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Diverse strategies, innovative solutions
2009 annual report
DMaa: the Care Continuum alliance701 Pennsylvania Ave. N.W. • Suite 700 • Washington, D.C. 20004-2694(202) 737-5980 • (202) 478-5113 fax • [email protected] • www.dmaa.org
about DMaa: the Care ContinuuM allianCe
DMAA: The Care Continuum Alliance convenes all stakeholders provid-
ing services along the care continuum toward the goal of population
health improvement. These care continuum services include strategies,
such as health and wellness promotion, disease management, and care
coordination. DMAA: The Care Continuum Alliance promotes the role
of population health improvement in raising the quality of care, im-
proving health outcomes and reducing preventable health care costs
for individuals with chronic conditions and those at risk of developing
chronic conditions. DMAA activities in support of these efforts include
advocacy, original research and the promotion of best practices in care
management.
DMAA: The Care Continuum Alliance represents more than 200 cor-
porate and individual stakeholders—including wellness, disease and
care management organizations, pharmaceutical manufacturers and
benefits managers, health information technology innovators, biotech-
nology innovators, employers, physicians, nurses and other health care
professionals, and researchers and academicians. Visit DMAA online at
www.dmaa.org.
offiCers
Chairgordon K. norman, MD, MbaChief Innovation Officer, Health ImprovementAlere
Chair-eleCtChristopher ColoianSenior Vice President, Global BusinessHealth Dialog
treasurerrose Maljanian, rn, MbaPresident and CEOStrategic Health Equations, LLC
seCretaryJerome v. vaccaro, MDPresident and Chief Operating OfficerAPS Healthcare
Chair: governMent affairsJan e. berger, MDPresident and CEOHealth Intelligence Partners
Chair: Quality & researChtehseen salimi, MD, MhaVP, Customer Medical SynergiesGlobal Medical & Regulatory Affairssanofi-aventis
at-largesusan b. riley
tracey MoorheadPresident & CEO, Ex Officio
DireCtors
Chris behlingPresidentHooper Holmes Inc.
Katie brooklerStrategic ProjectsColorado Department of Health Care Policy and Financing
gail borgatti Croall, MDChief Medical OfficerOptumHealth Inc.
D.W. edington, PhDDirector, Health Management Research CenterUniversity of Michigan
Jeffery gruen, MDDirectorPRTM Management Consultants
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A MessAge froM DMAA LeADership
An increasingly diverse mix of organizations and individuals within DMAA and the broader industry in 2009 heightened the role of population health management in health care and in efforts to reform the nation’s health care system. The indus-try’s expertise in many of the common elements of leading reform models – data use and analytics, health information technology, care coordination and coaching, outcomes measures – positioned population health as an essential component of a reformed system, regardless of the care models that prevail.
The past year also saw a strong consensus on the importance of prevention and wellness, both in the context of reform and, more broadly, in employers’ continued strong support of workplace health promotion programs. DMAA demonstrated leadership here, through its partnerships with prevention and wellness advocates, research focus on quality and outcomes and role as a strong industry representative in Washington and elsewhere. DMAA bolstered its advocacy presence in 2009 and launched a grassroots campaign to add a consumer voice to the value proposition for population health management.
Our research efforts in 2009 maintained a focus on outcomes evaluation and qual-ity improvement. DMAA produced a fourth volume of its Outcomes Guidelines Report and made the document freely available online – an association first that demonstrates our commitment to consensus measures of value. DMAA launched multiple quality initiatives, including a Web site portal, an online case studies reg-istry and an annual Quality Impact awards program, which made its debut at The Forum 09, our 11th annual meeting. The Sept. 21 to 22 Forum, the March 29 to 31 Integrated Care Summit and several Web-based seminars in 2009 fulfilled the DMAA mission to “convene, education and communicate” to advance the practice of population health improvement.
In the end, though, the proof of the pudding is in the eating. In that spirit, DMAA includes in this report an enhanced research section: case studies culled from pre-sentations at DMAA events and a review of noteworthy literature of the past year. This resource demonstrates, through real-world accounts, how population health management improves lives and lowers costs.
DMAA recognizes the commitment of its members to quality and value, and to advancing evidence-based care for the well, at-risk and chronically ill. Learn more about their work and the benefits of DMAA membership at www.dmaa.org.
Tracey Moorhead Gordon K. Norman, MD, MBAPresident and CEO Chair, Board of Directors
rajendra pratap guptaPresidentDisease Management Association of India
Joseph Kvedar, MDFounder and DirectorCenter for Connected Health, Partners Healthcare
gregg Lehman, phDPresident and CEOHealthFitness Inc.
