CCA Featured Members: February 2013

Every month, CCA features the work and contributions to the population health industry of some of its members. This brief highlights are shared through the CCA Connect: Voice of Population Health monthly newsletter.

Using a Calendar Approach to Drive Clinical Outcomes

Over 100M Consumers on the Move. Are You Prepared?

Today’s clinical leaders are looking for ways to optimize consumer communications and drive results.

Personalized, targeted and relevant information is key to helping members make better health decisions. When communicating with individuals,  it is essential to deliver highly personalized, scalable, and dynamic interactions, in a caring and compelling manner, around topics that impact day-to-day health.

One of the strategies we recommend to meaningfully impact care is a calendar-based approach to communications. This type of planning allows clinical leaders to be a thoughtful partner in care with communications designed from the member’s point of view. A well-planned schedule of outreach maximizes the effectiveness of clinical messages and avoids overwhelming or overlapping requests for action sent to the member.

Sometimes it isn’t possible to avoid asking people to do more than one thing in the same time period. For example, when an individual has multiple gaps in care, they may be targeted by multiple communications in a short time frame. In these cases, we recommend taking extra care to identify the affected individuals and deliver highly personalized outreach with a high-touch approach.

The communications calendar typically includes a broad set of calendar-based campaigns and trigger-based outreach that occurs more frequently, such as to provide support when a new medication is first prescribed. It may also include specialized campaigns, such as a multi-channel campaign designed to support seniors across a range of Star topics.

For more on Silverlink’s approach to smarter health engagement, visit

Long Time on the Road of Accountability

HealthPartners is among six organizations to receive a new accreditation as an Accountable Care Organization from the National Committee for Quality Assurance, a leading non-profit organization dedicated to improving health care quality.

“ACO accreditation demonstrates that HealthPartners model of care is achieving the three aims of improving health, delivering an excellent experience and lowering the cost of care,” said Beth Waterman, HealthPartners chief improvement officer.

HealthPartners has been on the road of accountability for a long time.

In 1995, HealthPartners developed the Total Cost of Care measure to bring awareness of health care costs to providers and patients, and to drive improved value for the health care dollar.

According to  the Agency for Healthcare Research and Quality (AHRQ), HealthPartners’ population-based Total Cost of Care and Total Resource Use measures provide valuable information to health plans and providers on how to make health care more affordable without sacrificing quality or experience. Health plans and providers can use cost and resource use data to identify areas where they can lower cost by improving resource use or shifting to less expensive, yet equally effective resources — for example, use of a surgery center instead of a hospital where it is medically appropriate, without negatively impacting quality. Evidence supports this idea as depicted in various studies on diabetes care, in academic medical centers, across metropolitan statistical areas and in group practices in Minnesota. These studies conclude that increased cost does not result in increased quality, while quality is not sacrificed when resource use is optimized.

A key benefit of HealthPartners’ population-based Total Cost of Care and Resource Use measures is the identification of potential overuse and underuse of health care services. For example, a primary care physician may be referring back pain patients to an orthopedic surgeon. Rather than managing the back pain in primary care, these patients may have increased specialist costs and potentially more back surgeries than would be expected for their population. Overuse of health care services has led to wide variation in health care cost and use across geographies. Studies suggest that Medicare spending would be decreased by almost 30 percent if medium and high spending geographies consumed health care services comparable to that of lower spending regions. Experts agree that reducing overuse can make care safer and more efficient.

The HealthPartners Total Cost of Care and Resource Use measures for identifying healthcare cost drivers and opportunities to address them were the first of their kind to be endorsed by the National Quality Forum (NQF).

As NQF-endorsed standards, the HealthPartners Total Cost of Care and Resource Use measures complement existing quality measures to provide a much-needed, common reference point supporting the development of accountable care organizations (ACOs) and payment reform models. Providers, insurers, government agencies, employers, consumers and other organizations can use the measures to manage costs, drive affordability and improve delivery of healthcare.

To learn more about their programs, visit

CCA Quality and Research Report

This time of year is always an exciting one for Quality & Research at CCA as we finalize our priorities for the year and look to our members for your support and expertise. A huge thank you goes to those of you who contributed through discussions and survey responses to help us determine areas of priority for the industry, and therefore priorities for CCA.

