Cancer Management: Fully Integrated population-based and Chronic Care Case-based Model

1. Cancer Management: Fully Integrated population-based and Chronic Care Case-based Model Marnie W. Bute, R.N. Director, Health and Care Business Development May 8, 2007

2. HealthPartners A consumer-governed health care organization Mission: To improve the health of our members, our patients and the community Health Plan HP Medical Group & Clinics Regions Hospital HP Dental Group & Clinics HP Central MN Clinics IME ICSI MNCM HPRF Administrative Support Contracted Medical Groups and Clinics

3. Market Demand • Trend management • Integrated solution • Outcome-based results • Improved employee health • Productivity • Absenteeism • Presenteeism • Emerging vendor carve outs: • Cancer disease management • Oncology Case Managers • Cancer networks • COE’s • Tiering • Second opinions

4. Population Health Management Approach to Cancer $ 20% of People Generate 80% of Costs High Risk Early Symptoms Active Disease Healthy/low Risk At-Risk Claims Cost Distribution

6. Integrated by Design • Integrated, national, member-centric model built on three integral components • Trained member advocates positioned to meet the member where they’re at, when they’re needed • Member decision Support all advocates are trained to help a member make decisions that are best for them • Member tools & resources communications protocols utilized in all member touch points to ensure optimal member experience

7. HealthPartners Approach • Comprehensive cancer components • Prevention/Wellness • Early diagnosis/Screening • Evidence-based treatment • Palliative care • End-of-life care • Measurement and reporting

8. Member Advocates Phone-based health improvement courses Weight Management Member Decision Support Should I quit smoking? What kind of a diet reduces my risk of cancer? Member Tools & Resources Health Assessment Tobacco use assessment and cessation Cost Calculator How much do I spend on cigarettes each year? Fitness Programs Worksite Wellness Programs Provider Support Patient-provider relationship support Integrated Member-Centric Model Cancer: Prevention

9. Shared Member-Centric Information Systems Health Assessment Integration • Personal, printable reports for individual participants. • Engagement into programs may be linked to incentives • Focus on participation in follow-up programs • Seamless hand-offs and outreach to other health care services to optimize impact (disease management, case management, behavioral health, dental, pharmacy)

10. Fruit and Vegetable Intake

11. N=534 (data from course completers) 20% of enrollees quit prior to lesson #1 Between baseline and post-course, 93% of survey completers quit smoking (n=112) At 6-months follow-up, 63% of survey completers quit smoking (n=63) Program Outcomes– Partners in Quitting Tobacco Cessation

12. Cost and Quality Information • Cost calculators • Medical and drug costs • Plan annual expenses • Look up costs for conditions and services • How much do I spent on cigarettes each year? Plan annual expenses Look up drug costs

13. Member advocates Where is the most cost effective mammogram? Member decision support Should I have a colonoscopy or a flex-sigmoidscopy? Member tools & resources Proactive cancer screening reminders Cost calculator Teachable moments Provider & treatment selection support Information therapy Provider support Patient-provider relationship support Integrated Member-Centric Model Cancer: Early Diagnosis

14. Teachable Moments Message Detail General message area, talking points, and instructions to deliver message Controls to enter disposition of message and email Member’s unique qualification for this campaign; plus objective of campaign

15. Teachable Moment Message Status and Outcome Message shown as delivered, along with Member response and email sent

16. MN Colon Cancer Screening Clinical Indicators includes all products

17. 2005 (2004 DOS) Colorectal Cancer rate: 58.9 Breast Cancer rate: 80.8 Cervical Cancer Rate: 85.4 2006 (2005 DOS) Colorectal Cancer Rate: 62.6 Breast Cancer Rate: 75.7 Cervical Cancer Rate: Rotated Out (RO) Commercial HEDIS Results

18. Cost and Quality Information • Find “Best Choice” providers who offer the best overall cost and high quality for different services

19. Member advocates Evidence based Medical & behavioral case management In patient & outpatient coordination of care Depression assessment Medical director advocacy Pharma by phone Member decision support Should I enroll in this clinical trail? Member tools & resources Centers of Excellence Complementary & alternative medicine Provider support Patient-Provider relationship support Collaborative practice models including physician and support-service providers Integrated Member-Centric Model Cancer: Treatment

20. Carol: “I was planning to have breast reconstruction surgery now that my breast cancer treatment is finished – I have so much going on, I’m just not sure.” Case Manager: Assess status, needs, and issues Identify decisional conflict Provide education Help clarify personal values & preferences Facilitate communication with physician(s) Decision Support

21. Results: Decision Support

22. Results: Decision Support

23. Member advocates Medical & behavioral case management; “end of life case management” Outpatient coordination of care Depression assessment Pharma by phone Medical director advocacy Member decision support One-on-one decision support in the member’s home Member tools & resources Advance directives Complementary & alternative medicine Hospice Provider support Patient-Provider relationship support Integrated Member-Centric Model Cancer: Palliative Care/End of Life

24. AllPalliativeCarepatientspre-PCALOS =6.14days

25. AllPalliative Care patients post-PC ALOS = 4.98 days

26. Variable Cost Difference Pre/Post Palliative Care Referral -All Palliative Care Patients Avg. cost of 1-5 days prior to PC consult Avg. cost of 1-5 days following PC consult *Basedon January 2005-December 2006 Cases

27. Survivorship Medication therapy management Clinical trials Payment reform Enhance specialty networks Productivity Integrated Member-Centric Model Moving Forward

28. Member support and provider support Cost and utilization Engagement Activity and intervention Clinical outcomes Satisfaction Member Provider Self-reported outcomes Self-perceived health status Productivity Integrated Member-Centric Model Measurement and Reporting

29. Personalized, tailored Comprehensive self-management materials and support Seamless and transparent integration Integrated Member-Centric Model Member Experience “Meet me where I’ll be when I need you”

30. Best Practice in Care

31. Results: Achieving Equity

32. Satisfaction • Member satisfaction overall • Ranges from 85-96 percent • Annual survey • Proof of member-centric approach

33. Ease of management Comprehensive integrated program Evidence-based High employee satisfaction Trend reduction Productivity Value for the Purchaser

34. Key Takeaways • Cancer management must be a population based approach • Integrated as a health plan solution • The broad continuum of prevention to end-of-life needs targeted and meaningful interactions • Interactions are dependant upon integrated platforms with member advocates, decision support, robust member tools and resources that are self directed and interactive • Carve out vendor programs can only impact a small slice of the large and complex cancer continuum

35. Thank You! Questions? Please feel free to contact me at: Marnie.W.Bute@HealthPartners.com