Jeffrey Levin-scherz, MD, MBA, fACpPrincipalTowers Watson
patricia p. Mueller, MDSVP and Chief Medical OfficerCoventry Health Care
Jeremy J. Nobel, MD, MphFaculty MemberHarvard School of Public Health
emad rizk, MDPresidentMcKesson Health Solutions
seth serxner, phD, MphPrincipal and Senior ConsultantTotal Health Management specialty groupMercer
Vicki shepard MsW, ACsW, MpASenior Vice President, Strategic and Government RelationsHealthways
Dexter W. shurney, MD, MBA, MphMedical DirectorEmployee Healthcare Plan, Vanderbilt University and Medical CenterAssistant Professor, Vanderbilt School of Medicine
John sorySenior Vice President, Health Care SolutionsERT
sue WilletteSenior Vice President and Chief Growth OfficerStaywell Health Management
randall e. Williams, MD, fACCCEOPharos Innovations LLC
David B. Nash, MD, MBADeanJefferson School of Population HealthHonorary, Non-Voting
A Respected Voice for Population Health
Politics and policy framed the past year like no other topic of concern for population health management and the broader care community. The year started with a new administration and Congress eager to revitalize the economy and reform the nation’s health care system. Both initiatives harbored op-portunities and challenges for chronic disease prevention and care.
As the year progressed, DMAA assumed an industry leader-ship role through vigorous efforts to advocate legislative rec-ognition of population health management and to challenge burdensome regulatory measures that threatened workplace health promotion programs. DMAA also made its members’ voice heard in policy-making for health information technol-ogy standards, Medicare special needs plans, state prevention and health promotion programs, employer-sponsored well-ness programs – and, of course, health care reform.
DMAA Advocacy and the Reform Debate
DMAA advocacy on reform, in fact, started in late 2008, with publication of its “Principles for Health Care Reform.” DMAA remained faithful to this roadmap as reform moved through 2009 from broad concepts to detailed legislative language. The Obama administration’s “down payment” on reform – the American Recovery and Reinvestment Act (ARRA), or economic stimulus package – aligned, generally, to DMAA advocacy for prevention and wellness and, directly, in its exception for population health under new provisions to tighten HIPAA data use standards.
As debate shifted to an almost exclusive focus on reform, DMAA took an active role individually and in concert with other chronic disease care advocates, including the Partner-ship to Fight Chronic Disease (PFCD). Through Capitol Hill briefings and the establishment and chairing of a PFCD working group on Congressional Budget Office assessment of chronic care savings, DMAA helped drive a strong pres-ence for prevention and wellness in leading reform packages. DMAA also regularly made its positions known through meetings with and letters to House and Senate leaders, reaf-firming its position as the industry’s recognized advocate.
A Strong Response to Regulatory Threats
In October, DMAA took the lead in an industry response to interim final regulations for the Genetic Information Non-discrimination Act (GINA). The GINA rule, published joint-ly by the departments of Health and Human Services, Labor and the Treasury, threatened to severely restrict workplace wellness and disease management programs with prohibitions on the collection of family medical history – defined as genet-ic information – and the provision of participation incentives. DMAA rallied opposition to the new rule with support from prominent allied organizations, provided well-documented arguments to regulators about the new rule’s potential harm-ful effects and generated media coverage of the issue through strategic communications.
In other advocacy accomplishments in 2009, DMAA:
( Launched a multistate grassroots campaign to collect personal accounts from patients, case managers, physi-cians and family caregivers about the value of population health programs. The resulting “Voices of Wellness & Care Coordination” story bank, on the DMAA Web site, supported advocacy around health care reform and other important issues.
( Participated in a White House Regional Health Care Reform Summit in Des Moines, Iowa.
( Established a Board-level Health Information Technology (HIT) Committee to promote the important role of HIT in chronic condition care.
( Successfully communicated to federal officials the associa-tion’s positions on regulations arising from the ARRA, including the definition of “meaningful use” of HIT and notification requirements for breaches of protected health information.
( Conducted complimentary member Webinars on ARRA changes to HIPAA and on the implications for wellness and disease management of the GINA interim final rule.
( Co-hosted with the Partnership to Fight Chronic Disease briefings for congressional staff on the importance of chronic disease prevention and management in health care reform.
ADVoCACy
2
Our Strategic Vision: Advocate population health
improvement as a tool to improve
the quality and value of
health care.
CoNVeNe, eDuCAte, CoMMuNiCAte
In 2009, DMAA honored its commitment to advancing best practices in population health management and communicat-ing value to purchasers, payers, policy makers and other audi-ences. DMAA conducted comprehensive, onsite education and exhibit events in March and September and educational Webcasts throughout the year on practice and policy topics. DMAA also leveraged new and traditional communications vehicles, including social networking and podcasting, to expand awareness of population health management’s role in chronic disease prevention and care.
The Forum 09
The historic debate in Congress over health care reform – and population health management’s role in a reformed system – set the tone for this 11th annual meeting of DMAA, Sept. 21 and 22, in San Diego. Educational sessions, includ-ing a new “Pacesetters Policy” series, explored relevant and timely issues, including comparative effectiveness, state initiatives and the implications of a new health IT law for population-based care. Speakers reinforced the theme: former Medicare and Medicaid administrator Mark B. McClellan, MD, PhD; Agency for Healthcare Research and Quality Director Carolyn M. Clancy, MD; researcher and informed consent advocate Michael J. Barry, MD; and medical home and HIT expert David K. Nace, MD.
