Guest Post: Implementation matters. Particularly if it relates to what matters to the purchaser

Paul Terry formal photoBy Paul E. Terry, Ph.D., Chief Science Officer, StayWell Health Management

I picked up an undercurrent during this year’s Care Continuum Alliance – CCA Forum 2013 that I tested often in break-time conversations. “Do you think there is a connection between the return on investment (ROI) and value on investment (VOI) discussions?” I asked. While the answers I got ranged from technical to philosophical, the general tenor from consultants and purchasers alike was a genuine appetite for broadening the criteria we use to judge success in population health management.

I think three things explain a great vibe at the conference that spoke to a readiness to take population health from what has been an inordinate focus on ROI to a preference for advancing VOI. Many view VOI as richer, if not more meaningful to purchasers, first, because of opportunities that accountable care organization (ACO) and regional exchanges could present; second, because of extant limitations in ROI methodology; and, probably most important, because VOI represents the next level of maturation and opportunity for the field.

Regional exchanges and the VOI of wellness

Most presenters who ventured into whether and how the exchanges could influence population health management acknowledged it’s too early to tell. I found Medical Director for Employers Health Coalition Bruce Sherman’s rendition especially edifying given his postulate that small employers may finally have enough critical mass to reconcile the VOI of prevention. Sherman, a medical director for Ohio’s Employer’s Health Coalition, is able to see more clearly than most how the lack of investment by one employer ultimately disadvantages the collective competitiveness of a region.

A scenario I posed to Sherman that he agreed was viable was one where exchanges and population health management providers become more focused. Businesses generally are adjusting to an era of hyper-specialization, and winning or losing in population health will relate to a VOI that is different from one employer to the next.

What I found telling about the VOI propositions offered by those who discussed exchanges or ACOs was the continued preoccupation with the employer as purchaser. It’s more than ironic that “patient centered” homes and value-based purchasing are watchwords, but that the consumer’s values and needs still get short shrift. When a conference has panels of patients replace experts, I’ll be convinced we are fully embracing patient-centered concepts.

At long last: positive proof that wellness works for everyone all of the time

Would the CCA Forum, or any science-oriented group, organize sessions to support this headline? Of course not, but it’s attention-getting isn’t it? That’s undoubtedly a goal behind the hyperbolic harbingers of the notion that wellness doesn’t work.  Nevertheless, the CCA Forum made room for a “great debate” on ROI so presenters could posit that piece meal programs tested using quasi-experimental methods will yield unimpressive or inconclusive results. Not much grist for disagreement but, ever the optimist, I’m predicting those bent on scaring up controversy will inadvertently help to advance VOI metrics.

Short of more randomized controlled trials for comprehensive, long-term population health programs that balance individual interventions with culture change, today’s ROI methods are about as good as they’re going to get. My Dad taught me that you don’t dignify some criticisms with an answer. If CCA is looking for debate questions, here are some that I’d find interesting: Do wellness programs over-measure and under-intervene? The ratio of incentives to educational program spending is nearing 4:1; could this do more harm than good? The Affordable Care Act (ACA) rules could lead to annual health screening for many who would otherwise not be due for screenings according to clinical consensus guidelines; how should this be reconciled? Qualified debaters would be credible scientists who don’t have a financial interest in proving or disproving the questions.

Taking PHM to the next level

Conferences are at their best when they offer healthy doses of both education and inspiration. That the behavioral economics principles advanced in the book “Nudge” are being successfully applied in a clever product like “StickK” is a grand testament to how research can drive innovation. Seeing how an icon to consumer-based health education such as Weight Watchers is mobilizing its formidable peer-support infrastructure as a population health strategy is also remarkable. Learning how the Joslin Diabetes Center is translating its exemplary results in diabetes management into the diabetes prevention sphere was another example of how champions for change build on their own success.

This year’s CCA Forum was, as usual, masterful at enabling networking. It was during an informal lunch debate I had with three of population health’s most prolific researchers — Ron Goetzel, Ph.D., vice president, Truven Health Analytics, Seth Serxner, Ph.D., MPH, chief health officer, OptumHealth and Dee Edington, Ph.D., Edington Associates — that I was reminded of a fourth tenet for why implementation matters. Thought leaders don’t bemoan the failings of others because looking for bad apples is precious time away from creating ever more effective systems that support implementation excellence. Leaders are problem solvers, not problem describers. What’s more, they have an abiding message advancing what they are for, not merely polemics about what they’re against. On this count, this year’s CCA Forum convinced me that when it comes to implementation matters, the value of population health management is in very capable, and constructive, hands.

