The Healthy Aging Project: Positioning Group Health as a “trusted resource” for Healthy Aging

1. The Healthy Aging Project: Positioning Group Health as a “trusted resource” for Healthy Aging Karen Lewis Smith, Director Medicare Strategy Chris Fordyce MD, Medical Director Healthy Aging Project Practice Change Fellows, January 2009

2. Session Overview • Overview of Group Health (GH) • Business case for the Healthy Aging Project (HAP) • HAP: Vision, core content and usages • Filling out the Chronic Care Model in Healthy Aging • The Medical Home • Aligning the business and clinical imperative for the Medicare population: education and support in Healthy Aging • Provider supports

3. Group Health Cooperative • Consumer governed, not-for-profit organization founded in 1947 • Integrated model: Local community-based health plan + delivery system • Service Area: 20 counties in WA and 2 counties in N. ID • 575,000 Members • 9,750 staff, including 889 Group Health Permanente Group physicians • Facilities: 1 Hospital, 25 primary care clinics, 6 specialty units, • Contract with 44 hospitals and 9,100 physicians • All lines of business

4. GH Medicare: Strategically Important LOB • Strong legacy, core competency for organization • Medicare enrollment is significant to GH • 10% of enrollment but 30 % of revenue • Profitable LOB – Significant contributor to margin • GH Medicare enrollment has been significant to WA state • 8% of total Medicare eligible's in state – 13% in current service area • 40% of total MA enrollees in WA • However: we have been losing 1 – 2K Medicare members for past couple of years AND our market position is being significantly challenged

5. 2008 MA Plans $350 = GHC = HMO $300 = PPO = PFFS $250 = MSA $200 $150 $100 $50 $0

6. Washington State Segment Growth 5% * * 85% of the growth in HMO plans came from 4 niche players Source: CMS

7. Take Away Messages • To be successful, GH needs to play differently in the Medicare space • Honed HMO product offerings • SNP • Value-based benefit design • Choice products • PPO • New service areas • Go where the Seniors are growing • Non-product initiatives • The Healthy Aging Project

8. The Business Case for HAP • Highlights our distinguishing strengths: • Primary care based structure w/health promotion/prevention as core competency • Chronic disease management expertise • High tech/High touch applications • Leader in evidence based medicine and healthy aging • Adds to the intellectual capital of the organization and the community • Contributes to organizational growth goals – enrolled lives and lives “touched” • Established nation’s first population-based breast cancer screening program • Developed “Free and Clear”, the endorsed as one of the most effective • smoking cessation programs • Developed first evidence based physical activity program w/proven results • Significant contribute to the body of work on evidence based healthy aging • First provide evidence that widely used heart drugs may protract brain against Alzheimer's • First to link physical activity and social isolation as the two most statistically important determinant of healthy aging • First to connect yoga and massage with improvements in chronic back pain • Developed evidence on key geriatric syndromes and threats to functional status and quality of life • Part of national “think tank” conducting ground braking research on the anticipated effect of the Baby Boomers as they age • Developed the Chronic Care Model, currently being used by WHO • • Rated #1 in State for diabetes care and 7th in nation (HEDIS) • • Our Medicare Plan was named one of America’s Best Health Plans (US News and World Report) • National leader in e-health and secure online messaging • 50% of our population registered on www.ghc.org • 75% of prescription refill ordered online

9. Overview of HAP • Vision: Position GH as a “trusted resource” for healthy aging • Create a national model for preventive care for older adults in the framework of the chronic disease model and guided by the new medical home model for primary care • Create a platform on which we build a reputation that will make people want to come to us for care and information • Foundational Thinking • GH is a steward and content expert for the evidence base around healthy aging • Our purpose is to package healthy aging resources in a way that is easily accessible to the aging population both in our clinics and in communities where they live • In packaging, we will draw on our own expertise and, where indicated/necessary, will select the appropriate organizations w/content expertise to partner w/and broker the programs they’ve developed

10. Healthy Aging Project: The Toolkit • Focus: Develop core content and tools in healthy aging with focus on prevention, health promotion andself management • Step 1: Development of a Healthy Aging Toolkit • Phase 1 toolkit focus is on health promotion/prevention, key geriatric syndromes and advanced planning • Phase 2 will add prevention/management of chronic diseases and topics of special interest to seniors • Toolkit products to include: 1)Screening and assessment;3)Clear, evidence based interventions; 3)Goal setting/individualized wellness plan; 4)Tracking tools and support; 5)Educational resources for both patients and providers

11. Healthy Aging Program: Toolkit Uses • Internally in clinical practice • Physical exam/group visits • Backbone of curriculum for MDs around approaches to geriatric care • Through MyGroupHealth and Incontext • Member education • In the community locally and nationally • Community forums • As part of an offering to senior retirement communities • As foundation for furthering a policy agenda on healthy aging

12. Healthy Aging Program: Building it out • Videos/DVDs • Companion collateral materials • Health Risk Assessment connectivity • Web-based functions and services • “Ask the expert” function • Access to discussion rooms • Access to Healthwise tools • Related healthy aging products • Ability to customize and package for unique needs/populations

