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.
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Medical Risk Lifestyle Risk
Your costs and the impact of different
medical and lifestyle risks
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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
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Employee Benefit Workshop 2009
• National Trends
• IBBP Information
• Analysis of the Plan
• Wellness
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» 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
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» 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
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Disease Management Programs»Diabetes
»Congestive Heart Failure
»Coronary Artery Disease
»Asthma (high risk)
»Chronic Obstructive Pulmonary Disease 8
Identification Stratification
Assessment Intervention
Program Design
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» 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
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» 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
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» 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.
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» 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
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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
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Programs are Designed to Achieve Results
• Clear need for program• Supported by evidence-based medicine • Measurable outcomes
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Member Satisfaction Above Benchmark
8.26 Overall program satisfaction
85% Improvement in taking medications as prescribed
92% Have more information on their overall health17
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