Cancer Management: Fully Integrated Cancer Management: Fully Integrated population-based and Chronic Care Case-population-based and Chronic Care Case-

based Modelbased ModelMarnie W. Bute, R.N.Marnie W. Bute, R.N.Director, Health and Care Business Director, Health and Care Business

Development Development May 8, 2007May 8, 2007

2

HealthPartners

HealthPlan

HP MedicalGroup &Clinics

RegionsHospital

HP Dental

Group &Clinics

HPCentral

MN Clinics

Administrative Support

A consumer-governed health care organizationMission: To improve the health of our members, our patients and the community

IME

ICSI

HPRF

MNCM

Contracted Medical Groups and Clinics

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Market DemandMarket Demand

• Trend management• Integrated solution• Outcome-based results• Improved employee health

– Productivity– Absenteeism– Presenteeism

• Emerging vendor carve outs:– Cancer disease management

• Oncology Case Managers– Cancer networks

• COE’s• Tiering• Second opinions

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Population Health Management Population Health Management Approach to CancerApproach to Cancer

Healthy/low Risk At-RiskHighRisk

Early Symptoms

ActiveDisease

20% of People

Generate

80% of Costs

Claims Cost Distribution

$

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Integrated by DesignIntegrated by Design

• Trained member advocates positioned to meet the member where they’re at, when they’re needed

• Member decision Support all advocates are trained to help a member make decisions that are best for them

• Member tools & resources communications protocols utilized in all member touch points to ensure optimal member experience

• Integrated, national, member-centric model built on three integral components

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HealthPartners ApproachHealthPartners Approach

• Comprehensive cancer components– Prevention/Wellness

– Early diagnosis/Screening

– Evidence-based treatment

– Palliative care

– End-of-life care

– Measurement and reporting

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Cancer: PreventionCancer: Prevention• Member Advocates• Phone-based health improvement

courses– Weight Management

• Member Decision Support – Should I quit smoking?– What kind of a diet reduces my

risk of cancer?• Member Tools & Resources • Health Assessment• Tobacco use assessment and

cessation• Cost Calculator

– How much do I spend on cigarettes each year?

• Fitness Programs• Worksite Wellness Programs• Provider Support • Patient-provider relationship

support

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Health Assessment Health Assessment IntegrationIntegration

• Personal, printable reports for individual participants.

• Engagement into programs may be linked to incentives

• Focus on participation in follow-up programs• Seamless hand-offs and outreach to other

health care services to optimize impact (disease management, case management, behavioral health, dental, pharmacy)

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Fruit and Vegetable IntakeFruit and Vegetable IntakeFruit and Vegetable Intake

2.60

2.70

2.80

2.90

3.00

3.10

3.20

3.30

3.40

3.50

3.60

3.70

2003 2004 2005 2006

0%

5%

10%

15%

20%

25%

30%

Avg F&V Serv/Day % > 5 F&V per Day

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• N=534 (data from course completers)

• 20% of enrollees quit prior to lesson #1

• Between baseline and post-course, 93% of survey completers quit smoking (n=112)

• At 6-months follow-up, 63% of survey completers quit smoking (n=63)

0

10

20

30

40

50

60

70

80

90

100

1 2 3

Assessment

Pe

rce

nt

Sm

ok

ers

0

2

4

6

8

10

12

14

16

18

20

Cig

are

ttes

pe

r Da

y

Percent Smokers

Cigarettes per Day

Baseline Post-course Follow-up

Program Outcomes– Program Outcomes– Partners in Partners in Quitting Quitting Tobacco Cessation Tobacco Cessation

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Cost and Quality Cost and Quality InformationInformation

• Cost calculators– Medical and drug costs– Plan annual expenses– Look up costs for

conditions and services• How much do I spent

on cigarettes each year?

Plan annual expenses

Look up drug costs

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Cancer: Early DiagnosisCancer: Early Diagnosis• Member advocates

– Where is the most cost effective mammogram?

• Member decision support – Should I have a

colonoscopy or a flex-sigmoidscopy?

• Member tools & resources• Proactive cancer screening

reminders• Cost calculator• Teachable moments• Provider & treatment selection

support• Information therapy• Provider support • Patient-provider relationship

support

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Teachable Moments Message Teachable Moments Message DetailDetailGeneral message area, talking points,

and instructions to deliver message

Controls to enter disposition of message and email

Member’s unique qualification for this campaign; plus objective of campaign

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Teachable Moment Message Teachable Moment Message Status and OutcomeStatus and Outcome

Message shown as delivered, along with Member response and email sent

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MN Colon Cancer ScreeningMN Colon Cancer Screening

2002 2003 2004 2005

HP Clinical Indicators 60% 68% 73% 75%

HP Comm HEDIS 62% 59% 63%

BCBS Comm HEDIS 60% 51%

Medica Comm HEDIS 54% 53%

HEDIS Comm Nat’l Ave

49% 52%

Clinical Indicators includes all products

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Commercial HEDIS ResultsCommercial HEDIS Results

• 2005 (2004 DOS)

• Colorectal Cancer rate: 58.9

• Breast Cancer rate: 80.8

• Cervical Cancer Rate: 85.4

• 2006 (2005 DOS)

• Colorectal Cancer Rate: 62.6

• Breast Cancer Rate: 75.7

• Cervical Cancer Rate: Rotated Out (RO)

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Cost and Quality Cost and Quality InformationInformation

• Find “Best Choice” providers who offer the best overall cost and high quality for different services

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Cancer: TreatmentCancer: Treatment• Member advocates• Evidence based• Medical & behavioral case

management• In patient & outpatient coordination

of care• Depression assessment• Medical director advocacy• Pharma by phone• Member decision support

– Should I enroll in this clinical trail?

