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From Wellness to Disease Management: Covering the Health Care Continuum

Wellness Presentation

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WORKPLACE WELLNESS

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  • 1. From Wellness to Disease Management: Covering the Health Care Continuum
  • 2. Reality Check
    • The top three causes of death are heart disease, cancer and stroke; The leading cause of all three is. A.) High Blood Pressure B.) Fatigue C.) Obesity
    • The director of the Behavioral Medicine Research Center at Baylor College predicts what percentage of Americans will be overweight or obese by 2040. A.) 50% B.) 90% C.) 75%
    • What percentage of US adults do not engage in any leisure time physical activity. A.) 40% B.) 25% C.) 60% (Department of Health and Human Services)
    • An American Cancer Society report shows obesity and lack of physical activity causes how many cancer cases in the United States? A.) 1/5 B.)1/2 C.) 1/3
  • 3. For Every 100 Employees
  • 4. 60 are Sedentary
  • 5. 25 Smoke
  • 6. 64 are Obese/Overweight
  • 7. 27 Have Heart Disease
  • 8. 10 Have Diabetes
  • 9. 50 Have High Cholesterol
  • 10. 24 Have High Blood Pressure
  • 11. 50 Are Distressed or Depressed
  • 12. Small changes, Big Impact
    • Reducing one health risk can
      • Reduce absenteeism by 2%
      • Improve productivity by 9%
    Reference: Pelletier B, Boles M, Lynch W. ( 2004). Change in health risks and work productivity over time. J Occup Environ Med.
  • 13. Activation!
    • Our level of personal activation (Take Chargedness) determines our behavior, our risks, our likelihood to change, and our medical costs.
        • Diet
        • Exercise
        • Disease specific self-management
        • Consumeristic behaviors
  • 14. Increased health risk, increased cost Impact of Modifiable Risk Factors on Medical Expenses Annual adjusted medical expenses ie. Overweight individuals cost 21% more than those whose weight is in the healthy range Adapted from Goetzel RZ, Anderson DR, Whitmer RW, et al, Journal of Occupational and Environmental Medicine (40) (10) October 1998, 1-12
  • 15. Care Management: Every Day Health
    • Integration between systems, people, programs
    • Lifelong support for members at any health stage
    • Simplification for member, employer, physician
    • Transformation of health care system
    CareEnhance Health Coach Special Beginnings Disease Management Case Management SUPPORT FOR EVERY DAY HEALTH WELLNESS COACHING SUPPORT MANAGEMENT
  • 16. CareEnhance: Decision Support The difference betweenwondering what to do and knowing.
  • 17. CareEnhance: Decision Support
    • 24/7 toll-free phone access to registered nurses
      • 5 call centers and support for more than 100 languages
    • Help knowing when, where (or whether) to seek care
    • Library of over 1,100 prerecorded health topics
    • Program reminders mailed to members quarterly
    • Administered by McKesson Health Solutions
    .
  • 18. Health Coach: Lifestyle Change The difference betweeninaction and taking charge.
  • 19. Special Beginnings: Healthy Pregnancy The difference betweenworry and peace of mind.
  • 20. Special Beginnings: Healthy Pregnancy
    • Nurses provide one-on-one member support
      • Assess each members risk to determine education and outreach
        • Members choice of pregnancy book or DVD (Spanish options)
        • What to expect during pregnancy and birth
        • Signs of premature labor and other complications
        • Tailored pregnancy information
      • 24/7 phone access (CareEnhance after hours)
    • Engine rewards for completing program
  • 21. Case Management: Advocate, Navigate The difference between going it alone and having a trusted advisor help you through.
  • 22. Case Management: Advocate, Navigate
    • Support for serious illness or injury
    • One-on-one nurse support based on conditions
      • Nurses advocate, navigate and coordinate care
      • Promote optimal quality
      • Match resources to needs
    • Avert unnecessary expenses ($20 million in 2005)
      • 1% of members drive 30% of health care costs
    Reminder: Case managers can help members understand their conditions, work with multiple providers and make the most of their benefits.
  • 23. Disease Management: Change the Future The difference between an existence controlled by your condition and taking control of your life.
  • 24. Disease Management: Change the Future
    • Targets diabetes, cardiac, and respiratory conditions
      • AdviCare packages may cover additional conditions
    • Prevent or postpone complications
    • Nurses and clinicians offer one-on-one support
      • Interventions based on members risk level
        • Newsletters, care reminders, phone contact, other outreach
      • Support treatment plans and improve compliance
        • Improved clinical measures and outcomes
      • Help members understand and manage their condition(s)
  • 25. Disease Management: Change the Future
    • Disease management is the difference between...
    BEFORE Uncontrolled Diabetic with Non-Healing Wound 3 Office Visits $ 375 Hospital Admission $25,000 Surgeon Fees $ 6,000 Prosthetic $12,000 Rehabilitation $24,000 Insulin $ 6,000 TOTAL $73,375 AFTER Controlled Diabetic 6 Office Visits $ 750 Foot Care $1,100 Dietician $ 300 Physical Therapy $ 500 Insulin $4,500 Pharmacy Services $ 110 TOTAL $7,260
  • 26. Why Regence Disease Management Matters
    • 45% of members with chronic conditions do not receive evidence-based care*
      • Medications, tests and exams, doctor visits
      • Improve diet and exercise
      • Reduce stress
    • Engaged members make better health care decisions
    • Improvements in quality of life may
      • Increase productivity
      • Reduce absenteeism and presenteeism
