Suppport Population Health Research: Sponsor a PHA Forum 2014 Scientific Track


PHA Forum 2014
October 3, 2014
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PHA Forum 2014 Educational Track Sponsor

NEW Sponsorship Opportunity – $25,000    

Collaborate + Communicate = Engage. Support the research that underpins your industry by sponsoring an educational track at the PHA Forum 2014

Educational Tracks

  • Analytics to Action for Providers and ACOs
  • Excelling in Engagement
  • Powerful PHM Strategies
  • Tech Touch: Strategies for Apps in Health
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Sponsorship Perks   

Be a Presidential Sponsor  
7 registrations. Multiple branding opportunities.
Choose a Track Moderator
Why do you support research? Say your piece.
Sponsor Recognition
Website. Mobile App. LinkedIn. Newsletter. Blog. Twitter. Signs.
Booth in The Solutions Zone
When we say integrated learning experience, we mean it.
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Your booth at The Solutions Zone 

The Solutions Zone is designed in four neighborhubs that complete attendees’ integrated learning experience with the hands-on demonstrations of the theories and initiatives presented in the scientific tracks.  

  • Innovations in Interventions
  • Worksite Solutions
  • Data Stream
  • Tools for Consumer Engagement
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PHA Forum Scientific Program is Different  

  • Peer Reviewed Program
  • No Pay for Play
  • Panel of Judges select presentations for the PHA Outstanding Leadership in Population Health Management Award
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Who attends the PHA Forum?

  • Health plans and payer organizations
  • Employer organizations
  • Physician group practices
  • Hospital and health systems
  • Federal, state and local governments
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Better Value for Exhibitors

PHA Forum offers a free, complete booth package, including electricity, chairs, skirted table and trash receptacle in a ballroom setting – no need to buy carpet. Each paid 10′ x 10′ booth includes three registrations.

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Want more information?

Just ask!
Cindy DeClark
Director, Meetings, Special Events & Corporate Relations
(202) 737-5681
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Walking Learning Labs

These are designed to provide an in-depth look at some of the key components of population health management, with an overview of PHA’s research followed by a guided tour of solution providers, in the Solutions Zone.  For more information go to Walking Learning Labs.

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PHA Forum 2014

Schedule of Events

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Educational Sessions

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Follow us @PHAVoice

#PHAForum 2014

Keynote Speakers

Esther Dyson

Brian Klepper


Kaveh Safavi

David B. Nash

Workplace Healthcare & Benefits Institute

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10 Reasons to Attend

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Population Health Alliance. P.O. Box 73127. Washington, DC 20056

(202) 737-5980.

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Showcase of Power Hitters in Population Health Management Strategies

PHA Forum Logo Final-01PHA Forum 2014 Educational Sessions

Every year at the Population Health Alliance’s conference, the latest and edgiest research in population health meets the proven and demonstrated best practices with a long record of good outcomes.

The Powerful PHM Strategies track showcases several of the tried and true strategies and programs with a great lineup of power-hitters in the industry. The peer-reviewed presentations address diabetes prevention employer-focused programs with a strong worksite wellness tilt; reporting of outcomes and program value; organizational support as the cornerstone of a culture of health.

Learn more

Register today for the PHA Forum 2014

Powerful PHM Strategies


Best Practices for Reporting Program Value, V2.0    


Michael J. Connor, Dr.P.H.

Senior Vice President, Health Intelligence, Alere

Creating a Culture of Health through Organizational Support


Jennifer Flynn, MS

Strategy Consultant, Mayo Clinic

Employer-vendor collaboration to build, communicate and execute on strategy delivers superior outcomes


Adam Long, PhD

Vice President, Research & Reporting, H2U | Health To You

DPS Health and Kognito to present at the PHA Population Health Management Framework Webinars

PHA Members Kognito and DPS Health will present complimentary webinars in September about tapping virtual humans to drive behavior change and improving the health of those with moderate risks, as part of the PHM Virtual Brown Bag Series.

The Population Health Alliance, the leader in advancing the principles of population health, today announced September’s lineup of webinar presenters for the Population Health Management Virtual Brown Bag Series: DPS Health and Kognito, on September 4 and 18, respectively.

