Toward Population Health Improvement

1. Toward Population Health Improvement Tracey Moorhead President and CEO May 21, 2008

2. Population Risk Segments What Did Disease ManagementOriginally Mean?

3. Population Risk Segments Industry Today

4. Population Health Spectrum “DM” is an Outmoded Label

5. Rebranding • DMAA launched rebranding initiative early 2007 • Objective: accurately reflect scope of membership and industry and recognize: • Limiting nature of “disease management” • Expansion of services and providers • Evolution of health care team concept

6. Refining our Vision All stakeholders in the health care continuum are aligned toward optimizing the health of populations.

7. Our Goals • Promoting population health improvement to: • Raise the quality of health care • Improve health care outcomes • Reduce preventable health care costs • Through the Care Continuum: • Health and wellness promotion • Disease management • Complex care coordination

8. 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:

9. Population Health Improvement • Aims to improve population health • Reduces 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

10. A Changing Landscape • Growth 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.

11. 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?

12. Challenges Demonstrating value Aligning incentives and reimbursements Patient engagement and trust Coordination of all providers

13. Foundations of PHI • Physician Engagement • Patient Engagement • Evidence-based care advocacy Strategic Approach to Healthcare

14. Integrating Population Health Strategies • Not competitive with or replacement for MH • Population 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 recommendations • MedPAC

15. NCQA PPC-PCMH • 9 Elements for Recognition • Access and Communication • Patient Tracking and Registry • Care Management • Patient Self-Management Support • Electronic Prescribing • Test Tracking • Referral Tracking • Performance Reporting and Improvement • Advanced Electronic Communications

16. Population Health Strategies • Support 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.

17. Supportive Industry Role • Address scalability concerns • Support healthcare providers in new roles • Assist with outcomes evaluations – clinical and financial • Lend experience in practice redesign efforts – culture, process, etc.

18. DMAA and Physicians • Physician Engagement Committee • Population Health Improvement Principles • PHI Strategies White Paper • Physician Satisfaction Survey • Patient-Centered Primary Care Collaborative

19. Demonstrating Value

20. Does Disease Management Save Money?

21. 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.

22. Better question: Do PHI Programs Improve Quality and Deliver Value?

23. 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?

24. Existing Spectrum of DM Outcomes Measures/Methods More Casual More Rigorous DMAA OutcomesProject TheDMAAMethod More Casual More Rigorous Narrower Spectrum of DM Outcomes Measures/Methods “Squeezing the Bookends” Single Standardized Approach for All DM Outcomes

25. Achieving Optimal Balance “Suitability” “Acceptability” Rigor Precision Replicability Evidence-based Bias, Confounders Causal Association Experimental Design Cost Time Ease Simplicity Accessibility Transparency Diverse Users

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

27. Outcomes Guidelines • Volume II, released September 2007. • DMAA collaborated throughout with leading quality, accrediting organizations—NCQA, URAC, Joint Commission. • Guidelines praised for sound methodology.

28. Next Steps/Current Work • Volume 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.

29. Medicaid Innovations • Medicaid 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.

30. Medicare as Laboratory • Special Needs Plans • Medicare Health Support • Medicare Care Coordination Demonstration • Care Management for High Cost Beneficiaries • Senior Risk Reduction • Medical Home Demonstration

31. Market Continues to Grow • Value proposition evidenced by dramatic industry growth in past decade • Health Plan penetration >90% • Employer and Medicaid growth >50% • International adoption growing rapidly - value perception independent of nationality • Employers overcome any doubt about short-term direct health savings with indirect health benefits • Buyers seem satisfied with value of their experiences

32. PHI Outlook • Future 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.

33. Learn More • DMAA: The Care Continuum Alliance • www.dmaa.org • (202) 737-5980 Sept. 7 to 10, 2008 . Westin Diplomat Resort & Spa . Hollywood, FL