis-jacobs
View:	215 times
Download:	0 times

© copyright 2004 American Healthways 1 The Role of Disease Management in the Private Sector The...

Documents