This FREE webinar series features PHA member organizations presenting on the core components of the Population Health Management (PHM) framework and how they relate to their work and underpin their research in areas of identification, assessment, stratification, engagement, interventions, and evaluation.

On September 4, DPS Health’s webinar, titled Improving outcomes for patients with multiple chronic conditions who are not yet very sick, will be presented by company leaders Neal Kaufman, MD, MPH Chief Medical Officer, and Adam Kaufman, PhD, CEO and President.

The two will talk about how an integrated approach to outreach, education, engagement, activation and intervention improves short-term and long-term business and health outcomes when applied to the Moderate Risk segment of the population. The webinar is taking place on Thursday, September 4, at Noon Eastern Time.

On September 18, Kognito’s Co-Founders CEO, Ron Goldman and Director of Research, Glenn Albright, Ph.D., will present the webinar Conversations that Drive and Sustain Change: Can Talking with Virtual Humans Change Behavior?

The webinar will showcase how Kognito, for the past decade, is tapping emotionally responsive, fully animated Virtual Humans in challenging conversations about health to drive behavior change. The presenters will discuss how conversations that are occurring across the care continuum today can be made more meaningful; the learning methodology that incorporates principles of neuroscience, social cognition and game mechanics into the Kognito Conversation PlatformTM; and demonstrate their ground-breaking technology and evidence-based approach in recent work for health and behavioral health clients.

The webinar is taking place on Thursday, September 18, at Noon Eastern Time.

The webinars are FREE to attend and registration and detailed information for both webinars is available here:

# # #

About DPS Health

Founded in 2004, DPS Health is the leader in moderate risk population health services. The company works with health plans, healthcare providers and employers to identify, engage and impact individuals with, or at-risk for chronic disease reducing disease morbidity and healthcare costs. For more information on DPS Health, visit

About Kognito

Founded in 2003, Kognito is a leader in immersive learning experiences that drive positive change in health behaviors. Kognito’s award-winning online and mobile simulations with virtual humans prepare individuals and professionals to effectively manage challenging conversations about health. Kognito uses a science-driven, research-proven approach and currently has more than 450 clients in education, government and healthcare settings. The company has been recognized for its evidence-based programs, and is the only company with online simulations listed in the National Registry of Evidence-Based Programs and Practices (NREPP). Learn more and access demos at

Got a Name for Us? Population Health Alliance Seeks Board of Directors Nominations

PHA-Logo-FinalThe Population Health Alliance, the leader in advancing the principles of population health, seeks nominations from members for its 2014 Board of Directors. PHA’s Volunteer Board is comprised of population health industry leaders. PHA Board members serve as industry champions and spokespersons and also shape organizational direction and policies. The Population Health Alliance seeks industry leaders with the appropriate skills and leadership abilities to guide efforts to align all stakeholders toward improving the health of populations.

Please, assist us by nominating individuals who would add value to the Board and who would be interested in this service opportunity to the population health community. A Nominating Committee will review nominations and forward the names of selected nominees to the Board. Final approval is given by membership at the Annual Business Meeting, held in conjunction with PHA Forum 2014, in Scottsdale, AZ December 10-12.

The criteria by which potential candidates are considered and judged include:

  1. Population Health Alliance membership;
  2. Recognized leadership position within organization and/or industry. Leadership is intended to include not only those with C-suite status, but also others demonstrating thought leadership among industry stakeholders;
  3. Engagement in population health improvement industry;
  4. Willingness to participate actively in and to support Population Health Alliance activities through personal involvement in at least one committee and, if an organizational member, through appointment of other organizational personnel to appropriate committee memberships, as well as to assist with development efforts in support of Population Health Alliance events and activities, requiring 60-80 hours of participation per year; and
  5. Bring diversity of membership to the Board of Directors; in particular, ability to assist Population Health Alliance in expanding affiliations with the provider and HIT communities and other stakeholder groups to extend our influence and constituent input for our collective population health improvement missions.

Board members serve two-year terms and are expected to attend all Board activities and participate actively on committees and with fundraising. Nominations should include a comprehensive biography of the nominee. Please send nominations to Fred Goldstein, Interim Executive Director at Nominations must be received by Wednesday, September 10, 5 p.m. Eastern Time.

