Impact of Purchaser Attention to Quality Alcohol Screening and Treatment in Commercial-Sector Health Plans: The NBCH eValue8 Process
Eric Goplerud, Ph.D.APHA Annual Conference
December 12, 2005 4:30-5:30
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The Annual Costs of Alcohol Problems 33 million work days lost costing more than
$4 billion 80% of people with alcohol problems work or are family
members of workers
$36 billion in additional health care costs Nearly $30 billion to treat the illnesses and injuries caused by
alcohol use
Sources: Ensuring Solutions’ analysis of 2002 National Survey on Drug Use and Health; Bureau of Labor Statistics; Alcohol Cost Calculator for Business
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About eValue8
Nation-wide health plan evaluation process – developed by business for business
Promotes continuous quality improvement and value-based purchasing
Collects annual information on health plan practices and performance 64 health plans in 24 states covering 10 million lives Data still to be analyzed from ~235 more health plans
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2005 eValue8 Health Plans
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Estimated Percentage of Plan Members with an Alcohol Problem
Recent estimates suggest that almost 8% of the US population has an alcohol problem
92%
8%
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How Many Get Identified?
<1% of plan members are diagnosed with alcohol problems.
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Identification Rates for Other Health Conditions
Alcohol 8%
Depression 40%
Diabetes 65%
Hypertension 70%
What percentage of affected individuals are identified?
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Follow-up Care for Members Identified with an Alcohol Problem
30%
17%
44%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Care Management Phone Calls
Reminders Based on RiskFactor or Condition
Reminders Based on MissedAppointments
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Members In Need Don’t Get the Recommended Treatment
Members identified with a serious alcohol problem who receive any additional services within 14 days: 45%
Members identified with a serious alcohol problem who receive three or more services within 30 days: 16%
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Using Clinical Guidelines
Authoritative Sources of Guidelines for the Screening and Treatment of Alcohol Use Disorders: National Institute on Alcohol Abuse and Alcoholism American Psychiatric Association World Health Organization Veterans Administration/Dept of Defense
Only 50% of plans recommend that primary care providers use any of these guidelines.
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Quality Treatment for Health Conditions
Health care practitioners provide evidence-based care only about half the time (E.McGlynn, et al., NEJ M, 2003)
76%
73%
69%
45%
23%
11%
Breast cancer
Prenatal care
Low back pain
Diabetes
Hip Fracture
Alcohol dependence
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Here is the Problem:
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How Plans Can Improve
Teach members about hazardous drinking and what to do about alcohol problems.
Require providers to use validated screening and treatment guidelines.
Follow-up to ensure that members get treatment.
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What business can do: Set expectations Inspect performance Use purchasing muscle
National Business Coalition on Health More 70 business coalitions with 7,000 employer
members nationwide employing 35 - 40 million people
eValue8: Uniform, annual assessment of the quality of alcohol
care provided by health plans
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Ensuring Solutions’ 2005 eValue8 behavioral health technical assistance:
ensuringsolutions.org/pages/nbch
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Eric Goplerud, Ph.D., Director
2021 K Street NW, Suite 800
Washington, DC 20006
P: (202) 296-6922 F: (202) 296-0025
www.ensuringsolutions.org