Disease Management Presentation to the Legislative Council

1. Disease ManagementPresentation to the Legislative Council July 24th, 2008 Denise M. Runde MSPH Policy Initiatives Advisor Department of Health Services

2. What is Disease Management? DM incorporates the continuum of screening, preventing, treating and managing a disease or decline in health status. Disease Management Association of America: defines DM as: a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant.

3. Current Situation Most commercial DM companies, health plans and physicians’ programs focus on: • identifying populations with common chronic conditions • intervening to improve the management of an existing disease with a goal of reducing complications, improving health status and reducing costs

4. Why is Disease Management Important? • The majority of health care costs are attributed to chronic diseases. • Chronic diseases are preventable and can be managed. • Many of the costs are avoidable if appropriate care were delivered. • Ambulatory Care Sensitive Hospitalizations • RAND: 52% of Adults and 32 % of children receive the care recommended by national guidelines.

5. What is appropriate care? • Defined by specialty societies or large national clinical trials “known as Evidence Based Medicine” • Problem: • Adults in the US receive appropriate care about 50% of the time. Children receive appropriate care 32% of the time. (including measuring height and weight to calculate BMI)

6. Percent of Wisconsin Medicaid members with diabetes who received a test for cholesterol

7. Wisconsin Medicaid performance in preventing and managing select conditions

8. Disease Management Process • Identify population of interest….say people with diabetes. • Define as appropriate care. • Collect data on appropriate care • Cholesterol test done • Test results • Assess if appropriate care was delivered and if patients disease is being “managed”. • Intervene to improve process of care and outcomes • Provide incentives to provide appropriate care (P4) • Provide incentives to patients to change health behavior • Develop “disease management” program (s) • “Carve out” the population with the “disease”(s) and have someone else manage them

9. Historical Pitfalls of Disease Management Programs • Single disease focused • First year cost savings difficult to sustain • Need to keep the focus on the ‘soon to be at risk” or the ‘faucet keeps flowing” • Expensive/proprietary programs take people out of their main source of care and fragment care even more

10. What is Medicaid Doing to Improve Disease Management? • Medicaid is largest purchaser of health services in Wisconsin • Transformation to a Value Based Purchaser in which Value = Quality/Cost • Primary Initiative focused on DM: • Pay for Performance in defined populations • Diabetes: Increase rate of LDL tests • Healthy Birth Outcomes: Decrease rate of LBW babies • Childhood Obesity: Increase reporting of BMI • Asthma: Increase appropriate medication management • Exploring new models of care delivery: Medical Home

11. Major Challenges • Getting the information needed to assess if appropriate care was provided AND if the outcomes were good. • What can legislature do? • Support development of method of collecting non claims based data • Introduce legislation to mandate reporting of BMI, LDL, Hba1c • SLH • Patient Registry (more difficult to

12. Contact Information Denise Runde Policy Initiative Advisor DHCAA Office of Administrator 1 West Wilson Room 350 Madison, Wisconsin 53701 Denise.runde@wisconsin.gov 608-267-3551