What Does the RAND Report on Workplace Wellness Programs Really Say?

Speculation was running rampant on the web and the blogosphere about the bad news that the Rand Report was going to be for the industry.

Only problem was: Those who were talking hadn´t read it. And those who had read it were not talking.

But here it is. Please, read the COMPLETE Final Report, from RAND Corp, on Workplace Wellness Programs Study.

And what did we find after a good read? Apparently, the old adage is true: Reading is fundamental.

May we quote?

“In an analysis of the CCA database, when comparing wellness program participants to statistically matched nonparticipants, we find statistically significant and clinically meaningful improvements in exercise frequency, smoking behavior, and weight control, but not cholesterol control. Those improvements are sustainable over an observation period of four years, and our simulation analyses point to cumulative effects with ongoing program participation.” Page XVII, for the inquisitive minds. This point is of critical importance as it speaks to the importance of workplace wellness programs to help contain the epidemic of lifestyle-related diseases in the U.S. (RAND report, p. xxvi)

Then, there is this other morsel of wisdom:

“The published literature, the results presented here, and our case studies corroborate the finding of positive effects of worksite wellness programs on health-related behavior and health risks among program participants.” Page XVIII

Please, CCA will issue a more complete analysis and responses to any of your questions and inquiries, now that we actually know what we are discussing… You know, we are sticklers for full picture, well-informed statements.

But we want to give our readers a nice preview of some of the most relevant points of the report. And, unlike others, we are actually giving you chapter and verse…and a link to the actual report, so you can make sure we are quoting correctly.

  • Programs with a weight management component can be credited with a positive impact on weight over time. Results show a differential change of about 1 pound per year sustained for the current year of participation and two years thereafter, in a population of 104,920 employees. (RAND report, p. 48) Compared to this: the average adult gains between 5 and 15 lbs. per year after age 40.
  • Cholesterol improved for participants and nonparticipants alike. (RAND report, p. 52) Increased use in statins among the full population can partly explain the lack of program effect.
  • Even with a small sample size (N=746), smoking cessation programs were found to have a significant sustainable effect for 1-2 years after the year of participation. “One year of program participation decreases the smoking rate of participating smokers by nearly 30% in the first year compared to nonparticipating smokers.” (RAND report, pp. 45-46)
    • Program participation is associated with a trend toward lower health care costs, while those changes are not statistically significant. Over a five year span, the cumulative simulated effect of wellness program participation on total health care costs per health plan member per month shows a curve that flattens for participants and continues on an upward trajectory for nonparticipants. This lower cost trend is driven by reduction in hospital inpatient cost of approximately $40 per member per month. (RAND report, pp. 56-57)
  • Corresponding to these cost reduction trends are declines in inpatient admissions and emergency department visits, compared with an increase or slight decrease for the nonparticipant comparison group. (RAND report, p. 57)
  • While the report’s estimates of wellness program effects on health care cost are lower than results reported in the literature, the RAND research sought to isolate the effect of lifestyle management interventions as opposed to the effect of an employer’s overall approach to health and wellness. (RAND report, p. xxvi) Even with a program that is cost neutral, positive impact on health risk, i.e. healthier employees, is a good result without added cost.

Read the Final Report, from RAND Corp, on Workplace Wellness Programs Study

View the presentation of Wellness Program Study Final Briefing

News from CCA Quality and Research

CCA Forum Program Committee

With more than 90 proposal submissions received last month, the Program Committee has a multitude of high quality presentations from which to choose for CCA Forum 2013 in Scottsdale, AZ, on October 23-25, 2013. Through a process of online review and scoring along with an in-person meeting and conference call, the Committee is making final selections for the educational program. Themes for 2013 will include collaborative strategies for practice transformation, Big Data, and employer strategies for employee health, to name a few. And the traditional session format of the past will be transformed into more engaged presentations, working sessions, and workshops.

