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, KMoseley@CareContinuumAlliance.org.

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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, kmoseley@carecontinuumalliance.org.

  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, kmoseley@carecontinuumalliance.org, 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!

 

Guest Post: Healthcare Choices, Patient Voices

A critically important goal of healthcare reform is to deliver patient-centric care.  However, in today’s busy practice of medicine, patients are too often asked to decide on care without fully understanding their options and without the opportunity to think about their preferences.  We make few decisions as important or personal as those affecting our health, yet too often our voice as a patient is not heard.

Healthcare decisions, particularly those regarding care for which there are multiple evidence-based options, (preference sensitive) are common.  82% of adults over the age of 40 have made a decision about a surgery, test, or new medication in the past two years.[i]  Too often physicians lack the training, resources, or time to educate patients on the risks and benefits of their various care options. Doctors do even less well with exploring patients’ personal preferences.  Because patients don’t know what they don’t know, it’s simply not possible to obtain truly informed consent from a patient who is not informed.  Risks and benefit discussions aren’t really meaningful without a full explanation of options and a full exploration of personal preferences.

A Shared Decision Making approach to care educates patients about any and all medically sound treatment options and helps them sort through the confusing clutter of medical terms and acronyms.  Patients are informed on the risks, benefits, trade-offs, and side effects of each viable choice. This approach puts the patient at the center of the decision, ensuring that the selection is not only clinically appropriate, but also the right course for them.   Thus prepared, patients can then have a better quality discussion about their treatment options with their physicians, which is the goal of Shared Decision Making.

As we continue to debate ways to improve quality and reduce costs, Shared Decision Making emerges as one such way.  Patients who go through a Shared Decision Making process tend to choose less invasive procedures[ii], which in turn leads to better outcomes and reduced spend. The patients are happier too, reporting a better care experience and improved doctor-patient communication.[iii]  This approach to care is both effective and practical. It has been successfully adopted in busy medical practices across the country resulting in more loyal patients and more satisfied clinicians.

Healthcare choices are hard. Knowing you even have a choice is paramount. Shared Decision Making will draw out patient voices where they so critically need to be heard.

Dr. Peter Goldbach brings more than 30 years of experience to Health Dialog’s management team, including 15 years of experience in medical administration and 17 years maintaining a primary care and pulmonary disease practice. Prior to joining Health Dialog, Dr. Goldbach served as President and Chief Executive Officer of Med-Vantage Inc., a healthcare informatics and engagement company. Before that, Dr. Goldbach was Medical Director for Blue Cross Blue Shield of Massachusetts, where he provided medical direction for the company’s “Pay for Performance” and eHealth programs. In other previous roles, Dr. Goldbach has held CEO, trustee, and medical staff president positions with two Boston-area community hospitals.

Dr. Goldbach received an undergraduate and master’s degree from UCLA and his medical degree from SUNY Downstate Medical Center College of Medicine. He completed his Internal Medicine internship and residency at George Washington University Hospital, and his Pulmonary Disease fellowship at Cedars-Sinai Medical Center / UCLA School of Medicine.

[i] Zikmund-Fisher., et al. The DECISIONS Study. Medical Decision Making. Sep-Oct 2010.

[ii] Decision Aids for People Facing Health Treatment or Screening Decisions. Cochrane Database of Systematic Reviews. 2011 October 5;(10).

[iii] Ibid.

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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.

 

Guest Post: Enabling the Consumer

The statistics can overwhelm: More than 35% of Americans are obese (CDC).  More than 38% of Americans work more than 50 hours a week (libraryspot).  On average, people spend more than $7,000 annually on health care (Forbes).  Employers are increasingly moving towards high deductible health plans for employees (USA Today).

To many consumers, health care may seem to be an uncontrollable morass.  But consumers can take control of their actions around health and wellness.  All of us can get fit.  We can find that right work-life balance.  We can make our own decisions around care.  We simply need to take action.

As my wife would say, “Can we hit the pause button, just reflect and adjust?”  With Consumer Driven Health Plans, consumers need to pause, reflect and adjust as they make health care decisions that have a more direct personal financial impact.  To make informed, personally appropriate health care decisions, people need information on the go, at the point of care, at work, 27/7 365 days a week.

That’s where UnitedHealth Group comes in. We bring you the decision-making tools, applications and services you need to make your health care decisions at any time, any place.    Tools such as:

  • Health4Me, an app that provides information on the go about locating an Urgent Care or Emergency room, getting a Medical ID card electronically, getting claims data, contacting nurselines and customer service;
  •  OptumizeMe,  an app that helps you track your fitness activities through goal-setting, set up challenges for your social network,  and connect you to Health and Wellness coaches;
  • Fitness Gaming, a way to engage in healthy activity through gaming;
  • Baby Blocks,  an app to help Mom and Baby get the care they need during pregnancy and the first 15 months of baby’s life; and
  • myHealthcare Cost Estimator, an online tool that helps consumers price procedures performed by Doctors and Clinics .

