It’s a penny wise pound foolish approach to Medicare’s dysfunctional sustainable growth rate (SGR) that kicks the can down the road at the expense of programs to fight the very conditions that drive most health care spending. We fully support fair payment to physicians and understand the magnitude of the threat they face with the scheduled SGR adjustment. But gutting badly needed federal support for wellness and prevention isn’t a solution. It’s an exclamation point on the short-sightedness of this legislation and a disheartening step back just as the federal government appeared to be moving firmly forward toward supporting workplace and community health promotion initiatives.

We wrote recently about the “glaring disconnect” that remains between the strong evidence base for programs targeting diabetes and other chronic conditions and the broader application of those care strategies. Throttling back federal spending on wellness and prevention robs us of a promising opportunity to close that gap. Yes, we must find payment strategies that satisfy providers and promote greater quality, value and accountability in care—and there are lawmakers working toward this sensible goal, such as Rep. Allyson Schwartz, D-Pa. But until we’re there, let us not dig the spending hole deeper with stop-gap solutions that diminish our best chance to climb out: wellness, prevention and care management.

Certainly, the recent CBO report was a catalyst for some of these conversations—especially as the Care Continuum Alliance (CCA) and others highlighted the outdated design of the programs detailed in that report. But another catalyst is the increasing interest in PHM strategies from public and community health organizations, as well as primary care groups.

This was reinforced in my mind this week as I read the Institute of Medicine (IOM) report, Living Well with Chronic Illness: A Call for Public Health Action. At the request of the Centers for Disease Control and Prevention (CDC) and the Arthritis Foundation, the IOM developed the report to identify public health strategies that reduce disability and improve the function of and quality of life for people with chronic conditions.

As you’d expect, the report focuses on public health and its authors almost exclusively are public health leaders. The important point here, however, is that the report gives great attention to and identifies significant opportunities for the current and likely future iterations of population health management strategies and services. Specifically, the report includes several recommendations significantly relevant to our industry, including that:

• the CDC increase demonstration programs for chronic disease control that cut across specific diseases or multiple chronic conditions and emphasize mitigating the secondary consequences of various chronic conditions;
• the Department of Health and Human Services and state and local government public health agencies evaluate existing, emerging and new models of chronic disease care that promote cooperation among community-based organizations, the health care delivery system, employers and other stakeholders to support living well with chronic illness; and
• HHS supports states in developing comprehensive, collaborative, population-based strategic plans with resources that focus on the management of chronic illness, including community-based efforts.

A key takeaway from the IOM report: Ultimately, successful health care is local. Current federal and state policy priorities seek to advance this concept through community-based, primary-care led models to improve health and health care quality and to constrain costs. Yet, all stakeholders recognize that this evolution in health care delivery will require the integration and coordination of numerous care providers and services in new ways. We’re seeing this happen throughout the industry in multiple collaborative projects. The IOM cites other challenges, including a lack of incentives for care coordination and the prevalence of fee-for-service payments.

This week’s IOM report asserts the potential for community-based care and collaborative models to improve the lives of people managing chronic conditions and to mitigate the impact of chronic disease. These models will benefit from the very strategies and tools in the wheelhouse of population health management as practiced today. It’s a particularly salient point in a week when so many were overly fixated on old approaches to chronic condition care.

—Tracey Moorhead, President & CEO

Well, CCA staff and Board members want to share this valuable experience with a broader swath of our members and industry leadership. This year, for the first time, we’re opening Capitol Caucus to a small group of non-Board member attendees. Capitol Caucus 2012 is shaping up to be a fabulous opportunity to hear updates and insights on a broad variety of health care policy issues, including Affordable Care Act implementation. Attendees also will hear an election-year forecast from a highly regarded campaign analyst.

We’re working hard to confirm speakers on an invitation list that includes Congress, the Centers for Medicare and Medicaid Services, Office of the National Coordinator for Health Information Technology, the Medicare Payment Advisory Commission, the National Governors Association and other federal and state offices; you can view the tentative agenda here, as well as member and non-member registration pricing and sponsorship opportunities.

This event aligns strongly with our strategic vision for advocacy, education and research: to convene, educate and communicate on behalf of population health management and to promote PHM strategies and tools to improve the quality and value of health care. I hope you’ll be a part of that process by joining us at the Capitol Caucus.

—Tracey Moorhead, President & CEO

Then, today, the Congressional Budget Office weighs in with a report on all the Medicare demonstration projects testing “disease management, care coordination, and value-based payment” models. Guess what? CBO says DM didn’t reduce Medicare spending in any of the Medicare demonstration and pilot programs. Really? This is news? Not at all.

The eight-page CBO Issue Brief released this morning summarizes a 30-page report, and I direct your attention to it: It contains a wealth of information that backs up much of what we, the population health management industry, know and that reflects program models being implemented today, in 2012.

Certainly, news reports will proclaim this yet another nail in DM’s coffin. Yet, the full report contains much about which we should crow – and loudly. The full report details the individual strategies upon which each demo or pilot was built and which of those strategies had more success than others. In addition, the report discusses the potential for success and the weaknesses of the studies due mainly to sample size. News flash: Many of the strategies that were more successful are the exact strategies that form the foundation for today’s programs. Further, (and here’s the really wonky part) the report correctly points out the confidence intervals for each study and suggests that, due to the large size of these CIs, we really don’t know how successful or unsuccessful each of these programs really were.

Bottom line: Today’s CBO report is a clear road map on how to build effective programs for Medicare populations. Remember that we can learn as much from what works as what does not work. This is a great road map for our industry and one, frankly, we’ve followed turn-for-turn in recent years.