13. Beautiful young people are an accident of nature, but beautiful old people are works of art. • --Eleanor Roosevelt

14. Chronic Care Model Community Health System Health Care Organization Resources and Policies ClinicalInformationSystems Self-Management Support DeliverySystem Design Decision Support Prepared, Proactive Practice Team Informed, Activated Patient Productive Interactions Improved Outcomes

15. The Medical Home:Group Health’s commitment • Rollout to all Primary Care Clinics in the next 18 months • Decreased panel sizes, template flexibility • Significant increase in MD’s, mid levels and support staff • Pilot demonstrated in 12 months significantly increased patient and staff satisfaction • Cost neutrality • ‘The relationship between the personal care physician and the patient is the core of all we do.’

16. Healthy Aging ToolkitPhase one: 12 module introduction • Healthy Aging Overview • General Preventive Care • Screenings, immunizations, chronic disease management • Key Geriatric Syndromes: • Physical Activity • Social Activation • Memory • Nutrition • Falls • Depression • Urinary Incontinence • Advance Planning • Medication Management • Putting it all together: Planning for the ‘What If’s’

17. Health Enhancement Project • Group Health and Pac Med patients >70 yo • Geriatric Syndrome screening, assessment, intervention and follow-up by ARNP/MSW team based in a senior center • Evidence-based interventions known to improve overall health outcomes with clear roles for each of the multi-disciplinary team • Shown to decrease healthcare costs, improve function and QOL in 6-12 months • Partnerships between health plans, patients, practitioners and community resources

20. Social and Physical Activity:The Biggest Bang for the Buck! • There are only 2 things shown to statistically significantly affect overall health outcomes for the Medicare Population: social isolation on the negative side and regular physical activity on the very positive one. • There is no more important ‘prescription’ to write, individualize and assure compliance with than regular PA for all patients, whether robust or frail, living independently or in nursing homes.

21. Physical Activity Recommendations:The Surgeon General Report • Endurance: moderate aerobic activity 5 days a week for at least 30 minutes • Flexibility: stretch every day • Strength training: 2-3 days per week • Balance training: 3 times a week for those in need

22. GHC Senior Care Integration ModelPOPULATION CONTINUUMHealth Status Sub-populations

23. Evidence Based Clinical Guidelines • Increasing physical activity levels is the most important intervention for virtually ALL chronic disease management and prevention programs. • In diabetes the evidence clearly shows exercise and diet interventions are better than metformin in controlling A1C’s (NNT 6.9 for exercise and 13.9 for metformin). • Diabetes Care 2000 DPP; 23:1619-1629

25. Group Health Physical Activity ProgramsMoving toward a Full Spectrum Formulary • Silver Sneakers • Enhance Fitness • Coop In Motion • Zoo Walkers • Diabetic Exercise Kit • Home exercise videos • Heart Care and COPD programs • Clinic based groups and classes (Dancing Ladies and a Few Good Men) • Take Care Products • HEDIS/HOS

26. Living Will Durable Power of Attorney Durable Power for Health Care Decisions POLST Resources to be used widely: Home Care Palliative Care Hospice Advanced Directives and End of Life Resources

27. What if: I can no longer drive? I cannot cook or clean regularly? I cannot do regular bathing ? I cannot manage all my finances? I get sick? I am unable to walk easily? Someone is trying to break in my house? I am temporarily unable to care for myself? I am permanently unable to care for myself? The power goes out? The phone goes out? I develop dementia? There is a natural disaster? Advanced Planning: Considering the ‘What-Ifs’

29. Group Health Permanente Group • ALL providers seeing older patients need a fundamental expertise in geriatrics. • Possible ‘certificate in geriatrics’ to be tied to practice/compensation. • Providers and entire multidisciplinary team to offer modules and expertise ‘in the communities where older people live’. • Module development across multiple specialty lines. • Tie to ‘Art of Aging’ for PBS. • Encouragement to volunteer/sponsor education in Healthy Aging.

30. Healthy Aging ToolkitPhase Two • Chronic Disease Management modules: arthritis, osteoporosis, diabetes, heart disease, lung disease, neurologic disease, fibromyalgia, chronic fatigue, cancer • Modules on topics of Special Interest: Pain management, digestion, skin care, sleep, downsizing, vision and hearing problems, sexuality, emergency planning, community resources • Web-based functions and services: ‘Ask the Expert’, Chat rooms • All built out on the myGroupHealth.org website and integrated into patient care in the Medical Home Model

31. The Chronic Care Model for Healthy Aging • Self Management support: modules on healthy agingessentials and areas of interest; screening and assessment, E-B intervention plans, goal setting, tracking tools and educational resources; chronic disease self management classes live and online • Delivery system design: Medical Home Model • Decision support: guidelines and protocols, EPIC, Incontext and provider training • Clinical Information Systems: fully integrated with EPIC and myGroupHealth.org.

32. Building Partnerships… • On To • Organizing Wisdom: • Healthwise Story

33. Questions/Discussion