Walking Learning Labs and a pre-conference workshop on program evaluation are new offerings for 2013, providing additional opportunities for attendees to gain hands-on learning. The walking learning labs will guide attendees through a mini-tour of The Solutions Zone exhibit hall and demonstrate how, for example, a health care provider might use population health management strategies to better care for his patients. The half-day program evaluation workshop, on Wednesday afternoon (Oct. 23), will interest employers (HR and benefit managers) who want to better understand their wellness programs and what they should measure, resulting in “take back to the office” information. Forum attendees will need to register separately for these opportunities.

For the third year, the International Symposium on Wellness & Chronic Care will demonstrate the application and success of a variety of population health management strategies around the globe. This half-day conference will take place on Friday afternoon (Oct. 25) and will bring new perspectives from countries/regions that have not been represented at past conferences.

Our sincere appreciation goes to the Program Committee, reviewers, and their associated organizations for the commitment of time and resources: Greg Berg (McKesson Health Solutions), Suzanne Duda (Healthways), Neil Gordon (INTERVENT International), Cynthia Hallam (Blue Cross Blue Shield Louisiana), Nancy Hedstrom Wigley (Cigna), Natalie Heidrich (Ethicon), Iver Juster (ActiveHealth Management), Craig Keyes (Alere), Rose Maljanian (HealthCAWS), Michael Taylor (Accenture), and Mike Van Den Eynde (Deloitte).

Stay tuned as we begin to release more details on the CCA Forum program within the next month. Those who submitted proposals can expect to receive notification of the Committee’s decision by the end of May.

Population Health Management in Health Insurance Exchanges

A 2013 research initiative, the Population Health Management in Health Insurance Exchanges has kicked off with two work groups: HIX Assessment and Exchanges 101. We are conducting an environmental scan of the state exchanges to better understand the variety in structure, design decisions, measurement, etc. We are also using past CCA research to build the value proposition for population health management and communicate that value to the exchanges. If you have resources or expertise to share in these areas, please contact Karen Moseley,

CCA Quality & Research Update – Focus on Partnerships

Quality & Research March Update

Population Health Management in Health Insurance Exchanges

The Affordable Care Act requires health insurance exchanges (HIX) to be established and working by 2014 in every state. Currently, 17 states are pursuing a state-run marketplace, while the remaining 33 states will allow a federally facilitated marketplace or partner for a state-federal marketplace. These exchanges will function as a transparent and competitive marketplace where buyers of health insurance, mainly individuals and small businesses, can buy affordable and qualified health benefit plans.

This move toward increased health care access for broader populations provides an opportunity to apply population health management (PHM) beyond Medicare and Medicaid populations to the commercial market. As employers shift the ways in which they provide health benefits, this work will be applicable to any population health model trying to gain access to broader populations through broader access models such as state and private exchanges.

CCA and its members have already laid the groundwork for population health management as the cornerstone for this broader access model. PHM strategies and tactics will be important to the success of the health insurance exchanges. As the voice of population health, CCA will develop tools and guidance to address three main objectives: 1) help PHM vendors to understand the health insurance exchanges and the opportunities that may exist in these new markets; 2) demonstrate the value of PHM to the health insurance exchanges; and 3) inform policy makers about the value of PHM for the HIX and differentiate the payment models used.

The Quality & Research Committee has formed two work groups for this effort. If you are interested in participating, please contact Karen Moseley,

  1. HIX Assessment. This work group will perform the environmental scan of HIX, including participating states, design decisions, product offerings, populations served, measurement, health information technology, and other exchanges such as private exchanges and state-federal marketplaces.
  2. Exchanges 101. This work group will develop guidance around the value proposition of HIX as a new business opportunity for PHM organizations as well as the value proposition of PHM for the success of HIX.

HERO-CCA Employer Dashboard

CCA’s collaborative effort with HERO is progressing and will be in the final stages of review within the next few months. The project leadership group plans to meet for a full-day working session in April to finalize the document for review by experts in the industry and stakeholder groups within HERO and CCA. If you have expertise in measures for employee health management programs—specifically the domains of health impact, satisfaction, participation, financial outcomes, productivity, organizational support, and value of investment—please contact Karen Moseley,, if you would like to serve as a reviewer of the work prior to release. The final review will include public comment, so stay tuned.

