Disease Management Program

Iowa Bankers

Prevalence

Wellmark BoB

Prevalence

Iowa Bankers

Paid PMPMW BoB Paid

PMPM

Oncology 1.16% 1.04% $2,654 $2,910

Diabetes Management 3.26% 3.84% $915 $813

Heart Failure (HF) 0.22% 0.30% $2,212 $2,109

Coronary Artery Disease (CAD)

0.99% 1.03% $1,175 $1,298

Chronic Obstructive Pulmonary Disease (COPD)

0.21% 0.43% $820 $1,054

Asthma 2.95% 3.06% $380 $389

Impact Conditions 10.40% 11.45% $558 $4601

Disease Management Comparing Iowa Bankers’ members diagnosed with conditions

applicable to disease management programs (prevalence) and the amount of claims paid for those members per month, with the Wellmark book of business prevalence and costs:– The Iowa Bankers’ prevalence rate was greater than the

Wellmark book of business for oncology conditions only. – Claims paid per diseased member per month exceeded

the Wellmark book of business for members with diabetes, heart failure, and impact conditions.

2

3

Medical Risk Lifestyle Risk

Your costs and the impact of different

medical and lifestyle risks

Weig

ht

Blo

od

Pre

ssu

re

TD

L/H

DL

Tri

gly

ceri

des

Blo

od

Glu

co

se

Sed

en

tary

Lif

esty

le

To

ba

cco

Use

Die

tary

Fat

Inta

ke

Fru

its/V

eg

eta

ble

In

tak

e

Alc

oh

ol

Use

Str

ess

Seat

belt

Us

e

M

em

bers

Im

pacte

d

Cla

ims P

aid

Cla

ims P

aid

per

Dis

eased

Mem

ber

Bones/Muscles/ Ligaments X X X 6,711 $7,777,889 $1,159 Benign/Cancerous Tumors X X X X X X 2,631 $5,887,662 $2,238 Heart/Vessels X X X X X X X X X X X 3,559 $4,859,427 $1,365 Digestive X X X X X X X X 2,653 $4,125,863 $1,555 Genital/Urinary X X X X X X X X X 4,262 $3,201,396 $751 Injuries/ Poisonings X X X X 4,120 $3,297,028 $800 Nose/Throat/ Lungs X X X X 9,421 $2,848,091 $302 Nerves/Eyes/Ears X X 6,859 $3,463,784 $505 Glands/ Metabolism/ Immune System X X X X X X X X 4,884

$1,892,943 $388

4

Employee Benefit Workshop 2009

• National Trends

• IBBP Information

• Analysis of the Plan

• Wellness

5

» Chronic illness accounts for more than 75 percent of all health care costs.*

» An estimated one in three Americans has some form of cardiovascular disease, which is responsible for direct and indirect costs of $431.8 billion dollars annually.**

» Participants who better manage chronic diseases have a lower number of emergency room visits, hospitalizations and

additional complications.

The Case for Disease Management

* National Centers for Disease Control and Prevention** American Heart Association, Heart Disease and Stroke Statistics, 2007

6

» 95% of what a person with diabetes should do to maintain good health is self-directed

» Only 1 in 5 are doing everything they should

Test and Exams Insulin Using Non-Insulin Using

Hemoglobin A1c

(Measures average blood sugar for past 3 mo.)

Four times a year (Quarterly)

Two times a year (once control established)

Foot inspection by Doctor or Nurse One time a year One time a year

Blood Pressure Each visit Each visit

Dilated Eye Exam One time a year One time a year

Lipid Profile

(Cholesterol; HDL; LDL; Triglycerides)

One time a year One time a year

Kidney Function Exam

(Serum Creatinine Tests – Microalbumin)

One time a year One time a year

Flu Shot – Vaccine One time a year One time a year

Pneumonia Shot – Vaccine Initial Initial

Talk To Your Doctor About

Pre-pregnancy – Family Planning Counseling As needed As needed

Aspirin Therapy Over 40 years Over 40 years

Stopping Smoking Each Visit Each Visit

Your Health Care Goals Each Visit Each Visit

Managing a Chronic Disease is Complex

7

Disease Management Programs»Diabetes

»Congestive Heart Failure

»Coronary Artery Disease

»Asthma (high risk)

»Chronic Obstructive Pulmonary Disease 8

Identification Stratification

Assessment Intervention

Program Design

9

» 4 stratification levels• Level 1: Participants who are stable and at lowest risk for

utilization, or aggravating their condition• Level 2: Participants who are at some risk for utilization, or

aggravating their condition• Level 3: Participants who represent moderate risk for

utilization or aggravating their condition, however, still preventable

• Level 4: Participants at highest risk for utilization, or aggravating their condition, and timely action is required to lessen the risks

Risk Stratification

10

» Welcome kit• Personalized welcome letter• Health workbook

» Quiet period

» Welcome call• Care coordinators engage participants in

the program after they are identified

» Opt-out engagement model• Participant must choose not to participate

Welcome Process

11

» It’s about people….not their disease• Depression• Co-morbidity• Working• Family• Denial

» Trust channels are essential for outcomes improvement and successful behavior modification

» Must establish unconditional credibility and positive intent to create change

Address the “Whole Person”

All co-morbidities and behaviors should be managed simultaneously by the same trusted relationship.

12

» Interventions, support, and stratifications are dynamic and based on current health status and behaviors of participant

» Prochaska readiness to change

» Set obtainable goals with member

Personalized Interventions

13

Member InterventionsCare Support Activities Frequency

• Welcome Packet/Letter• Welcome Call*

Initially

• Care Calls from Program Nurse Varies per disease condition and stratification level (2-39 times/year for Core and 1-28 times/year for Impact)

• Newsletter Quarterly**

• Good Health Guidelines Reminders 2-3 times/year and flu, varies by disease condition

• Depression Screening and Quality of Life Questionnaire• Program Satisfaction Survey

Annually

• Access to Dedicated Toll-Free Number (24/7)• Self Care Goals and Education Materials• Home Monitoring for Select Heart Failure Participants• Home Pulmonary Education Program for Select COPD Participants• Graduation Notification (Impact Conditions only)

As needed

*

*Asthma member interventions vary slightly. **Disease specific newsletters are sent quarterly for all programs except Impact conditions. 14

Improving the Patient-Physician Relationship

Physician Activities Frequency

» Introductory Letter» Welcome Kit

Once

» Face-to-face Discussions with Registered Nurses (Clinical Integration Managers)

Ongoing

» Local Physician Advisory Council» Newsletter

Quarterly

» Evidence-Based Treatment Guidelines» Standards of Care Flowsheet» Program Satisfaction Survey (Core 5 only)

Annually

» Access to Dedicated Toll-Free Number As needed

15

Programs are Designed to Achieve Results

• Clear need for program• Supported by evidence-based medicine • Measurable outcomes

16

Member Satisfaction Above Benchmark

8.26 Overall program satisfaction

85% Improvement in taking medications as prescribed

92% Have more information on their overall health17