impact of purchaser attention to quality alcohol screening and treatment in commercial-sector health...

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

goplerud@gwu.edu

www.ensuringsolutions.org