Starting in October 2012, several leaders with a keen interest in quality and research met at Forum 12 to brainstorm the issues facing the population health industry today. Following the brainstorming session, a survey and focus group provided additional insights that helped to identify the areas where CCA should focus its resources in 2013. The lead item on the following list reflects the top new priority for 2013, followed by three additional areas from previous years that continue to hold importance for the industry and CCA.

1. Role of Population Health Management (PHM) in Health Insurance Exchanges (HIEs). The new health insurance exchanges will need to be successful, and PHM strategies and tactics will be an important part of these exchanges. CCA will develop tools and educational materials to help the HIEs understand the role of PHM in their success. This work will be divided into three work streams.

  • HIE Assessment Work Group. This group will perform an environmental scan of HIEs, to include who is participating, what they look like, who is accountable, and what they offer.
  • Exchanges 101 Work Group. This group will develop guidance materials to explain HIEs and their value proposition, discuss how they differ from the current system, and how PHM can add value.
  • Exchange Options Work Group. This group will explain the different types of exchanges—public, private, state/federal—and the populations they serve.

2. HERO-CCA Measures and Standards Collaboration. This partnership will continue to move forward in 2013, building on the work of the past 18 months and culminating in the release of a core set of measures later this year. Volunteers from both HERO and CCA have combined their expertise toward recommending measures for employers in six domains: value of investment, financial outcomes, health impact, participation, satisfaction, and organizational support.

3. Data Aggregation. CCA’s vision to validate industry accomplishments and contribute to the advancement of future efforts for policy making, program development and evaluation has been realized in the creation of the first data repository of its kind. Very soon, we will have a release on the first study using data from the CCA database so stay tuned.

4. International Task Force. For the past few years, the international presence within CCA has become more prominent. In 2013, CCA will host the 3rd International Symposium on Wellness & Chronic Care on Oct. 23, in Scottsdale, AZ. Also, following the successful release of the first global population health report on Brazil, CCA will look to other regions as the focus for the second report.

These areas were presented at the first quarter Quality & Research Committee update on Feb. 27th. We are currently accepting volunteers for the three work groups focused on the health insurance exchanges. If you are interested in participating or have questions, please contact Karen Moseley, Director of Research, at or 202.747.4956.

CCA New Members Roll Call: February 2013

The Care Continuum Alliance welcomes three new members:

 Presbyterian Health Plan, Inc. and Presbyterian Insurance Company, Inc. are owned by Presbyterian Healthcare Services, the  state’s largest locally owned, New Mexico-based healthcare system. Presbyterian Health Plan offers a statewide healthcare delivery system and 25 years of experience in managed care.

Commitment to New Mexico

Presbyterian Health Plan is New Mexico’s largest locally owned health plan and offers a full spectrum of health insurance choices to meet the diverse needs of New Mexicans.  The National Committee for Quality Assurance (NCQA), which evaluates health plans across the country, has awarded “Excellent” accreditations for our Medicare HMO health plans and “Commendable” for our Commerical HMO/POS and Medicaid HMO plans.

More importantly, our quality is reflected in the health and wellness of our members and the ease with which they and network providers access health information and services. Putting the customer first, we have in recent years completely re-engineered our customer service processes and are now emerging as a leader in online services, offering an abundance of web-based tools and information for our members and network providers.

Investment in improving health

Presbyterian Health Plan has also invested in healthcare technologies and strategies that help more New Mexicans maintain or improve health through prevention and management of diseases and illnesses. We can now predict whether individuals are likely to face catastrophic health problems and can advise these members to follow healthcare and wellness strategies that are best suited to prevent such an event from happening. Plus, Presbyterian Health Plan is continuously working to improve breast cancer screening rates, immunization rates, and the care of members with asthma, diabetes and depression.

Learn more:

CCA Encourages Comments on the Proposed Rule about Medical Loss Ratios in Medicare Advantage

On Friday February 20th, the US Department of Health and Human Services issued a proposed rule outlining medical loss ratio (MLR) requirements for the Medicare Advantage Program and the Medicare Prescription Drug Benefit Program. Read the rule.

Population health management services are impacted by this regulation as it discusses how wellness and health services are viewed as “activities that improves health care quality” and not “administrative expenses”. This aligns with commercial MLR regulations.

