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Reducing Health Disparities in Persons with Mental Illness by Engaging Patients, Peers

Mobile Technology and Implementation Science

Steve Bartels, MD, MS Herman O. West Professor of Geriatrics, Professor of

Psychiatry and Community & Family Medicine Director, Dartmouth Centers for Health and Aging

Disclosures • Grant Funding:

– NIMH – CDC – HRSA – AHRQ – CMS

• Consultant:

– Substance Abuse and Mental Health Administration – National Council of Behavioral Health Care

Overview

• Serious mental illness as a health disparity • Serious mental illness as a high cost health

condition • The failure of conventional treatment to reduce

early mortality and costs • The challenge of implementation • The promise and potential of peers and technology

Serious Mental Illness: The Nation’s Greatest Hidden

Health Disparity?

The Epidemic of Premature Death in Middle-aged Persons with Mental Illness

For people with major mental illness: The average life expectancy is 53 yrs.

“50 is the New 75”

The average life expectancy in the US has steadily increased to 77.9 years (increasing by almost 5 years since the 90s alone) At the same time……….

The Hidden Health Disparity of Early Mortality for Patients with Major Mental Illness

Mean Years of Potential Life Lost

Year AZ MO OK RI TX UT

1997 26.3 25.1 28.5

1998 27.3 25.1 28.8 29.3

1999 32.2 26.8 26.3 29.3 26.9

2000 31.8 27.9 24.9

Compared with the general population, persons with major mental illness lose 25-30 years of normal life span

Colton CW, Manderscheid RW. Prev Chronic Dis [serial online] 2006 Apr [date cited]. Available at: URL:http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm

Cardiovascular Disease Is Primary Cause of Death in Persons with Mental Illness*

*Average data from 1996-2000. Colton CW, Manderscheid RW. Prev Chronic Dis [serial online] 2006 Apr [date cited]. Available at URL: http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm

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Heart Disease

Cancer

Cerebrovascular

Chronic Respiratory

Accidents

Diabetes

Influenza/Pneumonia

Suicide

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12

4.5

6

5

4.5

4

10

34

10

6

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Heart DiseaseCancerCerebrovascularChronic RespiratoryAccidentsDiabetesInfluenza/PneumoniaSuicide

MO30124.5654.5410

OK34106482.54.510

RI25161084456

TX271055.5115311

UT20665105415

VA453210.50140

• 203 studies including 29 countries over six continents

• mental health disorders 2.22 times higher mortality risk compared to general population or people w/o mental illness.

• average of 10 years of potential life lost • Medical causes 2/3 (67.3%) of deaths,

17.5% “unnatural causes; remaining unknown.

Cardiovascular Disease (CVD) Risk Factors and Major Mental Illness

A Paradigm for High Complexity and Risk

Vancamfort et al., 2013: Meta-analysis of 136 studies

Modifiable Risk Factors Serious Mental Illness

Prevalence Compared to General Population

Abdominal Obesity 4.4 X

Smoking 3-4X

Diabetes 2X

Hypertension 1.4 X

Metabolic Syndrome 2.4X

Hyperlipidemia 2.7X

Factors Contributing to Longevity vs. Premature Death in the General Population

40%

30%

15%

10% 5%

Source: N Engl J Med. 2007 Sep 20;357(12):1221-8.

Chart1

Health Behaviors

Genetic Predisposition

Social Determinants

Environmental Exposure

Health Care

Sales

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0.3

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Sales

Health Behaviors40%

Genetic Predisposition30%

Social Determinants15%

Environmental Exposure5%

Health Care10%

To update the chart, enter data into this table. The data is automatically saved in the chart.

The 2007 National “10 By 10” National Campaign

Aim: To Increase the Life Expectancy of People with Mental Illness by 10 Years in 10 Years SAMHSA, HRSA, CDC, Healthy People 2020, and Numerous Organizations and Advocacy Groups A Decade Later there has been no change in life expectancy

Health Care Costs of Mental Illness

• Mental illness and substance abuse account for 29% of all hospital days and 22% of hospital costs in the US.

• Direct cost of care for mental illness estimated at $100 billion per year, indirect costs estimated at an additional $193 billion.

• Hospitalization and emergency service costs (>25%) account for much of the excess in health care costs for people with SMI.

Co-Morbid Mental Illness also Doubles or Triples Health Care Costs

Bartels, Clark et al, 2003

Medical Costs 2-3 x Greater for Beneficiaries with Co-morbid mental Health or substance Use Disorders = $293 Billion in US Effective integrated Care estimated to result in savings of 9-16%

Milliman Report, Economic Impact of integrated medical-behavioral health care, 2014

$0

$10,000

$20,000

$30,000

$40,000

$50,000

19 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85+

Schizophrenia Depression Dementia Medical Diagnoses Only

$0

$10,000

$20,000

$30,000

$40,000

$50,000

19 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85+

Schizophrenia Depression Dementia Medical Diagnoses Only

_1300599516.xls

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19 to 3419 to 3419 to 3419 to 34

35 to 4435 to 4435 to 4435 to 44

45 to 5445 to 5445 to 5445 to 54

55 to 6455 to 6455 to 6455 to 64

65 to 7465 to 7465 to 7465 to 74

75 to 8475 to 8475 to 8475 to 84

85+85+85+85+

Schizophrenia

Depression

Dementia

Medical Diagnoses Only

24566.0662921348

15596.5740340909

9052.0657711443

26025.9595859213

19950.8740944882

14449.7655

30026.875753012

19258.5632368421

45744.24

12973.3059504132

34646.872125

23892.382972973

44001.4315151515

13610.6818699187

39153.8775555556

27850.0210793651

39586.7133742331

10897.6294650952

40995.6021505376

32030.3488888889

33978.3776382661

15715.8237293087

48921.110952381

33933.1798230088

33111.0779906103

23072.6042894057

KSINK Graphs

SchizophreniaMajor DepressionAlzheimer'sAll Other Non-Psych DiagnosesSchizophreniaMajor DepressionAlzheimer'sMedical Diagnoses OnlySchizophreniaMajor DepressionAlzheimer'sMedical Diagnoses Only

Total InpatientTotal OutpatientTotal PhysicianTotal Nursing HomeTotal Home HealthTotal DrugTotal Other CostsTotal MedicareTotal MedicaidTotal Costs19 to 3417817620119 to 34$24,566.07$15,596.57$9,052.0719 to 340.00%0.57%2.99%

19 to 34Schizophrenia$3,955.98$11,142.71$1,362.23$0.00$3,586.92$4,480.02$38.2135 to 4448338130035 to 44$26,025.96$19,950.87$14,449.7735 to 441.24%2.62%3.67%

Major Depression$4,237.02$4,692.98$1,899.34$307.01$1,398.36$2,810.86$251.0245 to 543323801236345 to 54$30,026.88$19,258.56$45,744.24$12,973.3145 to 540.90%5.00%58.33%7.99%

Alzheimer's55 to 641602593349255 to 64$34,646.87$23,892.38$44,001.43$13,610.6855 to 649.38%13.51%72.73%9.96%

All Other Non-Psych Diagnoses$1,318.31$1,564.26$768.19$1,385.68$2,003.07$1,479.86$532.69$3,120.32$5,931.75$9,052.0765 to 741353151631,10365 to 74$39,153.88$27,850.02$39,586.71$10,897.6365 to 7440.00%32.38%93.87%14.14%

35 to 44Schizophrenia$3,591.99$10,667.57$1,535.96$434.98$4,399.87$5,352.89$42.7075 to 84933696691,02775 to 84$40,995.60$32,030.35$33,978.38$15,715.8275 to 8476.34%65.85%93.27%32.23%

Major Depression$5,084.94$4,498.75$2,389.33$918.73$2,850.42$3,961.19$247.5185+423391,06577485+$48,921.11$33,933.18$33,111.08$23,072.6085+95.24%89.09%98.59%67.96%

Alzheimer's

All Other Non-Psych Diagnoses$2,303.13$2,217.13$1,107.08$704.94$4,909.19$2,421.30$787.00$5,667.37$8,782.39$14,449.77

45 to 54Schizophrenia$3,354.72$12,242.48$1,436.49$356.72$7,322.65$5,233.92$79.90

Major Depression$4,468.48$4,121.66$2,268.75$1,791.32$2,173.61$4,060.84$373.89

Alzheimer's$5,328.48$4,773.27$2,370.63$16,880.03$12,690.70$2,724.91$976.22$10,630.15$35,114.09$45,744.24

All Other Non-Psych Diagnoses$2,786.38$1,741.27$1,169.75$2,462.46$2,299.72$2,158.51$355.22$5,514.76$7,458.55$12,973.31

55 to 64Schizophrenia$3,896.87$12,894.85$1,682.01$4,041.64$7,656.54$4,416.99$57.98


Alzheimer's$5,070.66$4,585.98$1,538.26$20,177.54$9,868.66$2,603.02$157.31$7,497.63$36,503.80$44,001.43




Alzheimer's$5,565.00$1,062.80$1,657.13$27,192.72$1,376.70$2,378.12$354.25$10,082.18$29,504.53$39,586.71




Alzheimer's$3,256.95$936.22$1,307.83$25,341.83$741.30$2,079.81$314.45$6,973.57$27,004.81$33,978.38