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Guest Blog Post Disclaimer CCA invites guest bloggers to post on Voice on Population Health Blog as a benefit for our members and the industry and to allow for exchange of ideas and information regarding population health. The views, opinions and positions expressed within these guest posts are those of the author alone and/or of the company the author represents and do not represent those of the Care Continuum Alliance (CCA), its members, or the industry as a whole. CCA is not responsible for the accuracy, completeness and validity of any statements made within this guest post article. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author(s) and any liability with regards to infringement of intellectual property rights remains with them.

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Guest Post: For Better Healthcare Analytics, Look Outside of Healthcare

By Chris Coloian, President and CEO, Predilytics, Inc. 

The Population Health industry is experiencing a time of great change and growth.  There are new and enormous challenges and forces shaping the industry — The Affordable Care Act, growth in government programs (e.g., exchanges, Medicaid expansion), an aging population, changes in employer benefit strategies, new consumer preferences, innovation and technology advances, and the slow climb out of economic recession — to name but a few.

To successfully navigate these changes, a Population Health Organization will have to better identify population and individual health needs, improve outreach, optimize programs’ performance, decrease costs, and improve business and quality impacts.

Several trends will have to be understood and addressed by the industry, including:

  • Changing consumer preferences (e.g., transitioning from The Greatest Generation, to Boomers, GenXers, and Millennials)
  • Technology enablement (e.g., smartphones, wireless medical devices, consumer and provider health apps)
  • Explosion of available information and huge volumes of data enabled by all this new technology
  • Consumer responsibility and engagement
  • Provider accountability
  • Resource constraints (e.g., caregivers, providers, funding, government programs)

Focusing on just one of these trends illuminates a few of the opportunities emerging, and the challenges that go along with it.  Today over 90% of the information an individual consumer creates (one’s “data wake”) is outside the healthcare system.  Insights from their consumer purchasing, voting, and demographic data, along with general information about where they work, play and live, all lead to a refined picture of their health needs and wants.  In fact, these non-traditional data sources have shown themselves to add predictive accuracy to models developed in other spheres (financial services and consumer marketing, for example).  We are convinced this will be the case in healthcare also.

Todd Park, US CTO, and HHS Secretary Sebelius have clearly articulated a strategy to create an open health data platform to support a more effective healthcare system — see some of their efforts at Healthdata.gov.  Park’s vision is to liberate terabytes of government-stored data, similar to the way NOAA opened up meteorological data from thousands of reporting stations to improve forecasting of everyday weather and severe weather events.

But data alone will not be sufficient to create clinical and business insights.  If we are to follow the lead of the financial services and consumer products industries, we will need to bring in the same caliber of computer science talent and machine learning approaches that are fueling a revolution in on-line search, advertising and social media.   In a 2010 Harvard Business Review news article, Tony Hey, Microsoft’s’ VP of External Research, writes of the new “4th Scientific Paradigm”:

”The fourth paradigm also involves powerful computers. But instead of developing programs based on known rules, scientists begin with the data. They direct programs to mine enormous databases looking for relationships and correlations, in essence using the programs to discover the rules.”

The Population Health industry can improve its impact and cost-to-value ratio by pointing what might today be considered futuristic approaches – “big data” and advanced computer science — at many of our common performance issues.  Among these:  predicting hospitalization risk; preventing unnecessary re-hospitalizations; managing transitions of care; optimizing consumer health status and risks; ensuring compliance and adherence; and, capitalizing on receptivity or willingness of individuals to engage in recommended services.

These issues are multi-variant, and have complex underlying patterns that, if illuminated, will lead to provisioning readily-available tools, programs and services to effectively help mitigate looming sick-care events.

In this time of inevitable and far-reaching change, we need a return to the basics of coordinating and managing individuals who are about to utilize significant healthcare resources.  We need to minimize their risk of an untoward outcome by using improved technologies to identify, predict and engage them in their care.  It seems like a safe bet that it’s time to bring the 4th scientific paradigm to healthcare.

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Chris Coloian, President and CEO, is a seasoned executive with more than twenty years of healthcare experience. He has led the growth and development of new businesses thanks to his expertise in strategy, executive management, operations and product development for insurance, provider and healthcare services companies. Prior to launching Predilytics, he was a member of the leadership teams of Health Dialog, Cigna Healthcare and Matria Healthcare (now Alere Health). Mr. Coloian is the Chair of the Care Continuum Alliance Board of Directors, the leading population health management industry group representing over 225 care management company members. Mr. Coloian graduated from Ohio State University in 1990 with a Master’s in Health Administration and received his Bachelor’s degree in Zoology from Miami University in 1988.   Mr. Coloian currently serves on the advisory boards of Jefferson University Public Health Program and is an Editor for the Population Health Management Journal.

