cancer management: fully integrated population- based and chronic care case-based model marnie w....
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Cancer Management: Fully Integrated Cancer Management: Fully Integrated population-based and Chronic Care Case-population-based and Chronic Care Case-
based Modelbased ModelMarnie W. Bute, R.N.Marnie W. Bute, R.N.Director, Health and Care Business Director, Health and Care Business
Development Development May 8, 2007May 8, 2007
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HealthPartners
HealthPlan
HP MedicalGroup &Clinics
RegionsHospital
HP Dental
Group &Clinics
HPCentral
MN Clinics
Administrative Support
A consumer-governed health care organizationMission: To improve the health of our members, our patients and the community
IME
ICSI
HPRF
MNCM
Contracted Medical Groups and Clinics
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Market DemandMarket 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
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Population Health Management Population Health Management Approach to CancerApproach to Cancer
Healthy/low Risk At-RiskHighRisk
Early Symptoms
ActiveDisease
20% of People
Generate
80% of Costs
Claims Cost Distribution
$
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Integrated by DesignIntegrated by Design
• 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
• Integrated, national, member-centric model built on three integral components
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HealthPartners ApproachHealthPartners Approach
• Comprehensive cancer components– Prevention/Wellness
– Early diagnosis/Screening
– Evidence-based treatment
– Palliative care
– End-of-life care
– Measurement and reporting
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Cancer: PreventionCancer: Prevention• 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
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Health Assessment Health Assessment IntegrationIntegration
• 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)
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Fruit and Vegetable IntakeFruit and Vegetable IntakeFruit and Vegetable Intake
2.60
2.70
2.80
2.90
3.00
3.10
3.20
3.30
3.40
3.50
3.60
3.70
2003 2004 2005 2006
0%
5%
10%
15%
20%
25%
30%
Avg F&V Serv/Day % > 5 F&V per Day
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• 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)
0
10
20
30
40
50
60
70
80
90
100
1 2 3
Assessment
Pe
rce
nt
Sm
ok
ers
0
2
4
6
8
10
12
14
16
18
20
Cig
are
ttes
pe
r Da
y
Percent Smokers
Cigarettes per Day
Baseline Post-course Follow-up
Program Outcomes– Program Outcomes– Partners in Partners in Quitting Quitting Tobacco Cessation Tobacco Cessation
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Cost and Quality Cost and Quality InformationInformation
• 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
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Cancer: Early DiagnosisCancer: Early Diagnosis• 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
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Teachable Moments Message Teachable Moments Message DetailDetailGeneral 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
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Teachable Moment Message Teachable Moment Message Status and OutcomeStatus and Outcome
Message shown as delivered, along with Member response and email sent
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MN Colon Cancer ScreeningMN Colon Cancer Screening
2002 2003 2004 2005
HP Clinical Indicators 60% 68% 73% 75%
HP Comm HEDIS 62% 59% 63%
BCBS Comm HEDIS 60% 51%
Medica Comm HEDIS 54% 53%
HEDIS Comm Nat’l Ave
49% 52%
Clinical Indicators includes all products
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Commercial HEDIS ResultsCommercial HEDIS Results
• 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)
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Cost and Quality Cost and Quality InformationInformation
• Find “Best Choice” providers who offer the best overall cost and high quality for different services
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Cancer: TreatmentCancer: Treatment• 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
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Decision SupportDecision Support
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)
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Results: Decision SupportResults: Decision Support
Shared Decision Making4/2005 - 12/2006
18% 20%
49%
13%
0%
20%
40%
60%
Surg Issue: Elected Surg
Surg Issue: Elected Non Surg
Non Surg Issue Pending FinalDecision
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Results: Decision SupportResults: Decision Support
How satisfied are you with decision?
87% Satisfied
11%
0%
20%
40%
60%
80%
100%Very Satisfied
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Cancer: Palliative Care/End of Cancer: Palliative Care/End of LifeLife
• 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
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ALOS prior to PC consult
0
50
100
150
200
250
0-2 3-5 6-8 9-11
12-14
15-17
18-20
21-23
24-26
27-29
30-32
33-34
>34
ALOS prior to PC Consult
Cas
es
All Palliative Care patients pre-PC ALOS = 6.14 days
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ALOS after PC consult
020406080
100120140160
0-2 3-5 6-8 9-11
12-14
15-17
18-20
21-23
24-26
27-29
30-32
33-34
>34
ALOS after PC Consult
Cas
es
All Palliative Care patients post-PC ALOS = 4.98 days
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Variable Cost Difference Pre/Post Variable Cost Difference Pre/Post Palliative Care Referral -All Palliative Palliative Care Referral -All Palliative
Care PatientsCare Patients$1,236
$748
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
Avg Variable Cost/day
Pre-Palliative Care Post Palliative Care
*Based on January 2005-December 2006 Cases
Avg. cost of 1-5 days prior to PC consult
Avg. cost of 1-5 days following PC consult
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Moving ForwardMoving Forward
• Survivorship• Medication therapy
management• Clinical trials• Payment reform• Enhance specialty
networks• Productivity
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Measurement and Measurement and ReportingReporting
• 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
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Member ExperienceMember Experience
• Personalized, tailored• Comprehensive self-
management materials and support
• Seamless and transparent integration
“Meet me where I’ll be when I need you”
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Best Practice in CareBest Practice in CareStandard Staff Knowledge of “How To”• Consult multicultural and language resources
• Use internal and external resources appropriately to answer cultural competence questions
• Gather essential information
• Ask about language preference and ethnicity
• Chart information in patient records
• Use trained interpreters
• Arrange for an interpreter
• Work with an interpreter
• Use telephone interpreting services
• Provide translated vital documents
• Access translated documents or translations of needed documents
• Use vital translated documents with an interpreter
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Results: Achieving EquityResults: Achieving Equity
EthnicityEngagement Rate
Goal = 95%
Baseline YE 2006African American 92% 97%
Asian 88% 96%
Caucasian 95% 98%
Latino 100% 98%
Native or Alaskan American 89% 100%
Other Race 90% 94%
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SatisfactionSatisfaction
• Member satisfaction overall
– Ranges from 85-96 percent
– Annual survey
– Proof of member-centric approach
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Value for the Purchaser Value for the Purchaser
• Ease of management• Comprehensive
integrated program• Evidence-based• High employee
satisfaction• Trend reduction• Productivity
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Key TakeawaysKey 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