85 +Schizophrenia$8,817.75$1,459.44$2,054.54$32,806.26$1,217.84$2,356.30$208.98


Alzheimer's$2,194.01$576.86$1,048.86$27,125.32$195.53$1,707.56$262.93$5,335.94$27,775.13$33,111.08

All Other Non-Psych Diagnoses$1,843.53$788.93$1,048.65$16,012.15$1,430.40$1,651.67$297.26$4,866.88$18,205.72$23,072.60

KSINK Graphs

Total Inpatient

Total Outpatient

Total Physician

Total Nursing Home

Total Home Health

Total Drug

Total Other Costs

Total Costs: 1999

MEDICARE MEDICAID GRAPHS

Schizophrenia

Major Depression

Alzheimer's


Figure 1: 1999 Per Member Per Year Costs of Dual Eligible People

Schizophrenia

Schizophrenia

Major Depression

Alzheimer's

All Other Non-Psych Diagnoses

1999 Number of Dual Eligible People

Major Depression Costs

Schizophrenia

Major Depression

Alzheimer's


Figure 3: Proportion of Duals in Nursing Homes

ALZHEIMERS

SchizophreniaMajor DepressionCardiovascular

Total MedicareTotal MedicaidTotal MedicareTotal MedicaidTotal MedicareTotal Medicaid

19 to 34Schizophrenia$5,257.80$19,308.26$24,566.07

Major Depression$6,879.19$8,717.39$15,596.57

Alzheimer's

All Other Non-Psych Diagnoses$3,120.32$5,931.75$9,052.07



Alzheimer's




Alzheimer's$10,630.15$35,114.09$45,744.24




Alzheimer's$7,497.63$36,503.80$44,001.43




Alzheimer's$10,082.18$29,504.53$39,586.71




Alzheimer's$6,973.57$27,004.81$33,978.38


85+Schizophrenia$12,716.34$36,204.77$48,921.11


Alzheimer's$5,335.94$27,775.13$33,111.08


ALZHEIMERS

Total Medicare

Total Medicaid

Total Costs:1999

All Other Diagnoses

Total Medicare

Total Medicaid

Percentage of Total Costs:1999

Cardio Costs

1999 SCHIZOPHRENIA DUAL COSTS1999 SCHIZOPHRENIA DUAL COSTS1999 SCHIZOPHRENIA DUAL COSTS1999 SCHIZOPHRENIA DUAL COSTS

85+Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs

Per Member per Year$343.32$8,474.43$8,817.75$963.96$495.48$1,459.44$88.75$1,965.78$2,054.54$31,996.36$809.90$32,806.26$456.07$761.76$1,217.84$2,126.07$230.24$2,356.30$56.42$152.56$0.00$0.00$208.98$12,716.34$36,204.77$48,921.11

Number of People4242424242424242424242424242424242424242424242424242

Total Cost per Category$14,419.60$355,925.98$370,345.58$40,486.13$20,810.29$61,296.42$3,727.62$82,562.90$86,290.52$1,343,847.10$34,015.89$1,377,862.99$19,155.14$31,993.96$51,149.10$89,294.78$9,670.00$98,964.78$2,369.68$6,407.59$0.00$0.00$8,777.27$534,086.29$1,520,600.37$2,054,686.66

$8,817.75$370,345.58$1,459.44$61,296.42$2,054.54$86,290.52$32,806.26$1,377,862.99$1,217.84$51,149.10$2,356.30$98,964.78$208.98$8,777.27$12,716.34$36,204.77$48,921.11

Number of Non-Zero People111818323740364141406403934042424271008424242

Non-Zero PMPY$1,310.87$19,773.67$20,574.75$1,265.19$562.44$1,532.41$103.55$2,013.73$2,104.65$33,596.18$5,669.32$34,446.57$491.16$10,664.65$1,278.73$2,126.07$230.24$2,356.30$338.53$6,407.59$0.00$0.00$1,097.16$12,716.34$36,204.77$48,921.11

75 to 84Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs

Per Member per Year$134.52$4,562.26$4,696.77$2,111.60$361.84$2,473.44$73.89$1,260.79$1,334.68$26,768.19$1,074.26$27,842.46$1,588.24$136.74$1,724.98$2,574.31$217.96$2,792.27$125.20$5.67$0.13$0.00$131.00$7,526.76$33,468.84$40,995.60

Number of People9393939393939393939393939393939393939393939393939393

Total Cost per Category$12,510.00$424,289.96$436,799.96$196,378.85$33,651.23$230,030.08$6,871.54$117,253.74$124,125.28$2,489,441.95$99,906.51$2,589,348.46$147,706.71$12,716.76$160,423.47$239,411.07$20,270.00$259,681.07$11,643.56$527.12$12.00$0.00$12,182.68$699,988.88$3,112,602.12$3,812,591.00

$4,696.77$436,799.96$2,473.44$230,030.08$1,334.68$124,125.28$27,842.46$2,589,348.46$1,724.98$160,423.47$2,792.27$259,681.07$131.00$12,182.68$7,526.76$33,468.84$40,995.60


Non-Zero PMPY$695.00$14,630.69$15,062.07$2,517.68$480.73$2,584.61$85.89$1,274.50$1,349.19$35,062.56$9,082.41$35,470.53$1,697.78$1,589.60$1,822.99$2,720.58$230.34$2,950.92$831.68$527.12$12.00$0.00$761.42$7,526.76$33,468.84$40,995.60


Per Member per Year$1,128.89$5,261.16$6,390.05$6,797.21$786.45$7,583.66$131.73$1,434.13$1,565.87$15,689.00$584.23$16,273.23$3,577.50$122.31$3,699.80$3,343.80$227.65$3,571.45$60.60$7.14$2.08$0.00$69.82$8,256.01$30,897.87$39,153.88

Number of People135135135135135135135135135135135135135135135135135135135135135135135135135135

Total Cost per Category$152,400.20$710,256.70$862,656.90$917,623.35$106,170.67$1,023,794.02$17,784.09$193,607.95$211,392.04$2,118,015.34$78,870.43$2,196,885.77$482,962.14$16,511.24$499,473.38$451,413.41$30,732.50$482,145.91$8,180.60$963.85$281.00$0.00$9,425.45$1,114,561.44$4,171,212.03$5,285,773.47

$6,390.05$862,656.90$7,583.66$1,023,794.02$1,565.87$211,392.04$16,273.23$2,196,885.77$3,699.80$499,473.38$3,571.45$482,145.91$69.82$9,425.45$8,256.01$30,897.87$39,153.88


Non-Zero PMPY$4,354.29$13,152.90$15,404.59$7,168.93$1,051.19$11,414.82$150.71$1,434.13$1,565.87$39,222.51$6,572.54$39,230.10$3,658.80$1,375.94$3,783.89$3,526.67$240.10$3,766.76$454.48$963.85$70.25$0.00$428.43$8,256.01$30,897.87$39,153.88


Per Member per Year$158.03$3,738.84$3,896.87$12,395.94$498.90$12,894.85$94.39$1,587.61$1,682.01$3,514.37$527.27$4,041.64$7,547.58$108.97$7,656.54$4,221.32$195.67$4,416.99$43.39$0.00$14.59$0.00$57.98$6,504.98$28,141.89$34,646.87

Number of People160160160160160160160160160160160160160160160160160160160160160160160160160160

Total Cost per Category$25,284.34$598,214.61$623,498.95$1,983,350.95$79,824.25$2,063,175.20$15,103.17$254,018.29$269,121.46$562,299.62$84,362.81$646,662.43$1,207,612.18$17,434.58$1,225,046.76$675,410.77$31,307.50$706,718.27$6,942.52$0.00$2,333.95$0.00$9,276.47$1,040,797.06$4,502,702.48$5,543,499.54

$3,896.87$623,498.95$12,894.85$2,063,175.20$1,682.01$269,121.46$4,041.64$646,662.43$7,656.54$1,225,046.76$4,416.99$706,718.27$57.98$9,276.47$6,504.98$28,141.89$34,646.87


Non-Zero PMPY$1,149.29$12,727.97$12,989.56$12,632.81$643.74$20,570.99$108.66$1,587.61$1,682.01$37,486.64$7,669.35$30,793.45$7,547.58$1,089.66$7,656.54$4,301.98$199.41$4,501.39$385.70$145.87$272.84$6,504.98$28,141.89$34,646.87

$6,504.98$28,141.89$34,646.87


Per Member per Year$192.79$3,161.94$3,354.72$11,800.75$441.73$12,242.48$61.55$1,374.94$1,436.49$333.02$23.70$356.72$7,284.16$38.49$7,322.65$5,060.15$173.77$5,233.92$69.78$0.00$10.12$0.00$79.90$5,110.57$24,916.30$30,026.88

Number of People332332332332332332332332332332332332332332332332332332332332332332332332332332

Total Cost per Category$64,005.07$1,049,762.78$1,113,767.85$3,917,850.12$146,653.54$4,064,503.66$20,435.58$456,480.50$476,916.08$110,562.00$7,868.41$118,430.41$2,418,341.03$12,777.37$2,431,118.40$1,679,970.30$57,690.00$1,737,660.30$23,167.05$0.00$3,359.00$0.00$26,526.05$1,696,709.65$8,272,213.10$9,968,922.75