• Member tools & resources• Centers of Excellence• Complementary & alternative

medicine• Provider support• Patient-Provider relationship

support• Collaborative practice models

including physician and support-service providers

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Decision SupportDecision Support

Carol:“I was planning to have breast reconstruction surgery now that my breast cancer treatment is finished – I have so much going on, I’m just not sure.”

• Case Manager:– Assess status, needs,

and issues– Identify decisional

conflict– Provide education– Help clarify personal

values & preferences– Facilitate

communication with physician(s)

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Results: Decision SupportResults: Decision Support

Shared Decision Making4/2005 - 12/2006

18% 20%

49%

13%

0%

20%

40%

60%

Surg Issue: Elected Surg

Surg Issue: Elected Non Surg

Non Surg Issue Pending FinalDecision

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Results: Decision SupportResults: Decision Support

How satisfied are you with decision?

87% Satisfied

11%

0%

20%

40%

60%

80%

100%Very Satisfied

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Cancer: Palliative Care/End of Cancer: Palliative Care/End of LifeLife

• Member advocates• Medical & behavioral case

management; “end of life case management”

• Outpatient coordination of care• Depression assessment• Pharma by phone• Medical director advocacy• Member decision support• One-on-one decision support in the

member’s home• Member tools & resources• Advance directives• Complementary & alternative

medicine• Hospice• Provider support• Patient-Provider relationship

support

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ALOS prior to PC consult

0

50

100

150

200

250

0-2 3-5 6-8 9-11

12-14

15-17

18-20

21-23

24-26

27-29

30-32

33-34

>34

ALOS prior to PC Consult

Cas

es

All Palliative Care patients pre-PC ALOS = 6.14 days

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ALOS after PC consult

020406080

100120140160

0-2 3-5 6-8 9-11

12-14

15-17

18-20

21-23

24-26

27-29

30-32

33-34

>34

ALOS after PC Consult

Cas

es

All Palliative Care patients post-PC ALOS = 4.98 days

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Variable Cost Difference Pre/Post Variable Cost Difference Pre/Post Palliative Care Referral -All Palliative Palliative Care Referral -All Palliative

Care PatientsCare Patients$1,236

$748

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

Avg Variable Cost/day

Pre-Palliative Care Post Palliative Care

*Based on January 2005-December 2006 Cases

Avg. cost of 1-5 days prior to PC consult

Avg. cost of 1-5 days following PC consult

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Moving ForwardMoving Forward

• Survivorship• Medication therapy

management• Clinical trials• Payment reform• Enhance specialty

networks• Productivity

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Measurement and Measurement and ReportingReporting

• Member support and provider support– Cost and utilization– Engagement– Activity and intervention– Clinical outcomes– Satisfaction

• Member• Provider

– Self-reported outcomes• Self-perceived health

status• Productivity

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Member ExperienceMember Experience

• Personalized, tailored• Comprehensive self-

management materials and support

• Seamless and transparent integration

“Meet me where I’ll be when I need you”

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Best Practice in CareBest Practice in CareStandard Staff Knowledge of “How To”• Consult multicultural and language resources

• Use internal and external resources appropriately to answer cultural competence questions

• Gather essential information

• Ask about language preference and ethnicity

• Chart information in patient records

• Use trained interpreters

• Arrange for an interpreter

• Work with an interpreter

• Use telephone interpreting services

• Provide translated vital documents

• Access translated documents or translations of needed documents

• Use vital translated documents with an interpreter

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Results: Achieving EquityResults: Achieving Equity

EthnicityEngagement Rate

Goal = 95%

Baseline YE 2006African American 92% 97%

Asian 88% 96%

Caucasian 95% 98%

Latino 100% 98%

Native or Alaskan American 89% 100%

Other Race 90% 94%

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SatisfactionSatisfaction

• Member satisfaction overall

– Ranges from 85-96 percent

– Annual survey

– Proof of member-centric approach

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Value for the Purchaser Value for the Purchaser

• Ease of management• Comprehensive

integrated program• Evidence-based• High employee

satisfaction• Trend reduction• Productivity

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Key TakeawaysKey Takeaways

• Cancer management must be a population based approach

• Integrated as a health plan solution • The broad continuum of prevention to end-of-life

needs targeted and meaningful interactions • Interactions are dependant upon integrated

platforms with member advocates, decision support, robust member tools and resources that are self directed and interactive

• Carve out vendor programs can only impact a small slice of the large and complex cancer continuum

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Thank You!

Questions?

Please feel free to contact me at:

Marnie.W.Bute@HealthPartners.com