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Guest Blog Post Disclaimer CCA invites guest bloggers to post on Voice on Population Health Blog as a benefit for our members and the industry and to allow for exchange of ideas and information regarding population health. The views, opinions and positions expressed within these guest posts are those of the author alone and/or of the company the author represents and do not represent those of the Care Continuum Alliance (CCA), its members, or the industry as a whole. CCA is not responsible for the accuracy, completeness and validity of any statements made within this guest post article. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author(s) and any liability with regards to infringement of intellectual property rights remains with them.

NEW at CCA Forum 2013: Walking Learning Labs

Care Continuum Alliance Forum 2013This year the CCA Forum has made it easier than ever to make meaningful, face-to-face connections between attendees and exhibitors through our new Walking Learning Labs.

These unique, hands-on demonstrations are intended to help you determine the value of specific solutions for your organization. The Walking Learning Labs are guided and facilitated by CCA researchers and provide attendees with an opportunity to explore particular areas of interest throughout the exhibit hall. Register today!

Walking-Learning-Labs

All Eyes on Alere, CCA Forum 2013 Presidential Sponsor

The CCA Forum’s Presidential Sponsor is Worth WatchingCare Continuum Alliance Forum 2013

As Presidential Sponsor of the CCA Forum 2013, Alere brings acute expertise and advanced solutions to this year’s conference. With a vision of connected health, Alere is an established leader in the healthcare industry for innovation. Don’t miss this rare opportunity to meet several of Alere’s top innovators. Register today!

Alere-Innovators

Guest Post: Preventive Care & the Affordable Care Act: Why Engagement Is Essential for Success

By Jordan Dolin, Co-founder of Emmi Solutions 

Jordan DolinAll new models of care, including ACOs, medical homes and shared savings, are looking to answer the same question: What’s the most cost-effective and efficient way to manage the health of large populations? This is a major challenge, and I’ve found patient engagement is an ideal way to address the issue. However, patient engagement needs to happen both within and beyond the four walls of the hospital, especially when it comes to preventive care.

Patients not following recommended screenings and preventive services are a large contributing factor to the spiraling cost of healthcare. For example, despite colorectal cancer being the second-leading cause of cancer-related deaths in the United States and one of the most preventable, only 53 percent of people 50 years and older follow recommendations for screenings.

On the surface, the new preventive services provision under the Affordable Care Act (ACA) should help address this issue, as the screenings are one of many preventive services recommended by the United States Preventive Services Task Force that insurers must now cover without cost-sharing.

Yet, even with an estimated 71 million Americans now eligible for copay-free colonoscopies, what remains to be seen is the level at which these patients will take advantage of the benefit.

That’s why forward-thinking health plans, hospitals and physicians are turning to outcomes-driven patient engagement solutions that close gaps in care and inspire patients to take action.

The following engagement strategies are powerful ways healthcare professionals can increase utilization of preventive services as well as member satisfaction and loyalty:

  • Multi-modal communication: If the goal is to put patients at the center of care, then patient messaging efforts need to be designed with their convenience in mind. Patients need tools that allow them to be engaged on their terms, when and where they choose and on the devices they already own.
  • Customized contact: Tools such as the Patient Activation Measure (PAM) that gauge individual members’ ability and interest in managing their own health and healthcare can be used to meet patients where they are, tailor engagement strategies and increase activation levels.
  • Web-based interactive programs: Web-based programs cannot only increase the bandwidth of providers, free more time for the delivery of care and motivate patients to schedule colorectal cancer screenings and other types of preventive care, but they can also help patients to follow through. A study presented last year at Digestive Disease Week found that patients who viewed a 30-minute online instructional video were 40 percent more likely to keep their colonoscopy appointments.
  • Financial incentives: Financial incentives and wellness programs can be great motivators—if members know about them. Effective programs engage patients not only about the health benefits of preventive care, but also the more tangible ones, such as insurance premium reductions for adherence to scheduled screenings.

Empowering patients isn’t just good for their health—it’s good for disease management and the business of managed care.

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Jordan Dolin is co-founder of Emmi Solutions (www.emmisolutions.com), a healthcare communications company that builds technology-focused patient empowerment solutions for health organizations that measurably impact outcomes.