$3,354.72$1,113,767.85$12,242.48$4,064,503.66$1,436.49$476,916.08$356.72$118,430.41$7,322.65$2,431,118.40$5,233.92$1,737,660.30$79.90$26,526.05$5,110.57$24,916.30$30,026.88


Non-Zero PMPY$1,066.75$10,393.69$10,607.31$11,908.36$584.28$19,526.64$75.41$1,379.10$1,436.49$36,854.00$1,967.10$16,918.63$7,306.17$851.82$7,344.77$5,282.93$181.42$5,464.34$661.92$0.00$119.96$0.00$449.59$5,110.57$24,916.30$30,026.88



Number of People483483483483483483483483483483483483483483483483483483483483483483483483483483

Total Cost per Category$95,992.67$1,638,936.53$1,734,929.20$4,832,661.02$319,776.13$5,152,437.15$44,794.59$697,072.39$741,866.98$158,893.50$51,202.32$210,095.82$2,097,452.62$27,682.25$2,125,134.87$2,509,210.59$76,237.50$2,585,448.09$9,197.37$0.00$11,429.00$0.00$20,626.37$2,743,866.99$9,826,671.49$12,570,538.48

$3,591.99$1,734,929.20$10,667.57$5,152,437.15$1,535.96$741,866.98$434.98$210,095.82$4,399.87$2,125,134.87$5,352.89$2,585,448.09$42.70$20,626.37$5,680.88$20,345.08$26,025.96


Non-Zero PMPY$1,263.06$11,876.35$12,481.51$10,174.02$857.31$15,135.47$119.13$1,461.37$1,548.78$26,482.25$7,314.62$21,009.58$4,351.56$1,845.48$4,408.99$5,338.75$162.21$5,500.95$209.03$0.00$173.17$0.00$198.33$5,680.88$20,345.08$26,025.96

$5,680.88$20,345.08$26,025.96



Number of People178178178178178178178178178178178178178178178178178178178178178178178178178178

Total Cost per Category$58,035.83$646,128.73$704,164.56$1,925,642.54$57,759.76$1,983,402.30$13,266.73$229,210.04$242,476.77$0.00$0.00$0.00$638,471.31$0.00$638,471.31$774,885.73$22,557.50$797,443.23$2,790.75$0.00$3,606.00$404.88$6,801.63$935,889.28$3,436,870.52$4,372,759.80

$3,955.98$704,164.56$11,142.71$1,983,402.30$1,362.23$242,476.77$0.00$0.00$3,586.92$638,471.31$4,480.02$797,443.23$38.21$6,801.63$5,257.80$19,308.26$24,566.07


Non-Zero PMPY$3,054.52$10,768.81$11,543.68$10,879.34$398.34$14,729.63$106.99$1,317.30$1,385.58$0.00$0.00$0.00$3,607.18$0.00$3,607.18$4,531.50$131.92$4,663.41$214.67$0.00$180.30$404.88$206.11$5,257.80$19,308.26$24,566.07

$5,257.80$19,308.26$24,566.07

WS KSINK

1999 MAJOR DEPRESSION DUAL COSTS1999 MAJOR DEPRESSION DUAL COSTS1999 MAJOR DEPRESSION DUAL COSTS1999 MAJOR DEPRESSION DUAL COSTS


Per Member per Year$70.36$2,537.93$2,608.29$484.64$545.49$1,030.13$53.38$1,415.18$1,468.56$22,750.13$1,926.08$24,676.21$594.01$424.37$1,018.38$2,426.04$242.15$2,668.18$107.56$355.38$0.50$0.00$463.43$7,311.99$26,621.19$33,933.18

Number of People339339339339339339339339339339339339339339339339339339339339339339339339339339

Total Cost per Category$23,852.41$860,358.08$884,210.49$164,293.07$184,921.08$349,214.15$18,094.70$479,746.02$497,840.72$7,712,292.66$652,941.79$8,365,234.45$201,367.88$143,862.32$345,230.20$822,426.19$82,087.50$904,513.69$36,462.33$120,473.93$168.00$0.00$157,104.26$2,478,765.55$9,024,582.41$11,503,347.96

$2,608.29$884,210.49$1,030.13$349,214.15$1,468.56$497,840.72$24,676.21$8,365,234.45$1,018.38$345,230.20$2,668.18$904,513.69$463.43$157,104.26$7,311.99$26,621.19$33,933.18


Non-Zero PMPY$745.39$8,779.16$8,931.42$723.76$682.37$1,747.88$83.39$1,423.58$1,477.27$25,537.39$8,823.54$26,556.30$751.37$2,935.97$1,224.22$2,499.78$249.51$2,749.28$618.01$7,529.62$84.00$0.00$2,182.00$7,311.99$26,621.19$33,933.18


Per Member per Year$191.49$5,867.06$6,058.55$695.08$794.21$1,489.29$104.29$1,934.10$2,038.40$15,053.99$2,470.21$17,524.19$1,028.82$650.68$1,679.50$2,559.66$213.47$2,773.13$215.37$250.30$1.62$0.00$467.28$12,181.93$19,848.42$32,030.35

Number of People369369369369369369369369369369369369369369369369369369369369369369369369369369

Total Cost per Category$70,660.69$2,164,945.99$2,235,606.68$256,483.71$293,064.61$549,548.32$38,484.84$713,683.11$752,167.95$5,554,920.55$911,506.18$6,466,426.73$379,636.11$240,100.94$619,737.05$944,515.45$78,770.00$1,023,285.45$79,471.37$92,359.19$596.00$0.00$172,426.56$4,495,131.39$7,324,067.35$11,819,198.74

$6,058.55$2,235,606.68$1,489.29$549,548.32$2,038.40$752,167.95$17,524.19$6,466,426.73$1,679.50$619,737.05$2,773.13$1,023,285.45$467.28$172,426.56$12,181.93$19,848.42$32,030.35


Non-Zero PMPY$1,158.37$14,628.01$14,904.04$866.50$918.70$2,647.25$144.68$1,934.10$2,038.40$22,859.76$9,494.86$23,949.73$1,140.05$2,858.34$1,806.81$2,802.72$233.74$3,036.46$630.73$8,396.29$149.00$1,277.23$12,181.93$19,848.42$32,030.35


Per Member per Year$321.86$6,041.90$6,363.75$1,806.92$1,068.45$2,875.37$158.05$2,294.53$2,452.58$7,061.14$1,688.38$8,749.52$2,274.45$1,299.39$3,573.84$3,053.02$208.36$3,261.38$494.39$74.40$4.79$0.00$573.58$12,961.43$14,888.59$27,850.02

Number of People315315315315315315315315315315315315315315315315315315315315315315315315315315

Total Cost per Category$101,385.79$1,903,197.00$2,004,582.79$569,180.36$336,560.64$905,741.00$49,784.74$722,777.52$772,562.26$2,224,258.19$531,840.54$2,756,098.73$716,452.13$409,306.52$1,125,758.65$961,702.05$65,632.50$1,027,334.55$155,732.53$23,436.13$1,510.00$0.00$180,678.66$4,082,850.88$4,689,905.76$8,772,756.64

$6,363.75$2,004,582.79$2,875.37$905,741.00$2,452.58$772,562.26$8,749.52$2,756,098.73$3,573.84$1,125,758.65$3,261.38$1,027,334.55$573.58$180,678.66$12,961.43$14,888.59$27,850.02


Non-Zero PMPY$1,045.21$12,946.92$13,363.89$2,040.07$1,246.52$5,353.77$180.38$2,309.19$2,452.58$21,806.45$7,597.72$21,200.76$2,388.17$3,825.29$3,691.01$3,216.39$219.51$3,435.90$1,089.04$7,812.04$251.67$1,212.61$12,961.43$14,888.59$27,850.02


Per Member per Year$262.69$5,708.34$5,971.03$3,213.99$1,158.35$4,372.34$226.25$2,503.32$2,729.57$3,043.75$863.25$3,907.00$2,190.27$719.84$2,910.11$3,391.41$197.56$3,588.97$394.73$8.26$10.38$0.00$413.38$11,356.08$12,536.30$23,892.38

Number of People259259259259259259259259259259259259259259259259259259259259259259259259259259

Total Cost per Category$68,037.29$1,478,458.77$1,546,496.06$832,424.10$300,011.81$1,132,435.91$58,598.29$648,359.97$706,958.26$788,331.43$223,581.46$1,011,912.89$567,279.99$186,437.63$753,717.62$878,374.61$51,167.50$929,542.11$102,236.02$2,140.32$2,688.00$0.00$107,064.34$2,941,225.98$3,246,901.21$6,188,127.19

$5,971.03$1,546,496.06$4,372.34$1,132,435.91$2,729.57$706,958.26$3,907.00$1,011,912.89$2,910.11$753,717.62$3,588.97$929,542.11$413.38$107,064.34$11,356.08$12,536.30$23,892.38


Non-Zero PMPY$1,030.87$15,562.72$15,464.96$3,397.65$1,298.75$6,665.55$240.16$2,503.32$2,729.57$22,523.76$9,720.93$22,486.95$2,215.94$3,329.24$2,944.21$3,585.20$208.85$3,794.05$1,053.98$2,140.32$179.20$1,000.60$11,356.08$12,536.30$23,892.38

