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Stretching Scarce Resources: State Strategies to Design Effective, Affordable Benefit Packages

Stretching Scarce Resources: State Strategies to Design Effective, Affordable Benefit Packages. Autumn Dawn Galbreath, M.D. Director University of Texas Disease Management Center. Introduction to Disease Management (DM). Systematic, population-based approach Identifies people at risk

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Stretching Scarce Resources: State Strategies to Design Effective, Affordable Benefit Packages

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  1. Stretching Scarce Resources: State Strategies to Design Effective, Affordable Benefit Packages Autumn Dawn Galbreath, M.D. Director University of Texas Disease Management Center

  2. Introduction to Disease Management (DM) • Systematic, population-based approach • Identifies people at risk • Intervenes • Measures outcomes

  3. Important Characteristics • Best practices throughout the entire continuum of care • Clinical guidelines • Reduced cost • Improvement of measurable outcomes in the quality of care

  4. “Management Soup” • Case Management • High-Cost Case Management • Disease Management • Population Management • Managed Care

  5. Does It Work? • The “literature is now replete with titles in DM, quality improvement, and clinical practice improvement, but…there is not much evidence that {these}…improve efficiency in the care process for the disease.”9 9 – Curtiss F. Lessons learned from projects in disease management in ambulatory care. Am J Health-Syst Pharm 1997;54:2217-29.

  6. Summary of the Literature • 24 trials previously published, only 8 of which are randomized and controlled • CHF: 8 trials • Diabetes: 3 trials • Asthma: 1 trial • Coronary artery disease: 1 trial • General primary care/postdischarge care: 5 trials

  7. Remaining Questions • Is DM truly cost-effective in a heterogeneous patient population with a forthcoming and straightforward analysis of the economic data? • Does DM improve clinical outcomes? • Does DM improve subjective outcomes such as quality of life and patient satisfaction? • Does DM improve provider satisfaction with the care they are able to provide? • Is DM better administered in a face-to-face clinic setting or telephonically?

  8. South Texas CHF Demonstration Project • Target enrollment: 1200 patients • Target population: Veterans, Military, Medicare, Medicaid, and indigent patients • Time of Enrollment: 18 months

  9. Disease Selection • High volume • High cost • Variation in management • Propensity for acute decompensation

  10. Barriers to DM • Acute care model of the current health care system • Lack of integrated information systems • Lack of provider support • Limited resources • Danger of fragmentation of care

  11. Lessons Learned • Provider Buy-In • Start-Up Costs and Savings Realization • “Don’t promise what you can’t deliver”

  12. For additional information, contact: Autumn Dawn Galbreath, MD Director University of Texas Disease Management Center 4243 Piedras Drive East #240 San Antonio, Texas 78228 (210)567-9700 (office) (210)756-8184 (pager) galbreath@uthscsa.edu

  13. Disease Management in Uninsured Populations • Florida Medicaid Disease Management Initiative • Virginia Health Outcomes Partnership • Easy Breathing (Hartford, CN) • National Jewish Asthma Disease Management Pilots

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