      • Slow cost trends over time
    • *Source: McGlynn, et al., New England Journal of Medicine, 2003 .
  • 27. Regence Disease Management Basics
    • Targeted conditions
      • Diabetes
      • Coronary artery disease (CAD)
      • Congestive heart failure (CHF)
      • Asthma
      • Chronic obstructive pulmonary disease (COPD)
      • Depression
      • Anxiety
    • Prevents or postpones complications
    • Supports treatment plans and improves compliance
    • Helps members understand and manage their condition
  • 28.
  • 29. Having A Chronic Illness Is Complicated Only about 20% of people with health conditions do what they should to maintain good health
    • Take Medications
    • Do Prescribed Tests
    • Visit Doctor Regularly
    • Reduce Stress
    • Exercise
    • Follow Diet
  • 30. Physicians Have Challenges, Too
    • Health care systems have driven physicians to fix patients, not maintain their health
      • Lack of time with patients
      • Increasing prevalence of chronic conditions
      • Shift to short term episodes rather than long term health status.
    Our goal is to support the physician with patient behaviors between office visits
  • 31. We Stratify the Population
    • Stratification of Risk
      • Rules-based algorithms
      • Individually stratifies the population so we know where to start
    Low Risk High Risk
  • 32. We Apply the Right Level of Intervention
    • 4 levels of risk stratification
    • Program tailored to risk level
    • Fluid stratification algorithms (claims, prescriptions, updates, self report, physician and care calls)
    • Interventions based on member specific needs and best practice guidelines
    Level of intervention is based on individual stratification and risk status of the member
  • 33. What do members participating in the program receive?
    • AdviCare participants will be offered:
    • One-on-one nurse-based counseling
    • Support through telephone calls designed to help the member through coaching and education
    • Members talk by phone with a knowledgeable
    • RN who:
    • One-on-one nurse-based counseling
    • Understands the complexities of their conditions
    • Can take the time to answer all of their questions
    • Has access to a variety of educational materials
  • 34. We Address the Whole Person
    • Its about people, not the disease
    • Understand individual behaviors and help the participant modify them
    • In order to create change you must establish unconditional credibility and positive intent
    • Set goals with the patient that are achievable
    • Build on their successes
    All co-morbidities and behaviors must be managed simultaneously by the same trusted relationship
  • 35. We Extend the Physicians Reach
    • Expanded interventions between office visits
    • Comprehensive health condition protocols (evidence based standards of care)
    • Behavioral modification
    • In market nurses supporting practice patterns with tools and education
    A primary goal of our program is to support the physician with patient behaviors between office visits
  • 36. Outcomes Reporting
    • Financial semi-annual report reflects pre- versus post program results
    • Clinical Outcomes semi-annual report on members overall compliance with selected standards of care
    • Utilization semi-annual with % change in admissions, length of stay, ER visits and bed days
    • Member Satisfaction - annually
    • Activity quarterly report showing members counts and type/frequency of member contact
    • Note: Client level reporting varies based on group size.
  • 37. Program Results Health Care Cost for Diabetes Population Declined During Years 1 and 2 both in Real Terms and when Compared to Adjusted Base Period Costs Year 1 Trend is 7% Year 2 Trend is 12%
  • 38. Diabetes Clinical Indicator Improvement
  • 39. Results
    • 43,492 Program participants
    • 677,940 Educational mailings
    • 186,088 Telephonic interventions
    Office Visits ALOS (days) ER visits Admissions Bed Days Utilization Other Professional Pharmacy Outpatient Inpatient Overall Costs 6.56 6.0 263 157 938 $45 $97 $106 $58 $145 $431 Intervention 6.93 5.2 307 206 1,061 $47 $137 $118 $118 $147 $551 No Intervention -5% 13% -14% -24% -12% -4% -29% -10% -51% -2% -22% % Change
  • 40. Member Satisfaction Percent of Members Rating the Program Good to Excellent Member satisfaction with healthcare increases steadily so you hear less noise. 78% 89% 78%
  • 41. Success Story
    • Diagnosed with type 2 diabetes for over a decade.
    • During a Welcome Call, she told the AdviCare nurse that upon receiving her AdviCare diabetes workbook,she read it from "cover to cover." She stated more than once how pleased she was with it; in comparing it with others she had read, she found AdviCare's to be "more readable" and to contain "better dietary information" than others she had read. She reported that despite her long time diagnosis, she looked forward to participating in the AdviCare program.
  • 42. Making a Difference in Someones Life
    • A member had a history of substance abuse and uncontrolled diabetes prior to her calls from the AdviCare program. For four years she had not been having regular laboratory testing or reviews of her medications. In 2005, the AdviCare nurses sent her workbooks and encouraged the member to review the standards of care. The member also set a goal to call member services and find a physician to help her manage her diabetes. Since then the member has had her medications reviewed, her annual exams, and A1C testing. She has continued to remain sober and stated she attributes her current health with diabetes to the information and support provided by the AdviCare nurses.
  • 43. Thank you for attending
    • Jennifer Havlin, BA, BSN, RN
    • Regence BlueShield
    • (206) 332-5011
    • [email_address]