$11,356.08$12,536.30$23,892.38



Number of People380380380380380380380380380380380380380380380380380380380380380380380380380380

Total Cost per Category$105,976.39$1,592,047.27$1,698,023.66$1,186,084.22$380,147.96$1,566,232.18$70,756.66$791,369.03$862,125.69$560,257.98$120,444.07$680,702.05$643,752.13$182,220.13$825,972.26$1,472,720.72$70,397.50$1,543,118.22$108,313.35$27,263.62$6,503.00$0.00$142,079.97$3,201,805.43$4,116,448.60$7,318,254.03

$4,468.48$1,698,023.66$4,121.66$1,566,232.18$2,268.75$862,125.69$1,791.32$680,702.05$2,173.61$825,972.26$4,060.84$1,543,118.22$373.89$142,079.97$8,425.80$10,832.76$19,258.56


Non-Zero PMPY$1,492.63$12,437.87$12,671.82$3,223.05$1,098.69$5,862.03$204.50$2,088.04$2,268.75$29,487.26$6,339.16$21,271.94$1,712.11$3,313.09$2,196.73$4,113.75$197.19$4,310.39$814.39$9,087.87$203.22$934.74$8,425.80$10,832.76$19,258.56



Number of People381381381381381381381381381381381381381381381381381381381381381381381381381381

Total Cost per Category$134,728.55$1,802,635.41$1,937,363.96$1,364,056.60$349,966.02$1,714,022.62$132,705.91$777,629.55$910,335.46$321,660.33$28,374.47$350,034.80$927,381.17$158,629.77$1,086,010.94$1,451,887.51$57,327.50$1,509,215.01$85,114.72$0.00$7,566.00$1,619.52$94,300.24$3,202,349.94$4,398,933.09$7,601,283.03

$5,084.94$1,937,363.96$4,498.75$1,714,022.62$2,389.33$910,335.46$918.73$350,034.80$2,850.42$1,086,010.94$3,961.19$1,509,215.01$247.51$94,300.24$8,405.12$11,545.76$19,950.87


Non-Zero PMPY$1,496.98$12,694.62$13,179.35$3,747.41$1,076.82$7,081.51$392.62$2,073.68$2,408.29$32,166.03$4,729.08$25,002.49$2,453.39$4,174.47$2,873.04$4,044.25$159.69$4,203.94$967.21$160.98$1,619.52$736.72$8,405.12$11,545.76$19,950.87



Number of People176176176176176176176176176176176176176176176176176176176176176176176176176176

Total Cost per Category$104,170.00$641,544.79$745,714.79$690,641.05$135,323.92$825,964.97$45,945.03$288,337.94$334,282.97$33.27$53,999.73$54,033.00$187,353.11$58,757.40$246,110.51$473,854.27$20,857.50$494,711.77$32,773.16$0.00$10,588.00$817.86$44,179.02$1,210,736.94$1,534,260.09$2,744,997.03

$4,237.02$745,714.79$4,692.98$825,964.97$1,899.34$334,282.97$307.01$54,033.00$1,398.36$246,110.51$2,810.86$494,711.77$251.02$44,179.02$6,879.19$8,717.39$15,596.57


Non-Zero PMPY$2,125.92$9,869.92$10,653.07$4,110.96$966.60$5,823.67$298.34$1,647.65$1,899.34$33.27$26,999.87$18,011.00$1,070.59$5,341.58$1,406.35$2,889.36$127.18$3,016.54$1,092.44$330.88$817.86$761.71$6,879.19$8,717.39$15,596.57

Graphs

1999 ALTZHEIMER'S DUAL COSTS1999 ALTZHEIMER'S DUAL COSTS1999 ALTZHEIMER'S DUAL COSTS1999 ALTZHEIMER'S DUAL COSTS


Per Member per Year$70.38$2,123.63$2,194.01$218.27$358.59$576.86$43.56$1,005.30$1,048.86$25,626.29$1,499.03$27,125.32$108.44$87.09$195.53$1,539.16$168.41$1,707.56$19.68$242.62$0.63$0.00$262.93$5,335.94$27,775.13$33,111.08

Number of People1,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,065

Total Cost per Category$74,957.88$2,261,667.52$2,336,625.40$232,458.40$381,899.15$614,357.55$46,392.81$1,070,645.29$1,117,038.10$27,292,001.38$1,596,462.44$28,888,463.82$115,486.18$92,750.40$208,236.58$1,639,201.08$179,355.00$1,818,556.08$20,964.41$258,390.12$666.00$0.00$280,020.53$5,682,779.33$29,580,518.73$35,263,298.06

$2,194.01$2,336,625.40$576.86$614,357.55$1,048.86$1,117,038.10$27,125.32$28,888,463.82$195.53$208,236.58$1,707.56$1,818,556.08$262.93$280,020.53$5,335.94$27,775.13$33,111.08

Number of Non-Zero People922672676208169336801,0501,0521,0431741,050835498531,0341,0341,0347934201111,0651,0651,065

Non-Zero PMPY$814.76$8,470.66$8,751.41$374.93$468.01$782.25$68.22$1,019.66$1,061.82$26,166.83$9,175.07$27,512.82$138.31$1,892.87$244.12$1,585.30$173.46$1,758.76$265.37$7,599.71$333.00$2,522.71$5,335.94$27,775.13$33,111.08


Per Member per Year$95.53$3,161.42$3,256.95$405.17$531.05$936.22$60.61$1,247.22$1,307.83$23,812.89$1,528.94$25,341.83$549.87$191.43$741.30$1,898.34$181.47$2,079.81$84.26$229.24$0.94$0.00$314.45$6,973.57$27,004.81$33,978.38

Number of People669669669669669669669669669669669669669669669669669669669669669669669669669669

Total Cost per Category$63,908.56$2,114,990.85$2,178,899.41$271,060.33$355,272.67$626,333.00$40,546.76$834,390.40$874,937.16$15,930,822.15$1,022,860.37$16,953,682.52$367,862.41$128,064.56$495,926.97$1,269,987.68$121,402.50$1,391,390.18$56,371.63$153,364.77$629.00$0.00$210,365.40$4,665,315.25$18,066,219.39$22,731,534.64

$3,256.95$2,178,899.41$936.22$626,333.00$1,307.83$874,937.16$25,341.83$16,953,682.52$741.30$495,926.97$2,079.81$1,391,390.18$314.45$210,365.40$6,973.57$27,004.81$33,978.38


Non-Zero PMPY$900.12$9,526.99$9,770.85$643.85$671.59$1,662.53$94.29$1,262.32$1,321.66$25,903.78$7,991.10$27,169.36$677.46$1,707.53$888.76$1,950.83$186.49$2,137.31$633.39$5,898.65$209.67$1,861.64$6,973.57$27,004.81$33,978.38


Per Member per Year$154.90$5,410.11$5,565.00$594.01$468.78$1,062.80$67.56$1,589.56$1,657.13$25,132.05$2,060.67$27,192.72$1,177.89$198.80$1,376.70$2,188.24$189.88$2,378.12$49.23$305.02$0.00$0.00$354.25$10,082.18$29,504.53$39,586.71

Number of People163163163163163163163163163163163163163163163163163163163163163163163163163163

Total Cost per Category$25,248.00$881,847.44$907,095.44$96,823.71$76,411.95$173,235.66$11,013.09$259,098.29$270,111.38$4,096,524.00$335,889.48$4,432,413.48$191,996.75$32,404.79$224,401.54$356,683.49$30,950.00$387,633.49$8,024.30$49,718.99$0.00$0.00$57,743.29$1,643,395.24$4,809,239.04$6,452,634.28

$5,565.00$907,095.44$1,062.80$173,235.66$1,657.13$270,111.38$27,192.72$4,432,413.48$1,376.70$224,401.54$2,378.12$387,633.49$354.25$57,743.29$10,082.18$29,504.53$39,586.71


Non-Zero PMPY$901.71$13,161.90$13,538.74$904.89$538.11$2,371.64$90.27$1,639.86$1,709.57$27,493.45$9,330.26$28,970.02$1,352.09$1,800.27$1,547.60$2,271.87$197.13$2,469.00$334.35$5,524.33$1,749.80$10,082.18$29,504.53$39,586.71


Per Member per Year$186.40$4,884.25$5,070.66$4,323.68$262.30$4,585.98$144.70$1,393.57$1,538.26$19,539.62$637.93$20,177.54$9,687.14$181.51$9,868.66$2,425.75$177.27$2,603.02$138.07$0.00$19.24$0.00$157.31$7,497.63$36,503.80$44,001.43

Number of People3333333333333333333333333333333333333333333333333333

Total Cost per Category$6,151.34$161,180.39$167,331.73$142,681.43$8,655.82$151,337.25$4,774.98$45,987.74$50,762.72$644,807.33$21,051.54$665,858.87$319,675.68$5,989.96$325,665.64$80,049.67$5,850.00$85,899.67$4,556.36$0.00$635.00$0.00$5,191.36$247,421.81$1,204,625.43$1,452,047.24

$5,070.66$167,331.73$4,585.98$151,337.25$1,538.26$50,762.72$20,177.54$665,858.87$9,868.66$325,665.64$2,603.02$85,899.67$157.31$5,191.36$7,497.63$36,503.80$44,001.43


