Selected Results from Chronic Disease Management and Behavioral Health

1. Laura Jacobus-Kantor, Ph.D. The Michigan Purchasers Health AllianceSeptember 21, 2006 Selected Results from Chronic Disease Management and Behavioral Health

2. Ensuring Solutions to Alcohol Problems • Located at George Washington University Medical Center • Funded by The Pew Charitable Trusts • Goal: Improving access to alcohol treatment • How: Providing research-based materials through targeted outreach to business leaders, policy makers and advocates • www.ensuringsolutions.org

3. National Business Coalition on Health (NBCH) & eValue8 • More than 80 state and regional business coalitions made up of 10,000 employer members nationwide employing over 34 million covered lives • eValue8 RFI is a uniform, annual assessment of the quality of care for a range of health concerns provided by health plans to employees • Survey conducted by businesses for business – purchasing, accountability, incentives and penalties

4. 2003 eValue8 Participating Plans

5. 2006 eValue8 Participating Plans Key: Participating States

6. Aetna HMO Aetna PPO Blue Care Network HMO BCBS PPO Care Choices HMO Care Choices PPO HAP HMO HAP PPO Health Plus HMO Humana PPO M-Care HMO Physicians Health Plan HMO Physicians Health Plan South MI HMO Priority Health HMO Michigan Plans Surveyed in 2006

7. Chronic Disease Management

8. HEDIS Trends: Asthma- Appropriate Medication

9. HEDIS Trends: Cardiovascular 2002-2006

10. HEDIS Trends: Diabetes 2002-2006

11. Asthma Disease Management

12. WhoHas Alcohol Problems? • 11.1% of full-time workers ages 18 – 49 • Approximately 12.3% of MI workers • Twice as many men (13.7%) as women (7.4%) • Prevalence by age: • 18-25(18.9%) • 26-34(12.5%) • 34-49(7.8%)

13. Here is the Problem: Source: Office of Applied Studies. (2004). Results from the 2003 National Survey on Drug Use and Health: National findings. Rockville, MD: Substance Abuse and Mental Health Services Administration.

14. Problem Drinking Causes Disease and Injury

15. How do alcohol problems cost businesses? • Lower productivity • Lost workdays • Extra health care use • Other costs: • Workers compensation and disability • Accidents and damage • Turnover and worker replacement • Diverted supervisory and co-worker time • Workplace friction • Family disruption

16. Spending by Insurers 1991-2001 Chart Source, SAMHSA, 2005

17. Spending by Insurance Source 1991-2001 Chart Source, SAMHSA, 2005

18. Current State of Treatment • Employment-based health benefits • treat addiction as if it were an acute illness or willful bad behavior • General medical system • unprepared and un-paid to identify or treat alcohol problems early • Specialty substance use treatment system • hampered by low insurance reimbursement, acute care model • Many people with alcohol problems do not want the primary treatment goal offered: • abstinence

19. Behavioral Health Overview

20. Alcohol Disease Management

21. 8% 92% Estimated Percentage of Plan Members with an Alcohol Problem Recent estimates suggest that almost 8% of the US population has an alcohol problem

22. How many get Identified? 8% Less than 1% of Michigan members are identified. 92%

23. 9% 91% Estimated Percentage of Plan Members with Depression Recent estimates suggest that almost 9% of the US population has a major depressive disorder

24. How many get Identified? 9% 4.3% of Michigan members are identified. 91%

25. Identification Rates for Other Health Conditions

26. Alcohol Screening Instruments for Primary Care Providers

27. Alcohol Screening Instruments for Behavioral Health Providers

28. DepressionHEDIS Collected 2003-2006

29. Behavioral Health Comparisons • Disparities between behavioral health and non-behavioral health are evident: • Identification rates • Use of data elements to identify affected members • Rate of communication between plans • Rate of activities that encourage follow-up with identified or high-risk individuals

30. What more can be done? • Employee Assistance Programs • Work with other businesses and health care providers • Use EAP and Health Plan data to build the case for the effectiveness of employment-based alcohol treatment in business terms: • Avoidable health care costs • Avoidable productivity losses • Avoidable absenteeism

31. What Businesses Can Do to Make Their Workplaces Safer, Healthier and More Productive • Comprehensive Health Insurance Benefits • Average cost of upgrading is around $5 per beneficiary per month • Equitable co-pays, deductibles, limits. Co-pays less than $10/session. • It is being done! • Managing health plan benefits • National Business Coalition on Health’s eValu8 RFI at www.nbch.org • Confidential screening and brief intervention • Encourage primary care screening and treatment • Monitoring utilization and outcomes

32. Looking forward: The 2007 eValue8 RFI • Investigate eValue8 scales-both within and between sections: • Section scales • Summary scales • eValue8 total scale • What are the properties of these scales? Do they accurately measure what we want them to? • Which items do not contribute any unique variance to scales and can be eliminated from future versions of the RFI?