Under this proposed rule, wellness and health services include: wellness assessments; wellness/lifestyle coaching programs designed to achieve specific and measurable improvements; coaching programs designed to educate individuals on clinically effective methods for dealing with a specific chronic disease or condition; public health education campaigns that are performed in conjunction with state or local health departments; actual rewards, incentives, bonuses, reductions in copayments (excluding administration of such programs), that are not already reflected in premiums or claims; any quality reporting and related documentation in non-electronic form for wellness and health promotion activities; coaching or education programs and health promotion activities designed to change member behavior and conditions (for example, smoking or obesity); and health information technology (HIT) to support these activities.

Specific to the HIT category, the proposed rule goes on to state that, “[a]ny HIT expenditure that is attributable to improving health care, preventing hospital readmissions, improving safety and reducing errors, or promoting health activities and wellness to an individual or an identified segment of the population, would under our proposal be classified as a quality improving activity.” Public comments will be accepted until April 16th.

Comment and Read the Rule

Learn more about CCA’s advocacy and government affairs initiatives.

CCA Statement on the Essential Health Benefits Final Rule

On February 20, 2013, the Department of Health and Human Services issued a final rule covering the essential health benefits, actuarial value, and accreditation requirements of the Affordable Care Act.

View an Overview of the rule: Essential Health Benefits Standards: Ensuring Quality, Affordable Coverage (CMS)

This regulation outlines health insurance issuer standards for coverage of essential health benefits (EHB). Under the Affordable Care Act, health plans offered in the individual and small group markets must offer the EHBs which include ‘preventive and wellness services and chronic disease management’ among others.

“Throughout the regulatory process, Care Continuum Alliance met with officials from the Center for Consumer Information and Insurance Oversight and filed comments on the initial proposed rule outlining the EHBs. In our December 2012 formal comments, CCA strongly supported the proposed regulation’s latitude for flexible program design within the EHBs category of ‘preventive and wellness services and chronic disease management.’

The Institute of Medicine’s Workgroup on Essential Health Benefits emphasized the importance of balancing comprehensiveness with affordability for both beneficiaries and health plans. Flexible standards around program design are fundamental to this balance. They are crucial to insurance issuers’ ability to create options for health care beneficiaries to access a variety of evidence-based services.

Flexible program design standards are also necessary for insurance issuers to tailor services to the health care needs of different beneficiary populations. As long as healthcare services are evidence-based, the specific program design and delivery mode standards should remain adjustable to encourage innovative and patient-centered options in the EHBs. This flexibility was maintained in the final version of the EHB rule.”

Read the rule.

Read CCA Letter to CMS from January 31, 2012.

Last Call for Nominations for the Warren Todd Achievement Award

To honor the passing of Warren Todd, who –as the first Executive Director of the Care Continuum Alliance and lead author of Disease Management:  A Systems Approach to Improving Health Outcomes  — could be considered the grandfather of disease management, IHPM  announced the Warren Todd Award last summer, following his passing.  This is a reminder that nominations (including self-nominations) are due February 28, to  The winner(s) will be announced March 10, and will receive the award March 25 at IHPM’s 13th Annual International ConferenceDeadline: February 28,2013

Nominations of individuals (not organizations) should be submitted on a one-page pdf attachment, and address the following criteria, which we believe exemplify Warren’s attributes:

  • Demonstrated advancement of the disease management (and population health, but primarily disease management) field;
  • Excellent relationships with colleagues and reputation within the industry;
  • Promotion of the field before promotion of self.

Preference will be given to “standalone” candidates, as Warren achieved his greatest successes as a consultant, but individuals within organizations will be considered as well.

Submit your nominations today:

Deadline: February 28,2013

Questions? Email Al Lewis at


A Population Health Management Essential: CCA Obesity Toolkit 2.0 Now LIVE

Care Continuum Alliance 2012 Obesity Toolkit

Care Continuum Alliance 2012 Obesity Toolkit

If you follow this blog, chances are you are immersed in population health management and health care. So, if I tell you there is an obesity epidemic in this country, you’ll likely ask, what else is new?

Well, there is something new: The Care Continuum Alliance just launched the CCA Obesity Toolkit 2.0, an invaluable step-by-step guide for payers and providers involved in weight management and patient care, which incorporates proven population health management strategies to address the obesity problem in the front lines, and at the policy level.

Who Could Benefit from This Toolkit?

We would say: everyone. But let’s dive in further.