Non-Zero PMPY$768.92$13,431.70$13,944.31$5,284.50$332.92$15,700.43$176.85$1,393.57$1,538.26$28,035.10$5,262.89$27,744.12$10,312.12$1,197.99$10,505.34$2,425.75$177.27$2,603.02$911.27$635.00$865.23$7,497.63$36,503.80$44,001.43


Per Member per Year$320.00$5,008.48$5,328.48$3,703.30$1,069.97$4,773.27$141.15$2,229.47$2,370.63$15,568.26$1,311.77$16,880.03$12,648.72$41.98$12,690.70$2,535.95$188.96$2,724.91$81.16$887.31$7.75$0.00$976.22$10,630.15$35,114.09$45,744.24

Number of People1212121212121212121212121212121212121212121212121212

Total Cost per Category$3,840.00$60,101.74$63,941.74$44,439.60$12,839.69$57,279.29$1,693.85$26,753.68$28,447.53$186,819.12$15,741.24$202,560.36$151,784.62$503.76$152,288.38$30,431.43$2,267.50$32,698.93$973.90$10,647.75$93.00$0.00$11,714.65$127,561.76$421,369.12$548,930.88

$5,328.48$63,941.74$4,773.27$57,279.29$2,370.63$28,447.53$16,880.03$202,560.36$12,690.70$152,288.38$2,724.91$32,698.93$976.22$11,714.65$10,630.15$35,114.09$45,744.24


Non-Zero PMPY$960.00$8,585.96$9,134.53$3,703.30$1,167.24$17,421.99$169.39$2,229.47$2,370.63$26,688.45$15,741.24$28,937.19$12,648.72$251.88$12,690.70$2,535.95$188.96$2,724.91$486.95$5,323.88$46.50$2,342.93$10,630.15$35,114.09$45,744.24


Per Member per Year$0.00$0.00$0.00$10,812.83$406.20$11,219.03$14.33$700.88$715.21$3,275.25$0.00$3,275.25$58,952.45$0.00$58,952.45$6,761.71$238.75$7,000.46$1,590.98$0.00$0.00$0.00$1,590.98$2,698.05$80,055.32$82,753.37

Number of People44444444444444444444444444

Total Cost per Category$0.00$0.00$0.00$43,251.32$1,624.79$44,876.11$57.31$2,803.52$2,860.83$13,101.00$0.00$13,101.00$235,809.80$0.00$235,809.80$27,046.84$955.00$28,001.84$6,363.90$0.00$0.00$0.00$6,363.90$10,792.21$320,221.27$331,013.48

$0.00$0.00$11,219.03$44,876.11$715.21$2,860.83$3,275.25$13,101.00$58,952.45$235,809.80$7,000.46$28,001.84$1,590.98$6,363.90$2,698.05$80,055.32$82,753.37


Non-Zero PMPY$10,812.83$541.60$70,171.48$14.33$700.88$715.21$13,101.00$13,101.00$58,952.45$58,952.45$6,761.71$238.75$7,000.46$6,363.90$6,363.90$2,698.05$80,055.32$82,753.37

1999 ALL OTHER NON-PSYCH DIAGNOSES DUAL COSTS1999 ALL OTHER NON-PSYCH DIAGNOSES DUAL COSTS1999 ALL OTHER NON-PSYCH DIAGNOSES DUAL COSTS1999 ALL OTHER NON-PSYCH DIAGNOSES DUAL COSTS


Per Member per Year$66.68$1,776.86$1,843.53$335.53$453.41$788.93$63.70$984.96$1,048.65$15,112.00$900.15$16,012.15$973.98$456.42$1,430.40$1,491.56$160.10$1,651.67$125.61$169.48$2.17$0.00$297.26$4,866.88$18,205.72$23,072.60

Number of People774774774774774774774774774774774774774774774774774774774774774774774774774774

Total Cost per Category$51,609.24$1,375,285.90$1,426,895.14$259,699.07$350,936.30$610,635.37$49,302.33$762,355.86$811,658.19$11,696,685.47$696,716.52$12,393,401.99$753,864.03$353,268.98$1,107,133.01$1,154,469.49$123,920.00$1,278,389.49$97,222.93$131,180.60$1,679.00$0.00$230,082.53$3,766,967.09$14,091,228.63$17,858,195.72

$1,843.53$1,426,895.14$788.93$610,635.37$1,048.65$811,658.19$16,012.15$12,393,401.99$1,430.40$1,107,133.01$1,651.67$1,278,389.49$297.26$230,082.53$4,866.88$18,205.72$23,072.60


Non-Zero PMPY$781.96$7,598.26$7,883.40$510.21$612.45$2,092.79$90.13$1,007.08$1,072.20$23,161.75$7,182.64$23,561.60$1,140.49$2,919.58$1,620.99$1,564.32$167.91$1,732.24$589.23$4,685.02$139.92$1,167.93$4,866.88$18,205.72$23,072.60


Per Member per Year$138.12$3,012.42$3,150.54$572.89$656.71$1,229.60$121.46$1,297.81$1,419.27$5,531.61$745.95$6,277.56$1,091.62$553.30$1,644.93$1,562.63$123.23$1,685.86$213.33$91.87$2.86$0.00$308.06$6,571.40$9,144.42$15,715.82

Number of People1,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,027

Total Cost per Category$141,847.56$3,093,754.81$3,235,602.37$588,354.47$674,443.66$1,262,798.13$124,735.99$1,332,854.49$1,457,590.48$5,680,963.84$766,093.62$6,447,057.46$1,121,096.80$568,244.10$1,689,340.90$1,604,822.13$126,560.00$1,731,382.13$219,086.79$94,351.71$2,941.00$0.00$316,379.50$6,748,829.18$9,391,321.79$16,140,150.97

$3,150.54$3,235,602.37$1,229.60$1,262,798.13$1,419.27$1,457,590.48$6,277.56$6,447,057.46$1,644.93$1,689,340.90$1,685.86$1,731,382.13$308.06$316,379.50$6,571.40$9,144.42$15,715.82

Number of Non-Zero People1612952957728059198331,0131,014267115331937196950913906913332191003511,0271,0271,027

Non-Zero PMPY$881.04$10,487.30$10,968.14$762.12$837.82$2,594.01$149.74$1,315.75$1,437.47$21,277.02$6,661.68$19,477.51$1,196.47$2,899.20$1,778.25$1,757.75$139.69$1,896.37$659.90$4,965.88$294.10$901.37$6,571.40$9,144.42$15,715.82


Per Member per Year$118.90$2,279.62$2,398.52$609.69$605.33$1,215.02$122.14$1,032.35$1,154.49$2,437.89$391.08$2,828.97$924.02$482.49$1,406.51$1,539.48$102.94$1,642.42$200.75$47.06$3.91$0.00$251.71$5,038.66$5,858.97$10,897.63

Number of People1,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,103

Total Cost per Category$131,144.37$2,514,418.75$2,645,563.12$672,489.44$667,676.91$1,340,166.35$134,722.04$1,138,680.28$1,273,402.32$2,688,993.25$431,357.16$3,120,350.41$1,019,193.65$532,182.28$1,551,375.93$1,698,045.72$113,540.00$1,811,585.72$221,421.88$51,908.57$4,311.00$0.00$277,641.45$5,557,645.83$6,462,439.47$12,020,085.30

$2,398.52$2,645,563.12$1,215.02$1,340,166.35$1,154.49$1,273,402.32$2,828.97$3,120,350.41$1,406.51$1,551,375.93$1,642.42$1,811,585.72$251.71$277,641.45$5,038.66$5,858.97$10,897.63

Number of Non-Zero People1352452508628609829411,0751,077115651561,0321411,033928927928297162303241,1031,1031,103

Non-Zero PMPY$971.44$10,262.93$10,582.25$780.15$776.37$2,402.61$143.17$1,059.24$1,182.36$23,382.55$6,636.26$20,002.25$987.59$3,774.34$1,501.82$1,829.79$122.48$1,952.14$745.53$3,244.29$187.43$856.92$5,038.66$5,858.97$10,897.63



Number of People492492492492492492492492492492492492492492492492492492492492492492492492492492

Total Cost per Category$118,406.52$1,460,850.47$1,579,256.99$530,188.16$492,511.02$1,022,699.18$95,392.31$598,512.68$693,904.99$715,621.61$127,484.78$843,106.39$907,213.22$345,989.62$1,253,202.84$1,064,919.57$62,297.50$1,127,217.07$173,216.53$1,939.49$1,912.00$0.00$177,068.02$3,200,504.59$3,495,950.89$6,696,455.48

$3,209.87$1,579,256.99$2,078.66$1,022,699.18$1,410.38$693,904.99$1,713.63$843,106.39$2,547.16$1,253,202.84$2,291.09$1,127,217.07$359.89$177,068.02$6,505.09$7,105.59$13,610.68


Non-Zero PMPY$1,691.52$12,073.14$12,735.94$1,216.03$1,253.21$4,168.28$220.82$1,260.03$1,457.78$19,878.38$5,311.87$17,206.25$1,890.03$4,613.19$2,605.41$2,488.13$145.55$2,633.68$967.69$969.75$106.22$936.87$6,505.09$7,105.59$13,610.68



Number of People363363363363363363363363363363363363363363363363363363363363363363363363363363