Workplace Wellness

The CCA data aggregation buzz has been quiet for several months, but it is becoming louder as we await the release of RAND’s Report to Congress on the effectiveness of wellness programs in the workplace, including factors such as the incentives offered, the impact participation has on employee behavior, and programs’ ultimate impact on employees’ health. We expect to have the full report in April, and RAND has offered to brief the CCA data advisory board as well as the data contributors on the report findings post release.

On a similar note, CCA Quality & Research is collaborating with CCA Advocacy to develop a detailed, comprehensive, and evidence-based response to a recent article in Health Affairs titled, Wellness Incentives In The Workplace: Cost Savings Through Cost Shifting To Unhealthy. The authors draw several conclusions that merit a response, and CCA members are called to submit case studies to increase the evidence. Read the Call to Actionand act now!


CCA Response to CMS Medicare Advantage 2014 Method and Payment Changes



March 1, 2013
Mr. Jonathan Blum
Deputy Administrator and Director
Center of Medicare
Centers for Medicare & Medicaid Services
Department of Health & Human Services
7500 Security Boulevard
Baltimore, MD 21244

Re: Call Letter – Methodological Changes for Calendar Year (CY) 2014 for Medicare Advantage Capitation Rates, Part C and Part D Payment Policies and 2014

Dear Mr. Blum,

Care Continuum Alliance (CCA) and our members offer comments on the February 15th CMS Call Letter detailing proposed changes to 2014 Medicare Advantage Methodologies and Payment Policies.

CCA convenes all stakeholders along the continuum of care to improve the health of populations, including individuals who are healthy, at risk of illness, or managing chronic conditions. Through advocacy, research, and education, CCA advances population health management strategies to increase the quality of care, improve health outcomes, and achieve cost-savings. Our diverse membership includes physician groups, nurses, other health care professionals, hospital systems, health plans, wellness and prevention providers, population health management organizations, pharmaceutical manufacturers, pharmacies and pharmacy benefit managers, health information technology innovators, employers, researchers and academics.

We are pleased CMS expressly encourages plans to offer Medication Therapy Management to beneficiaries in the proposed call letter. We also applaud CMS for its efforts to support innovative programs that encourage beneficiaries to adopt and maintain healthy lifestyles by lifting the annual limit on incentives. There is a large and growing body of evidence that demonstrates the power of incentives to increase patient engagement and drive healthy behavior.[1] CCA members also regularly integrate incentives into their efforts to apply proven techniques of behavior change science in commercially insured populations, with marked success.

The significant new Medicare Advantage (MA) funding reductions proposed in the call letter cause concern for MA market destabilization and unintended consequences to beneficiaries. When added to the reductions already required by the Affordable Care Act (ACA) for 2014, the cumulative reductions result in about an 8% cut in MA funding. If an eventual sequestration is included, this increases to a 10% reduction. These reductions have strong potential to cause disruptions the MA plan market and to MA beneficiaries through unexpected increased costs and decreased benefits to maintain fiscal sustainability. This may result in benefit reductions and premium increases ranging from $600 and $1,080 annually for a typical MA beneficiary next year.[2] Such abrupt funding changes put the MA program at substantial risk of destabilization along with its care coordination efforts, which are critical benefits to contain health costs for chronically ill Medicare beneficiaries. CCA members anticipate that this marked decrease in government support for the MA program may cause several MA plans to disappear from the market.

CCA recognizes that increasing value and cost savings in Federal health care spending are critical in the current fiscal environment. We also appreciate the challenge of identifying cost effective strategies, however there are tangible ways to reduce health care spending in the MA program without shocking the market and MA beneficiaries.

Recommendation: Avert destabilization of the MA market and unanticipated encumbrances on beneficiaries by accounting for the annual Sustainable Growth Rate (SGR) adjustment to the Medicare Physician Fee Schedule.

We strongly encourage CMS to account for impending Congressional action to avert the SGR’s projected 30% payment reduction for 2014 in the Medicare Physician Fee Schedule. This is reasonable and consistent with Congressional actions in prior years to stabilize physician payments, by providing a flat payment rate absent a long-term policy solution. Accounting for an SGR adjustment would successfully restore 5% to MA payment rates.