Managing Obesity to Improve Population Health: A Toolkit is particularly useful for:

  • Employers implementing wellness programs;
  • Hospitals administrators;
  • Physicians in private practices searching for effective interventions for patient’s weight management;
  • Health plans;
  • Academics and researchers looking for best practices and proven interventions, as well as new avenues for research.

What Is in the CCA Obesity Toolkit 2.0?

The toolkit includes an updated review of evidence from the literature on effective treatment options for people who are obese, an updated benefit design for payers interested in developing a benefit for obesity related services, a treatment and guideline index that offers the most up to date information on recommended guidelines for obesity treatment, and a series of in depth case studies that review obesity programs in different settings.

Does the Population Health Management Industry Need an Obesity Toolkit 2.0?

You bet it does! Recent statistics from the CDC show that more than one-third of the U.S adult population is obese and that in 2008 medical costs associated with obesity were estimated at 147 billion. Clearly we have a problem of epic proportion and are in desperate need for tools to help our health care community address this very alarming problem.

The CCA Obesity Toolkit 2.0 was brought to life by acclamation. In 2008, CCA released the first Obesity Toolkit to assist organizations in designing a health plan benefit for the treatment of obesity. Since its release, it has been downloaded by more than 500 organizations, representing all industry segments and including private and public payers, delivery systems, employers and other purchasers.

However, with all the new research and the evidence emanating from the implementation of the population health management strategies, tools and approaches, industry voices made it clear that we were due for an update.

The CCA Obesity Toolkit 2.0 showcases an updated review of successful programs addressing weight management and a discussion of the role of chronic conditions in the treatment of obesity. A host of new resources have been added, emanating from the continuous work with CCA member organizations, as industry leaders.

What Next?

What else? Download the CCA Obesity Toolkit 2.0.

Share the CCA Obesity Toolkit 2.0 with your networks.

Then, let us know if it was useful for you.

  • What did you expect?
  • Did it deliver on its promises?
  • What did we miss?
  • How can we make it better?
  • How are you going to use it?

Send us your feedback:

CCA Statement on CMS Bundled Payments for Care Improvement Initiative

On January 31, 2013, the Centers for Medicare & Medicaid Services (CMS) announced the health care organizations selected to participate in the Bundled Payments for Care Improvement initiative, an innovative new payment model.

Under the Bundled Payments for Care Improvement initiative, organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare. Read more.

“The Care Continuum Alliance supports the CMS efforts around the Bundled Payment Model Initiative, and, as it represents a broad spectrum of organizations and companies, it is very pleased to have members engaged in this effort.

As our industry evolves, we believe it is important to pilot projects that can examine new payment arrangements that test both financial and performance accountability for episodes of care. We believe that efforts such as this can expand our knowledge of which models may lead to higher quality and more coordinated care at a lower cost to Medicare.

CCA supports projects that can reduce fragmented care and enhance coordination across providers and health care settings. We also believe that bundled payments can align incentives for providers – hospitals, post-acute care providers, physicians, and other practitioners – providing opportunities to work closely together across all specialties and settings. Ultimately, this will benefit the consumer, the caregiver and our health care delivery system.”

Learn more about CCA’s advocacy and government affairs initiatives.

CCA Letter to HHS Secretary Sebelius on Incentives for Wellness Programs

January 25, 2013

The Honorable Kathleen Sebelius
U.S. Department of Health and Human Services
200 Independence Ave. SW
Washington, DC 20201

RE: CMS–9979–P / RIN 0938–AR48

Dear Madam Secretary,

Care Continuum Alliance (CCA) appreciates this opportunity to comment on the proposed rule regarding Incentives for Nondiscriminatory Wellness Programs in Group Health Plans.

CCA is an association that convenes all stakeholders in the population health management industry. Our members design and provide services, programs and tools to better coordinate care for all patients along the continuum, from the healthy to those with chronic conditions. Through advocacy, research and education, CCA advances strategies that improve quality in the health care system and achieve cost savings. Our diverse membership includes: physician groups, nurses, other health care professionals, hospital systems, wellness and prevention providers, population health management organizations, health plans, pharmaceutical manufacturers, pharmacies and pharmacy benefit managers, health information technology innovators, employers, researchers, and academics.