Total Cost per Category$72,406.78$939,047.71$1,011,454.49$301,878.82$330,202.37$632,081.19$60,047.23$364,570.86$424,618.09$835,054.08$58,817.73$893,871.81$651,932.44$182,867.31$834,799.75$745,170.23$38,370.00$783,540.23$123,147.70$3,203.80$2,593.00$0.00$128,944.50$2,001,857.48$2,707,452.58$4,709,310.06

$2,786.38$1,011,454.49$1,741.27$632,081.19$1,169.75$424,618.09$2,462.46$893,871.81$2,299.72$834,799.75$2,158.51$783,540.23$355.22$128,944.50$5,514.76$7,458.55$12,973.31


Non-Zero PMPY$1,366.17$11,886.68$12,487.09$999.60$1,130.83$3,890.95$188.24$1,029.86$1,196.11$39,764.48$5,881.77$30,823.17$1,868.00$4,571.68$2,391.98$2,373.15$122.20$2,495.35$1,070.85$3,203.80$123.48$991.88$5,514.76$7,458.55$12,973.31


Per Member per Year$128.62$2,174.51$2,303.13$1,064.03$1,153.10$2,217.13$194.02$913.06$1,107.08$618.06$86.88$704.94$4,328.95$580.24$4,909.19$2,329.29$92.02$2,421.30$721.70$37.89$19.66$7.76$787.00$5,667.37$8,782.39$14,449.77

Number of People300300300300300300300300300300300300300300300300300300300300300300300300300300

Total Cost per Category$38,584.62$652,353.07$690,937.69$319,209.77$345,928.57$665,138.34$58,205.45$273,917.95$332,123.40$185,417.42$26,063.62$211,481.04$1,298,685.89$174,071.28$1,472,757.17$698,786.24$27,605.00$726,391.24$216,508.74$11,368.31$5,897.00$2,326.72$236,100.77$1,700,211.54$2,634,718.11$4,334,929.65

$2,303.13$690,937.69$2,217.13$665,138.34$1,107.08$332,123.40$704.94$211,481.04$4,909.19$1,472,757.17$2,421.30$726,391.24$787.00$236,100.77$5,667.37$8,782.39$14,449.77


Non-Zero PMPY$1,134.84$13,047.06$13,287.26$1,271.75$1,459.61$7,167.24$218.00$931.69$1,114.51$30,902.90$5,212.72$19,225.55$4,417.30$5,439.73$5,009.38$2,677.34$105.77$2,783.11$2,640.35$11,368.31$163.81$775.57$2,146.37$5,667.37$8,782.39$14,449.77


Per Member per Year$180.36$1,137.95$1,318.31$795.26$769.01$1,564.26$129.22$638.97$768.19$1,384.15$1.52$1,385.68$1,943.52$59.55$2,003.07$1,415.44$64.43$1,479.86$348.91$164.42$19.37$0.00$532.69$3,120.32$5,931.75$9,052.07

Number of People201201201201201201201201201201201201201201201201201201201201201201201201201201

Total Cost per Category$36,253.18$228,727.95$264,981.13$159,846.52$154,570.47$314,416.99$25,973.90$128,432.10$154,406.00$278,215.09$305.59$278,520.68$390,647.13$11,969.70$402,616.83$284,502.80$12,950.00$297,452.80$70,130.37$33,047.42$3,893.00$0.00$107,070.79$627,183.60$1,192,281.62$1,819,465.22

$1,318.31$264,981.13$1,564.26$314,416.99$768.19$154,406.00$1,385.68$278,520.68$2,003.07$402,616.83$1,479.86$297,452.80$532.69$107,070.79$3,120.32$5,931.75$9,052.07


Non-Zero PMPY$1,908.06$8,168.86$8,547.78$992.84$1,051.50$4,028.94$159.35$679.53$808.41$55,643.02$305.59$46,420.11$2,066.92$1,088.15$2,130.25$1,683.45$77.08$1,760.08$1,348.66$33,047.42$185.38$1,508.04$3,120.32$5,931.75$9,052.07

1999 CARDIOVASCULAR DUAL COSTS1999 CARDIOVASCULAR DUAL COSTS1999 CARDIOVASCULAR DUAL COSTS1999 CARDIOVASCULAR DUAL COSTS


Per Member per Year$76.17$2,082.03$2,158.20$376.34$484.75$861.09$66.52$1,121.24$1,187.76$15,153.88$1,023.02$16,176.90$1,055.74$553.88$1,609.63$1,567.09$168.33$1,735.42$136.30$137.38$2.35$0.00$276.03$5,538.60$18,466.43$24,005.03

Number of People617617617617617617617617617617617617617617617617617617617617617617617617617617

Total Cost per Category$46,996.92$1,284,615.02$1,331,611.94$232,203.63$299,089.35$531,292.98$41,042.32$691,804.38$732,846.70$9,349,944.84$631,200.73$9,981,145.57$651,394.63$341,746.61$993,141.24$966,892.83$103,860.00$1,070,752.83$84,094.16$84,765.81$1,451.00$0.00$170,310.97$3,417,316.06$11,393,786.17$14,811,102.23

$2,158.20$1,331,611.94$861.09$531,292.98$1,187.76$732,846.70$16,176.90$9,981,145.57$1,609.63$993,141.24$1,735.42$1,070,752.83$276.03$170,310.97$5,538.60$18,466.43$24,005.03


Non-Zero PMPY$783.28$7,646.52$7,926.26$558.18$633.66$2,223.10$93.28$1,137.84$1,205.34$23,492.32$7,172.74$24,050.95$1,231.37$3,051.31$1,805.71$1,633.26$175.44$1,808.70$632.29$4,036.47$161.22$1,084.78$5,538.60$18,466.43$24,005.03



Number of People733733733733733733733733733733733733733733733733733733733733733733733733733733

Total Cost per Category$122,604.79$2,814,378.48$2,936,983.27$480,638.36$574,148.06$1,054,786.42$98,940.36$1,150,842.42$1,249,782.78$4,159,967.99$657,353.48$4,817,321.47$857,400.85$504,223.89$1,361,624.74$1,282,099.50$101,230.00$1,383,329.50$176,103.87$51,948.64$2,736.00$0.00$230,788.51$5,928,998.84$7,105,617.85$13,034,616.69

$4,006.80$2,936,983.27$1,439.00$1,054,786.42$1,705.02$1,249,782.78$6,572.06$4,817,321.47$1,857.61$1,361,624.74$1,887.22$1,383,329.50$314.85$230,788.51$8,088.68$9,693.89$17,782.56


Non-Zero PMPY$882.05$11,080.23$11,562.93$846.19$944.32$2,837.07$166.01$1,578.66$1,714.38$21,666.50$6,639.93$19,346.67$1,275.89$2,914.59$1,987.77$1,933.79$153.84$2,086.47$672.15$4,722.60$304.00$845.38$8,088.68$9,693.89$17,782.56



Number of People686686686686686686686686686686686686686686686686686686686686686686686686686686

Total Cost per Category$104,533.61$2,239,214.05$2,343,747.66$500,947.94$534,477.24$1,035,425.18$97,276.16$898,600.96$995,877.12$1,696,266.01$389,632.46$2,085,898.47$735,073.62$431,524.95$1,166,598.57$1,241,432.97$83,470.00$1,324,902.97$175,035.09$38,075.95$3,482.00$0.00$216,593.04$4,706,560.70$4,462,482.31$9,169,043.01

$3,416.54$2,343,747.66$1,509.37$1,035,425.18$1,451.72$995,877.12$3,040.67$2,085,898.47$1,700.58$1,166,598.57$1,931.35$1,324,902.97$315.73$216,593.04$6,860.88$6,505.08$13,365.95


Non-Zero PMPY$941.74$11,085.22$11,432.92$894.55$949.34$2,828.27$162.67$1,333.24$1,473.19$22,616.88$6,957.72$19,313.87$1,132.62$3,995.60$1,794.77$2,048.57$137.97$2,186.31$837.49$4,759.49$232.13$962.64$6,860.88$6,505.08$13,365.95



Number of People279279279279279279279279279279279279279279279279279279279279279279279279279279

Total Cost per Category$108,876.65$1,318,580.54$1,427,457.19$344,893.33$392,123.13$737,016.46$67,212.57$454,610.25$521,822.82$309,471.45$109,236.66$418,708.11$519,243.31$228,528.21$747,771.52$704,867.03$41,910.00$746,777.03$119,159.04$1,096.10$1,155.00$0.00$121,410.14$2,623,333.93$2,097,629.34$4,720,963.27

$5,116.33$1,427,457.19$2,641.64$737,016.46$1,870.33$521,822.82$1,500.75$418,708.11$2,680.18$747,771.52$2,676.62$746,777.03$435.16$121,410.14$9,402.63$7,518.38$16,921.02


Non-Zero PMPY$1,756.08$13,593.61$14,418.76$1,347.24$1,640.68$4,618.60$273.22$1,683.74$1,932.68$14,736.74$5,201.75$12,688.12$1,901.99$4,155.06$2,729.09$2,842.21$168.99$3,011.20$1,036.17$1,096.10$105.00$1,028.90$9,402.63$7,518.38$16,921.02