Recommendation: Phase in Fee-For-Service normalization reductions, past restatement of trend, and other rate calculation refinements.

CCA appreciates CMS’s work in considering ways to make the Average Geographic Adjustment and the calculation of Fee For Service rates more accurate. We recommend that any refinements should be phased in over multiple years to defray market destabilization.

Recommendation: Omit the proposal to shift star scores closer to the mean and implement changes prospectively,in a manner that gives plans enough time to prepare for changes, to ensure measurement calculations more accurately reflect plan performance.

The proposed changes to the Star Ratings calculation shift overall star scores closer to the mean, or a 3 rating. Our members are concerned that this would cause dramatic shifts in the rating of MA plans, even though the underlying quality metrics of a plan will not have changed. As a result, meaningful differences in plan performance will not be distinguished for beneficiaries.

Plans need a consistent and fair performance approach on which to base investments and drive operational improvement. Similarly, beneficiaries also need consistency in evaluation of plan performance under the Star Ratings to accurately compare MA plans. CCA recommends that CMS omit the proposal to shift star scores closer to the mean to ensure measurement calculations more accurately reflect plan performance. We also recommend that future changes to Star Ratings calculations should be prospective to advance higher quality performance. Currently, CMS publishes updates to its Star Ratings criteria after the time period in which plans are evaluated on those measures. This retroactive assessment and use of data collected as many as three years prior to a plan’s Star Ratings determination, create an inescapable lag cycle for plans trying to deploy quality improvements and boost their Star Ratings. Changes in quality within a plan are not reflected in its Star Rating for at least two years. Prospective changes to Star Ratings calculations support CMS’s objective of providing an effective Star Ratings program that empowers informed plan selection and will ensure that a MA plan’s evaluation is based on known requirements.

In conclusion, CCA appreciates the positive improvements in various portions this call letter around Medication Therapy Management, the annual limit on incentives, and calculating the Average Geographic Adjustment and Fee-For-Service rates. We believe our combined recommendations will help prevent sudden disruptions in the MA market and important beneficiary health benefits, while successfully reducing Federal health care costs associated with the MA Program. CCA would be glad to serve as a resource as CMS refines the proposed changes to 2014 Medicare Advantage Methodologies and Payment Policies.

Thank you for your consideration.

Frederic S. Goldstein

Acting Executive Director

Care Continuum Alliance

Vicki Shepard

Chair of the Government Affairs Committee

Care Continuum Alliance

Victoria L. Shapiro

Director of Government Affairs

Care Continuum Alliance

[1] Goetzel RZ, Ozminkowski RJ. The health and cost benefits of work site health-promotion programs. Annu Rev Public Health. 2008;29:303-23; Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Affairs. 2010;29(2):304-11; Volpp KG, John LK, Troxel AB. et al. financial incentive-based approaches for weight loss: a randomized trial. JAMA. 2008;300(22):2631-2637; Volpp KG, Troxel AB, Pauly MV, et al. A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med. 2009;360:699-709; Seaverson EL, Grossmeier J, Miller TM, Anderson DR. The Role of Incentive Design, Incentive Value, Communications Strategy, and Worksite Culture on Health Risk Assessment Participation. Am J Health Promot. 2009 May-Jun;23(5):343-52; Goetzel RZ, Shechter D, Ozminkowski RJ, Marmet PF, Tabrizi MJ, Roemer EC. Promising practices in employer health and productivity management efforts: findings from a benchmarking study. J Occup Environ Med. 2007 Feb;49(2):111-30; Prochaska JO, Evers KE, Castle PH, Johnson JL, Prochaska JM, Rula EY, Coberley C, Pope JE. Enhancing Multiple Domains of Well-Being by Decreasing Multiple Health Risk Behaviors: A Randomized Clinical Trial. Popul Health Manag. 2012 Feb 21.

[2] Giese, Glenn and Chris Carlson, “Proposed Changes to 2014 Medicare Advantage Payment Methodology and the Effect on Medicare Advantage Organizations and Beneficiaries,” Oliver Wyman (February 2013)

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 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.

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