Overall, we are pleased with the thoughtful and balanced approach by the Department of Health and Human Services (HHS), the Department of the Treasury, and the Department of Labor in jointly drafting this proposed rule. The rule makes great strides in balancing the need for flexibility in wellness program and incentives design, with appropriate patient protections to access and participate in wellness services.

Recommendation: Maintain flexibility in the core features of a “reasonably designed” wellness program.

CCA and our members would appreciate flexibility in interpreting the language of “reasonably-designed” wellness programs. In determining “reasonable design”, we strongly agree with the notion that wellness programs cannot be ‘one size fits all’. Different patient populations require different health interventions, as clearly indicated in this proposed rule. Also, maintaining a basic framework that permits flexibility in “reasonable design” reflects HHS’s broad goal of delivering the right care, at the right time, in the right setting.

We defined core components of a wellness program in the CCA Outcomes Guidelines Volume 5 Report.[1] This report also provides a framework and relevant factors for evaluating the impact of wellness programs on health outcomes and cost-savings. Noting that wellness programs employ many different behavior change techniques and lifestyle management strategies, core design features should include:

  • Help for individuals to maintain and improve their level of health and well-being by identifying health risks and educating them about ways to mitigate these risks;
  • increasing awareness of factors that can affect health and longevity;
  • enabling individuals to take greater responsibility for their health behaviors;
  • preventing or delaying the onset of disease; and
  • promoting healthful lifestyles and general well-being [2]

These guidelines establish a flexible foundation to build a variety of wellness programs tailored to the specific health needs and preferences of different patient populations. We suggest that HHS maintain the level of flexibility exemplified by these guidelines in the final rule, along with core features outlined in the consensus statement by the Health Enhancement Research Organization, the American College of Occupational and Environmental Medicine, the American Cancer Society and American Cancer Society Cancer Action Network, the American Diabetes Association, and the American Heart Association.[3]

Recommendation: Key considerations for both wellness program and incentives design.

While CCA supports the use of evidence-based strategies in wellness program design and implementation, the proposed rules must also allow for program innovation to create new evidence on wellness strategies for specific populations. To achieve a balance and provide guidance to fellow healthcare industry stakeholders, CCA’s members assembled the Outcomes Guidelines Steering Committee. The Committee developed the following basic considerations for wellness program design in a consensus report entitled Outcomes Guidelines Report Volume 5: [4]

  • the program is designed to address modifiable health risks;
  • an evidence-based tool is used to assess health risks;
  • a targeted intervention is used to support healthful behavior;
  • individual patient-level information is collected to measure outcomes; and
  • the outcome is measured in a scientifically rigorous manner, using appropriate comparative measures

CCA and a working group of our members also outlined key considerations for designing incentives in a 2012 report entitled Participant Engagement and the Use of Incentives.[5] The considerations include:

  • Incentive-related needs and expectations evolve as patient needs and interests change.
  • Organizations should have an evaluation plan to determine whether incentives are improving health outcomes and/or achieving cost savings in a given population.
  • Intrinsic and extrinsic incentives can have different effects.
  • It is important to encourage active engagement and participation to achieve lasting healthy behavior change, not just enrollment.

The working group distilled these overarching considerations from a current comprehensive literature review and case study analysis. In light of these broad considerations, we recommend that HHS leave ample room for program innovation in wellness program and incentives design.

CCA would be glad to offer additional case studies, share peer-reviewed literature, and field questions as HHS moves forward in the rulemaking process.

Thank you,

Frederic S. Goldstein
Acting Executive Director
Care Continuum Alliance

Vicki Shepard
Chair of the Government Affairs Committee
Care Continuum Alliance

Victoria Shapiro
Director of Government Affairs
Care Continuum Alliance

[1] Care Continuum Alliance, Outcomes Guidelines Report, Vol. 5 (2010)

[2] Id. at 37.

[3] Health Enhancement Research Organization, American College of Occupational and Environmental Medicine, American Cancer Society and American Cancer Society Cancer Action Network, American Diabetes Association, and American Heart Association, Guidance for Reasonable Designed Employer Sponsored Wellness Programs Using Outcomes Based Incentives, Journal of Occupational and Environmental Medicine, vol. 54 (July 2012).

[4] Care Continuum Alliance, Outcomes Guidelines Report, Vol. 5 at 42.

[5] Care Continuum Alliance, Participant Engagement and the Use of Incentives (2012): 16
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