Number of People154154154154154154154154154154154154154154154154154154154154154154154154154154

Total Cost per Category$64,726.78$715,537.84$780,264.62$189,542.60$233,397.55$422,940.15$43,112.55$231,403.25$274,515.80$190,239.25$48,857.82$239,097.07$155,093.04$98,821.61$253,914.65$405,612.28$21,467.50$427,079.78$76,832.00$0.00$1,515.00$0.00$78,347.00$1,404,850.07$1,071,309.00$2,476,159.07

$5,066.65$780,264.62$2,746.36$422,940.15$1,782.57$274,515.80$1,552.58$239,097.07$1,648.80$253,914.65$2,773.25$427,079.78$508.75$78,347.00$9,122.40$6,956.55$16,078.96


Non-Zero PMPY$1,505.27$12,553.30$13,224.82$1,353.88$1,781.66$3,932.20$303.61$1,522.39$1,806.03$27,177.04$6,107.23$18,392.08$1,033.95$4,491.89$1,692.76$2,856.42$151.18$3,007.60$1,302.24$137.73$1,205.34$9,122.40$6,956.55$16,078.96


Per Member per Year$320.69$5,385.43$5,706.12$2,080.90$3,157.67$5,238.56$537.24$1,771.84$2,309.09$972.84$306.67$1,279.51$2,709.91$278.66$2,988.57$3,256.28$128.26$3,384.54$939.77$0.00$17.82$0.00$957.58$11,840.03$10,023.94$21,863.97

Number of People8282828282828282828282828282828282828282828282828282

Total Cost per Category$26,296.62$441,605.09$467,901.71$170,633.64$258,928.55$429,562.19$44,053.97$145,291.04$189,345.01$79,772.62$25,146.85$104,919.47$222,212.88$22,850.25$245,063.13$267,014.73$10,517.50$277,532.23$77,060.80$0.00$1,461.00$0.00$78,521.80$970,882.58$821,962.96$1,792,845.54

$5,706.12$467,901.71$5,238.56$429,562.19$2,309.09$189,345.01$1,279.51$104,919.47$2,988.57$245,063.13$3,384.54$277,532.23$957.58$78,521.80$11,840.03$10,023.94$21,863.97


Non-Zero PMPY$1,384.03$20,072.96$19,495.90$2,509.32$3,983.52$8,464.61$572.13$1,771.84$2,309.09$26,590.87$6,286.71$14,988.50$2,743.37$1,904.19$3,025.47$3,560.20$140.23$3,700.43$2,752.17$132.82$2,181.16$11,840.03$10,023.94$21,863.97


Per Member per Year$837.10$4,540.14$5,377.24$2,051.99$2,951.36$5,003.35$441.02$2,046.53$2,487.55$1,819.25$0.00$1,819.25$3,105.16$309.86$3,415.01$3,439.12$160.00$3,599.12$748.57$1,139.57$36.79$0.00$1,924.93$11,736.03$11,890.43$23,626.45

Number of People2929292929292929292929292929292929292929292929292929

Total Cost per Category$24,275.92$131,664.05$155,939.97$59,507.63$85,589.54$145,097.17$12,789.60$59,349.44$72,139.04$52,758.21$0.00$52,758.21$90,049.61$8,985.81$99,035.42$99,734.41$4,640.00$104,374.41$21,708.52$33,047.42$1,067.00$0.00$55,822.94$340,344.78$344,822.38$685,167.16

$5,377.24$155,939.97$5,003.35$145,097.17$2,487.55$72,139.04$1,819.25$52,758.21$3,415.01$99,035.42$3,599.12$104,374.41$1,924.93$55,822.94$11,736.03$11,890.43$23,626.45


Non-Zero PMPY$4,045.99$13,166.41$14,176.36$2,288.76$3,291.91$9,044.11$532.90$2,046.53$2,487.55$26,379.11$26,379.11$3,463.45$1,797.16$3,809.05$3,989.38$185.60$4,174.98$1,447.23$33,047.42$533.50$3,283.70$11,736.03$11,890.43$23,626.45

Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs

85+$66.68$1,776.86$1,843.53$335.53$453.41$788.93$63.70$984.96$1,048.65$15,112.00$900.15$16,012.15$973.98$456.42$1,430.40$1,491.56$160.10$1,651.67$125.61$169.48$2.17$0.00$297.26$4,866.88$18,205.72$23,072.60

85+774774774774774774774774774774774774774774774774774774774774774774774774774774

75 to 84$138.12$3,012.42$3,150.54$572.89$656.71$1,229.60$121.46$1,297.81$1,419.27$5,531.61$745.95$6,277.56$1,091.62$553.30$1,644.93$1,562.63$123.23$1,685.86$213.33$91.87$2.86$0.00$308.06$6,571.40$9,144.42$15,715.82

75 to 841,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,027

65 to 74$118.90$2,279.62$2,398.52$609.69$605.33$1,215.02$122.14$1,032.35$1,154.49$2,437.89$391.08$2,828.97$924.02$482.49$1,406.51$1,539.48$102.94$1,642.42$200.75$47.06$3.91$0.00$251.71$5,038.66$5,858.97$10,897.63

65 to 741,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,103

55 to 64$240.66$2,969.21$3,209.87$1,077.62$1,001.04$2,078.66$193.89$1,216.49$1,410.38$1,454.52$259.12$1,713.63$1,843.93$703.23$2,547.16$2,164.47$126.62$2,291.09$352.07$3.94$3.89$0.00$359.89$6,505.09$7,105.59$13,610.68

55 to 64492492492492492492492492492492492492492492492492492492492492492492492492492492

45 to 54$199.47$2,586.91$2,786.38$831.62$909.65$1,741.27$165.42$1,004.33$1,169.75$2,300.42$162.03$2,462.46$1,795.96$503.77$2,299.72$2,052.81$105.70$2,158.51$339.25$8.83$7.14$0.00$355.22$5,514.76$7,458.55$12,973.31

45 to 54363363363363363363363363363363363363363363363363363363363363363363363363363363

35 to 44$128.62$2,174.51$2,303.13$1,064.03$1,153.10$2,217.13$194.02$913.06$1,107.08$618.06$86.88$704.94$4,328.95$580.24$4,909.19$2,329.29$92.02$2,421.30$721.70$37.89$19.66$7.76$787.00$5,667.37$8,782.39$14,449.77

35 to 44300300300300300300300300300300300300300300300300300300300300300300300300300300

19 to 34$180.36$1,137.95$1,318.31$795.26$769.01$1,564.26$129.22$638.97$768.19$1,384.15$1.52$1,385.68$1,943.52$59.55$2,003.07$1,415.44$64.43$1,479.86$348.91$164.42$19.37$0.00$532.69$3,120.32$5,931.75$9,052.07

19 to 34201201201201201201201201201201201201201201201201201201201201201201201201201201

19 to 3419 to 34

35 to 4435 to 44

45 to 5445 to 54

55 to 6455 to 64

65 to 7465 to 74

75 to 8475 to 84

85 +85 +

Schizophrenia

Major Depression

1999 Number of Dual Eligible People Diagnosed with Schizophrenia or Major Depression

178

176

483

381

332

380

160

259

135

315

93

369

42

339

19 to 3419 to 34

35 to 4435 to 44

45 to 5445 to 54

55 to 6455 to 64

65 to 7465 to 74

75 to 8475 to 84

85 +85 +

Schizophrenia

Major Depression

1999 Per Member Per Year Costs of Dual Eligible People Diagnosed with Schizophrenia or Major Depression

24566.0662921348

15596.5740340909

26025.9595859213

19950.8740944882

30026.875753012

19258.5632368421

34646.872125

23892.382972973

39153.8775555556

27850.0210793651

40995.6021505376

32030.3488888889

48921.110952381

33933.1798230088

Schizophrenia19 to 34Schizophrenia19 to 34Schizophrenia19 to 34Schizophrenia19 to 34Schizophrenia19 to 34Schizophrenia19 to 34Schizophrenia19 to 34

Major DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor Depression











Schizophrenia85 +Schizophrenia85 +Schizophrenia85 +Schizophrenia85 +Schizophrenia85 +Schizophrenia85 +Schizophrenia85 +