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Guest Blog Post Disclaimer

CCA invites guest bloggers to post on Voice on Population Health Blog as a benefit for our members and the industry and to allow for exchange of ideas and information regarding population health.

The views, opinions and positions expressed within these guest posts are those of the author alone and/or of the company the author represents and do not represent those of the Care Continuum Alliance (CCA), its members, or the industry as a whole. CCA is not responsible for the accuracy, completeness and validity of any statements made within this guest post article. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author(s) and any liability with regards to infringement of intellectual property rights remains with them.

CCA Letter to Congressman Ryan on behalf of Medicare Advantage Beneficiaries

October 4, 2013

The Honorable Paul Ryan

Chair, Committee on Budget

United States House of Representatives

1233 Longworth House Office Building

Washington DC 20515

Dear Representative Ryan:

As the Congressional discussion of budget priorities continues, we are writing on behalf of the Care Continuum Alliance (CCA) to seek your support in assuring that the more than 14 million Medicare beneficiaries enrolled in a Medicare Advantage (MA) plan will not experience any additional cuts to the MA program, and will continue to have access to the quality care delivery, care coordination and wellness and prevention services offered by MA plans.

CCA convenes a broad range of stakeholders dedicated to enhancing the health of populations. Through advocacy, research, and education, CCA advances evidence-based population health management strategies. The CCA aims to improve care quality and health outcomes while reducing preventable costs for the healthy and those at risk of or suffering from chronic conditions. Our diverse membership of more than 200 organizations and individuals includes physician groups, nurses, other health care professionals, hospital systems, wellness and prevention providers, population health management organizations, pharmaceutical manufacturers, pharmacies and pharmacy benefit managers, health information technology innovators, employers, researchers, and academics.

Our member organizations serve Medicare beneficiaries across the country, including a large majority of beneficiaries enrolled in MA plans across the country. MA enrollees receive high quality care and enhanced services at lower costs. Of particular importance, MA enrollees often receive enhanced, evidence-based wellness and prevention services and chronic care management. These programs directly benefit America’s seniors and help reduce health care spending overall.

For example:

Medicare seniors with diabetes in a MA Special Needs Plan had 7% more primary care physician office visits and 19% fewer days in the hospital compared to seniors in Medicare fee for- service (FFS). [i]

Seniors in an MA plan had a 14.5% 30-day readmission rate from 2006-2008, which was 22% lower than FFS readmission rates.[ii]

Seniors in MA plans are less likely to report trouble in receiving care, more likely to have a usual source of care, and more likely to receive necessary preventive services compared to seniors in FFS.[iii]

Despite the measurable success of MA, the program faces challenges in 2014, 2015 and beyond. The Patient Protection and Affordable Care Act (PPACA) mandated $200 Billion in cuts to the MA program. In addition, the 2012 Fiscal Cliff deal cut $2.5 Billion from Medicare Advantage through a coding intensity provision. The Congressional Budget Office has outlined projected cuts to these programs in the coming years:

Even though only a small portion of PPACA cuts have taken effect so far (only ten percent of the cuts will have gone into effect by the end of 2013), the reduction in beneficiary choices has begun.[iv]  The number of MA plans is projected to drop in 2014.[v] Although we understand that Congress faces many difficult choices in the budget debate, we are concerned that any further cuts to the MA program will undermine the ability of the program to sustain its impressive track record in improving care and reducing costs for Medicare beneficiaries.

We would be pleased to provide additional information on the program, highlight examples of the program’s success, and further detail the positive impact it is having on the lives of America’s seniors.  If we can be of assistance, please feel free to contact Vicki Shepard at 202-525-9588 Vicki.shepard@healthways.gov.

Sincerely,

/signed/

Fred Goldstein

Acting Executive Director

Care Continuum Alliance

Vicki Shepard

Chair, Government Affairs Committee

Care Continuum Alliance


[i] “Medicare Advantage Chronic Special Needs Plan Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients.” Health Affairs 31.1 (2012).

[ii] Lemieux, J., Sennett, C., Wang, R., et al., “Hospital Readmission Rates in Medicare Advantage Plans.” American Journal of Managed Care 18(2):96-104 (2012).

[iii] Centers for Medicare and Medicaid Services, Medicare Advantage, Hill Notification Document, 11 (2007).

[iv] Congressional Budget Office, Letter to the Honorable Nancy Pelosi (March 20, 2010).

[v]Avalere Health analysis of CMS Landscape File, September 23, 2013 accessed at http://www.avalerehealth.net

 

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