Consumers can use all these tools to take control of their health and wellness needs.  UnitedHealth Group will highlight them at the Care Continuum Alliance’s Population Health Innovations Showcase July 11.  We look forward to seeing  you at the Innovation Showcase, and showing you the many ways UnitedHealth Group is empowering consumers to make the health care decisions that are best for them.

Patrick Keran is a Senior Director of Information Technology of Innovation at UnitedHealth Group helping drive strategic initiatives to cut healthcare costs by enabling consumer action through various innovations.  Patrick has been in Healthcare for the last 7 years and in the overall Information Technology industry the last 20 years.

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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.

Guest Post: Regardless what the Supreme Court Rules: Technological Innovations Are the Future of Health Care

The Healthcare Industry waits today for the decision of the U.S. Supreme Court to determine the fate of the Affordable Care Act (ACA), no doubt the single greatest change to the nation’s health care system since the creation of Medicare and Medicaid Programs in 1966. A ruling on its constitutionality, therefore, will likely have a considerable impact on the state of the healthcare industry for years to come.

While the judges argue their positions and write opinions, and opponents and supporters stake out the Court’s steps with chants and signs, there is a long term and much less conspicuous movement that has been shaping the health care industry through innovation, collaboration and adoption and adaptation of cutting edge technology.

In a recent report[i], Ernst & Young declared that health care is shifting to a new level of consumer centricity and moving to a “Third place of delivery”.

“To address the challenge of behavior change, the epicenter of health care system – how health care is produced, delivered, consumed, and paid for – will move beyond the two places in which it has traditionally been delivered, the hospital and doctor’s office,” the report says.

“The third place is wherever the patient happens to be.  It is both every place and no place.  For health care, the third place is the patient,” it concludes.

The Population Health Management industry has long understood the need for coordinating and providing care for the patient outside the traditional delivery settings.  Our members have been developing the innovative technologies, approaches, strategies and methods for reaching and engaging the individual as patient and health consumer.

I am here to extend you an invitation: Come to have a taste of what the future of patient-centered, value-driven and technology-supported health care looks like at the:

Population Health Innovations Showcase

Wednesday, July 11th, 2012

11 am – 7 pm

Rayburn House Office Building – Rayburn Foyer

Washington DC

This Showcase brings an elite group of ten health care innovators to Capitol Hill for live interactive demonstration of cutting-edge health tools, services and programs.

Regardless of what the Supreme Court decides, we know that the innovations we are seeing in 2012 are the foundations of the health care delivery system of the future.  CCA staff had a hard time selecting only ten among the many potential participants and it was clear that there is a plethora of innovation and companies investing in Population Health Management.

Join us on July 11 to glance into the future of health care.

– Chris Coloian, Chair, CCA Board of Directors


[i] Ernst & Young, Progressions Global Life Science Report 2012

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.

Guest Post: Reimbursement Policy Needs to Join the 21st Century

Imagine a banker making a loan without knowing the precise interest rate.  Imagine a drone flyer dropping a bomb without knowing the exact coordinates.  Imagine a doctor prescribing hypertension medication based on one data point – the blood pressure score recorded in the office after the patient fought through rush hour traffic, in a panic, fearing being late for the appointment.

Of those three scenarios, one happens hundreds of times a day in America, and the others almost NEVER happen.

Wouldn’t it be great if your primary care physician could look at your last 30 blood pressure scores, recorded over the last 2 months?  Well…it is happening today, but it doesn’t happen with nearly enough frequency because the old, tired, inaccurate “one data point” process gets reimbursed; whereas, contextual, longitudinal trends on blood pressure don’t.

At Healthrageous, we witnessed the positive benefits of empowering people with hypertension through the use of wireless blood pressure cuffs.  In a random controlled trial conducted in 2008 with 404 employees of the EMC Corporation in Eastern Massachusetts, those in the intervention group who used their wireless cuffs ended up receiving twice as many medication consults as the control group – leading to more precise titration of their blood pressure medications.

We are talking about a disease that is called the “silent killer” and which affects one in three adults in our country.  Yet, reimbursement policy for wireless devices that yield meaningful clinical biometrics remains stuck in the 1950s.  Back then, a farmer with high blood pressure paid for his doctor’s visit with a dozen eggs and a quart of milk.  Surely health care reform can include accountable, self-managing consumers sharing their BP scores with their doctors.  Yet, we don’t allow reimbursement for wireless blood pressure cuffs.  We don’t reimburse physicians for interpreting treasure troves of accurate hypertension data collected over time.  We simply shrug when patients find it too difficult and disruptive to visit their doctors in order to get medication for the silent killer.  Hence, they don’t see the doctor and are “silently” being killed by our stuck-in-time reimbursement policies.

And hypertension is but one example of wireless biometrics better informing overworked doctors and giving them the necessary information to effectively prescribe for our growing, mobile population.

Rick Lee is the CEO of Healthrageous, a CCA member.  He has made a career in the creation and sales of specialty health care applications and companies.  Prior to founding Healthrageous in 2009, he ran the largest EAP in the country for Magellan, was a founder of Quality Oncology, a disease management company, and was on the founding team of Value Health, with his specialization mostly in behavioral health.

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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