Total Inpatient

Total Outpatient

Total Physician

Total Nursing Home

Total Home Health

Total Drug

Total Other Costs


3955.9806741573

11142.7095505618

1362.2290449438

0

3586.9174719101

4480.0181460674

38.2114044944

4237.0158522727

4692.9827840909

1899.3350568182

307.0056818182

1398.3551704546

2810.8623295454

251.0171590909

3591.9859213251

10667.5717391304

1535.9564803313

434.9809937888

4399.8651552795

5352.8945962733

42.704699793

5084.9447769029

4498.7470341207

2389.3319160105

918.7265091864

2850.4224146982

3961.1942519685

247.5071916011

3354.722439759

12242.4809036145

1436.4942168675

356.7181024096

7322.6457831325

5233.9165662651

79.8977409639

4468.4833157895

4121.663631579

2268.7518157895

1791.3211842105

2173.6112105263

4060.8374210526

373.8946578947

3896.8684375

12894.845

1682.009125

4041.6401875

7656.54225

4416.9891875

57.9779375

5971.0272586873

4372.3394208494

2729.5685714286

3906.9995752896

2910.1066409266

3588.9656756757

413.3758301158

6390.0511111111

7583.6594074074

1565.866962963

16273.2279259259

3699.8028148148

3571.4511851852

69.8181481481

6363.7548888889

2875.3682539683

2452.5786031746

8749.5197777778

3573.836984127

3261.3795238095

573.583047619

4696.7737634409

2473.4417204301

1334.6804301075

27842.4565591398

1724.9835483871

2792.2695698925

130.9965591398

6058.5546883469

1489.2908401084

2038.3955284553

17524.1916802168

1679.504200542

2773.131300813

467.2806504065

8817.7519047619

1459.4385714286

2054.5361904762

32806.2616666667

1217.8357142857

2356.3042857143

208.9826190476

2608.2905309735

1030.1302359882

1468.5566961652

24676.2078171091

1018.3781710914

2668.1819764012

463.4343952802

19 to 3419 to 34

35 to 4435 to 44

45 to 5445 to 54

55 to 6455 to 64

65 to 7465 to 74

75 to 8475 to 84

85 +85 +

Schizophrenia

Major Depression

1999 Median Per Member per Year Costs of Dual Eligible People Diagnosed with Schizophrenia or Major Depression

18720.86

8089.71

17102.79

11003.07

21319.17

12060.42

23169.99

14422.43

39847.09

23395.72

39684.83

30622.99

44571.15

36423.41

Schizophrenia19 to 34Schizophrenia19 to 34

Major DepressionMajor Depression











Schizophrenia85 +Schizophrenia85 +


Total Medicaid

Total Medicare


19308.2613483146

5257.8049438202

8717.386875

6879.1871590909

20345.0755486542

5680.8840372671

11545.7561417323

8405.1179527559

24916.3045180723

5110.5712349398

10832.7594736842

8425.8037631579

28141.8905

6504.981625

12536.2981081081

11356.0848648649

30897.8668888889

8256.0106666667

14888.5897142857

12961.4313650794

33468.84

7526.7621505376

19848.42100271

12181.9278861789

36204.7707142857

12716.3402380952

26621.1870501475

7311.9927728614

Increasing Life Expectancy and Reducing Costs for People with Serious Mental Illness

1. Integrated Illness Self-Management and Technology

2. Prevention, Health Promotion, Peer Support and Technology

Telehealth and Illness Self-Management

Illness Self-Management Health Coaching for n=71 older adults (mean age 60) with

mental disorders and chronic illness (diabetes, COPD, CHF, CVD,

hypertension, arthritis)

Self-management support, cognitive behavioral, and motivational skills training

We Know Integrated Self-management Works

Self-Management Training and Support Outcomes

Improved Self-management • Patient and provider ratings

of self-management – Knowledge of Symptoms,

Meds, Coping – Symptom Distress – Symptoms Affecting

Functioning

• Improved participation in

the health care encounter

Decreased hospitalizations

31%

0%

17.40%

12.10%

25% 25%

BL 10mo 14mo

Hospitalizations I-IMR UC

Pilot 1: Automated Remote Telemedicine Supported Medical Illness Self-Management

Health Buddy: Electronic unit connected to a phone line provides two-way communication between healthcare providers and patients. -100 participants age 18+ with SMI plus CHF, COPD, Diabetes, or CAD) enrolled in 12 month RCT cross-over design (HB v. wait list control)

Health Buddy Automated Daily: - Self-monitoring - Health Data Entry - Self-management Education - Remote Nurse Monitoring

63% (n=15) Fasting Glucose >130

At Baseline: 63% FG>130

After Telehealth Majority (2/3) in range FG

Service Use Outcomes for People with Diabetes (both p

TeleFriend

• Tablet-based, in-home program • Users complete daily sessions (5-10 minutes) • Sessions include medication adherence

monitoring, symptom monitoring, education about illness, training on illness self-management and healthy lifestyle behaviors, trivia question or inspirational quote

• Content & monitoring matched to users’ diagnoses

• Responses sent to secure server and reviewed daily on desktop application by Telehealth Specialist

Which Works Best for Implementing Chronic Disease Self-Management in High Risk, Complex Patients?

• Automated Telehealth? Or

• Health Coaching and Self-management Training

NIMH Randomized Trial with VinFen (n=300) Bartels, PI

What About Peers, Mobile Technology

And Illness Self-managent?

Pilot Study of Integrated Medical and Psychiatric Self-Management mHealth for Adults with SMI

• Psychoeducation • Coping skills training • Relapse prevention

training • Behavioral tailoring

Fortuna, K., Gill, L., Lohman, M., Bruce, M., & Bartels, S. (2017). Adaptation and usability of an integrated medical and psychiatric self-management smartphone application for middle-aged and older adults with serious mental illness. American Journal of Geriatric Psychiatry.

Improved Self-management

What About Prevention?

Cardiovascular Disease (CVD) Risk Factors and Major Mental Illness

Vancamfort et al., 2013: Meta-analysis of 136 studies

Modifiable Risk Factors Serious Mental Illness

Prevalence Compared to General Population

Abdominal Obesity 4.4 X

Smoking 3-4X

Diabetes 2X

Hypertension 1.4 X

Metabolic Syndrome 2.4X

Hyperlipidemia 2.7X

The InSHAPE Program

Integrated Health Promotion and Health Behavior Change: In SHAPE

• Nurse Evaluation and Consultation • Initial Fitness Assessment

– Individualized fitness and healthy lifestyle assessment

• Individual Meetings with a “Health Mentor” • Vouchers to Local Fitness Centers

• Individual and group nutrition education

• Smoking cessation referrals

• Group Education/Motivational “Celebrations“

Promoting Health and Functioning in Persons with SMI: CDC - R01 DD000140 (PI: Bartels) Health Promotion and Fitness for Younger and Older Adults With SMI: R01 MH078052-01 (PI: Bartels)

1st RCT (n=133) : At 12 months: 49% in

intervention group achieved either clinically

significant increased fitness (>50 m on

6MWT) or weight loss (5% or greater)

41% 51%

46% 37% 38% 37%

0%

20%

40%

60%

80%

100%

6-month 12-month 18-month

In SHAPEFitness Club Membership and Education

2nd RCT Boston, Mass (Multiple Sites: n=210; half underserved minorities)

51% achieved either clinically significant increased fitness (>50 m on 6MWT) or weight loss (5% or greater)

Weight Loss and Fitness Outcomes

WE KNOW WHAT WORKS!

Research Review of Health Promotion Programs for People with Serious Mental Illness http://www.integration.samhsa.gov/health-wellness/wellnesswhitepaper Health Promotion Resource Guide: Choosing Evidence-based Practices for Reducing Obesity and Improving Fitness for People with Serious Mental Illness http://www.integration.samhsa.gov/health-wellness/Health_Promotion_Guide.pdf

http://www.integration.samhsa.gov/health-wellness/wellnesswhitepaperhttp://www.integration.samhsa.gov/health-wellness/Health_Promotion_Guide.pdf

It’s Hard Enough to Change Health Behaviors……….

But Even Harder to Change the Behavior

of Organizations….

What does it take to implement health promotion?

(especially when it is not in the mission, competency, scope of practice, or financing of a health care

organization)

Can Behavioral Health Organizations Change Health Behaviors?

Rediscovering the Neck

48 mental health organizations:

Three phases of 16 organizations over two years

Estimated

Patient Participants:

2400

Training and Individual Technical Assistance

• Individually tailored, phone-based implementation technical assistance

Virtual Learning Collaborative

• Coaching organizations to work together to share processes and outcomes, engage in group problem solving, and apply systems improvement

Randomized

R01MH102325, PI: Bartels

Are Learning Collaboratives the Most Effective Approach to Implementing a New Practice that Requires a Significant Change in Organizational Culture?

Individual Technical Assistance (18 months)

Learning Collaborative (18 months)

Ongoing engagement with

research team (until 24 months)

Ongoing engagement with

research team (until 24 months)

Participation Over 24 Months

Site Selection Sites selected for each phase to achieve an optimal mix of the following:

– Organizational readiness

– Geographic distribution

– Diversity of patient population

– Organizational size

– Urban vs. rural

http://www.thenationalcouncil.org/training-courses/dartmouths-shape-implementation-study/

InSHAPE From Community Need, to Research, to Implementation

(The 16 Year Science to Practice Gap!)

Community Development

Identification of Need,

Community Coalition

Development of InSHAPE Model

(2002)

Effectiveness Research

Academic Research Partnership,

1st Pilot Study (2004-2009)

Effectiveness RCT Studies

(CDC, NIMH) (2006-2012)

Implementation Research

Statewide Implementation and

Evaluation (2009-2014); Statewide

Medicaid Incentives Grant (2011-2016)

Nationwide Implementation

Project (2014-2018)

Is Fidelity the Gold Standard for Successful and

Sustainable Implementation?

What About Adaptation and

Innovation?

Paradox of Ensuring Fidelity While Promoting Contextually Relevant Change

• Adherence to core intervention (fidelity) vs. the modification (adaptation) of a program to improve the fit for a specific health care setting.

• Chambers et al. assert the goal of long-term program sustainability needs to reflect real-world challenges in the fit between the intervention and the context

• Fidelity consistent vs. fidelity inconsistent

modifications to InSHAPE health promotion program

What if Organ

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