A final point: Archelle noted, “At the end of the day, DM that does not achieve a net savings is not successful.” It’s an astonishingly cynical conclusion, especially juxtaposed with her “About Me” commitment to “health care projects, initiatives, and causes I believe are most meaningful to making a difference for people.” So, saving money is the only way to make a meaningful difference? Consider this counterpoint, published in the January 2008 American Journal of Managed Care and penned by former Care Continuum Alliance Chair Gordon K. Norman, MD:

“Let us return to the question of whether the current excess of $1 billion spent annually for DM is a good investment. Let us suppose that it is eventually shown by replicated RCTs that, in aggregate, DM programs consistently improve clinical outcomes, quality of life, functional status, and worker productivity but do not invariably produce cost savings. Might it still be the case that DM is consistently cost-effective? If that were the case – and many DM experts believe that it is plausible – it would be noteworthy because little of what physicians do to patients is ever cost saving (albeit life saving). Medicare is not allowed to consider cost-effectiveness in approving new technology for reimbursement, and the US Food and Drug Administration must approve any new drug shown to be safe and effective regardless of cost or comparative effectiveness. Few would question whether health plans should conduct case management, whether hospitals should provide discharge planning, or whether physicians should educate patients about prevention and healthful lifestyles, but none of these accepted health interventions have been shown by replicated RCT evidence to be consistently cost saving or cost-effective, to my knowledge.”

Bingo. Few health care interventions have been shown to save money, yet no rational person would suggest, for example, an office visit with a physician is “not successful” or bypass surgery is “not successful.” A more responsible measure of success might be whether the intervention creates value – in other words, whether you get your money’s worth. It’s the same yardstick we hold up to most other transactions, from a grocery store purchase to a new home. In that light, the evidence is clear that the right disease management intervention for the right population at the right time improves clinical outcomes (and, despite what disease management’s pallbearers would have you believe, can save money).

Where does that leave us? With a vibrant industry that continues to grow and evolve, as evidenced by the rapid pace of recent acquisitions and investments. There’s clearly value to be derived from current population health management strategies in new care delivery models – we see that in the quality improvement drive in the Medicare Advantage Star Ratings program. While I’m sure we haven’t yet heard the last post-mortem on these outdated demos and pilots, when they do crop up we can’t help but think of that memorable Saturday Night Live Weekend Update line, “Generalissimo Francisco Franco is still dead.”

—Tracey Moorhead, President & CEO

She writes about the “staggering” reach of the disease – 285 million to 347 million affected globally – and its “stunning medical costs”: an estimated $1 out of every $3 in Medicare spending goes toward people with diabetes. Dentzer wryly notes: “You don’t have to be a math major to grasp the likelihood that growing spending on diabetes could easily overwhelm our other efforts at constraining health care costs.”

What caught our eye, though, is the exasperation she expresses. “What’s so frustrating is that we essentially know how to keep most diabetes, once diagnosed, under control – through weight loss, exercise, and appropriate medical management to attain tight control over blood glucose levels and blood pressure,” Dentzer writes. “Still, as is often the case in US health and health care, just because we know what to do doesn’t mean that we do it.”

We share her frustration. Diabetes management is among the most well-studied interventions in chronic disease prevention and care. Yet, a glaring disconnect remains between that strong evidence base and a broader application of it. That can’t continue – not when we face the disease prevalence and costs documented in Health Affairs and not when we have the tools and strategies readily at hand, through population health management, to make a meaningful difference.

Tracey Moorhead, Care Continuum Alliance President & CEO

Welcome! We’re thrilled to launch this blog as another important step in the evolution of Care Continuum Alliance (CCA). Our members, along with other industry leaders and observers, know that CCA has long served as the convening voice for care management strategies, first for disease management and, since 2007, for the full continuum of population health interventions – wellness, prevention and other approaches to improving health, reducing disease risk and raising productivity. Today, we add the industry’s voice to the vibrant online community of social media commentary.

Since early in the debate over health care reform, there’s been much talk about the Triple Aim of better care quality, outcomes and value – and nearly as much head scratching over just how to achieve it. That’s a perplexing sight from the perspective of population health management (PHM), which has long offered tools and resources to reach all three goals (and a growing body of work to support its view). PHM also has an indispensable role in the drive toward greater accountability in care delivery, a point that came through clearly in the comments of industry leaders in a recently published CCA white paper on key industry issues for 2012.

We reached out, through a survey, to high-level thought leaders within and outside our membership to develop the paper and found strong optimism about opportunities in accountable care and other new delivery models; expanding government and societal recognition of the value of wellness and prevention; and increasing consumer acceptance of mobile health and other technology-enabled care common in PHM programs. “Key Issues in Population Health Management – Key Industry Issues for 2012,” available freely as a download from the CCA website (www.carecontinuum.org), illustrates the many avenues available to population health management for making meaningful differences in care quality and value.

There may be those who say the white paper’s resolutely positive tone comes filtered through rose-colored glasses. But the industry isn’t alone in its optimism. From policymakers to patient advocates to employers and others at ground zero of the chronic disease fight, the precepts of population health management – care coordination, patient self-management, physician collaboration, outcomes assessment and others – are increasingly part of the arsenal. Also, population health management isn’t shy about looking in the mirror: Survey respondents tempered their upbeat outlook with admonishments that the industry must do more to build the evidence base for and to promote its work.

We intend to meet that challenge with robust research in 2012, vigorous advocacy in support of PHM strategies and promotion through education, including at our annual meeting, The Forum 12, online learning and new events (more on that soon). CCA members and the broader community of stakeholders in wellness, prevention and health management must do the same to broaden the reach of these essential programs.

— Tracey Moorhead, President & CEO