Integrated Care Summit
DMAA, the National Association of Manufacturers and Center for Health Value Innovation (CHVI) presented the employer-focused Integrated Care Summit March 29 to 31, in Austin, Texas. The Summit brought together employers at the forefront of workplace health promotion and lead-ing population health management providers in an intimate setting that fostered exceptional learning opportunities. Keynote speakers included CHVI President and CEO Cyndy Nayer, MA, Partnership to Fight Chronic Disease Executive Director Kenneth Thorpe, PhD, and Christine C. Ferguson, JD, director, Strategies to Overcome and Prevent (STOP)Obesity Alliance.
Webcasts
DMAA offered several remote learning opportunities in 2009, all at no or reduced cost to members, including Webcasts on “Improving Employee Health and Productiv-ity Through Communities of Medical Value,” “HIPAA and the Economic Stimulus Law: What You Need to Know” and “The GINA Regulation: Implications for Wellness and Disease Management Programs.”
Communicating the Value of Population Health
DMAA serves as a primary source of timely industry intel-ligence for members, policy makers, health care purchasers and other audiences through a variety of print and electronic vehicles. The bimonthly, peer-reviewed DMAA journal, Population Health Management, comprehensively covers the clinical and business aspects of population health manage-ment and is available online at no cost to members. The weekly DMAA electronic newsletter, DMAA eNews, provides valuable reports on health policy issues, research, corporate news and other essential topics.
Online, DMAA continues to expand its award-winning Web site, www.dmaa.org, with new features and content, including many exclusive to members. DMAA also extended its reach electronically to social media in 2009, establishing a profes-sional networking group on Linkedin and a Twitter account for updates on conference planning and other activities.
To bolster its international efforts, DMAA launched in December 2009 an International Population Health Manage-ment Wiki to build an evolving and expanding online clearinghouse of population health management practices worldwide. DMAA encourages contributions of new and updated information to the wiki, at dmaa.pbworks.com.
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eDuCAtioN/CoMMuNiCAtioN
Our Strategic Vision: Convene, educate and communicate
to aid in the continued evolution
of population health
improvement.
pArtNerships
BuiLDiNg ALLiANCes for QuALity CAre
DMAA recognizes the value of coalition building and strate-gic alliances with stakeholders across the continuum of care – physicians, employers, case managers and others. DMAA strengthened established partnerships in 2009 and formed new alliances with organizations aligned with its vision for high-quality, population-based care.
In 2009, DMAA:
( Enhanced its role as a partner organization and advi-sory board member of the Partnership to Fight Chronic Disease. DMAA contributed a chapter to the PFCD 2009 almanac, co-hosted Capitol Hill briefings on preven-tion and chronic disease issues in health care reform and established and chaired a new PFCD work group on the Congressional Budget Office scoring process.
( Co-hosted a series of Washington, D.C., briefings on pre-ventive care with the Center for Studying Health System Change and the American College of Preventive Medi-cine, including a June 8 presentation, “The Dollars and Sense of Prevention: A Primer for Health Policy Makers.”
( Collaborated with the Case Management Society of America on a case management model act and an initia-tive to identify synergies between case management and population health.
( Participated in “National Workplace Wellness Week,” April 5 to 11, 2009, as a member of the U.S. Workplace Wellness Alliance.
( Sponsored, through The Campaign to End Obesity, a Capitol Hill federal-state workshop on obesity prevention initiatives.
( Held a second annual Capitol Caucus in April 2009 with the American Association of Preferred Provider Organi-zations.
( Participated as an Executive Committee member of the Patient-Centered Primary Care Collaborative.
( Developed and led a broad-based coalition and response to federal regulations for the Genetic Information Nondiscrimination Act.
( Hosted in October 2009 the Third Annual Predictive Modeling Symposium with the Society of Actuaries.
( Engaged and supported creation of a new organization representing the Clinical Groupware Collaborative.
( Provided resources and information to a National Busi-ness Coalition on Health project to update eValu8 tool modules on wellness and disease management programs.
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Our Strategic Vision: Promote and expand stakeholders
to include all members of the
coordinated health
care team.
Our Strategic Vision: Research, identify and promote best
practices for population health
improvement strategies.
Research as a Roadmap to Quality
Understanding the best approaches to wellness, prevention and chronic condition care requires a sound base of evidence in study design and outcomes measurement. In 2009, as in each of the previous three years, DMAA advanced the science of program evaluation with its Outcomes Guidelines project, the centerpiece of an active research agenda.
DMAA research leverages the rich experience of industry-leading member organizations and individuals through a framework of committees and work groups on critical issues in population health management. Under the umbrella of the DMAA Quality and Research Committee, related panels explore current practices and emerging issues in outcomes evaluation, quality improvement, market trends, transitions of care, predictive modeling and other key topics. DMAA members enjoy exclusive access to committee participation and represent many of the brightest minds in population health improvement.
Building Consensus on Outcomes Evaluation
At its 2009 annual meeting, The Forum 09, in San Diego, DMAA released a fourth volume of its landmark Outcomes Guidelines Report. This work incorporates the recommen-dations of three previous volumes and adds significant new material, including a definition, framework, basic capabilities and core measures for population health management; addi-tional recommended measures for medication adherence and wellness programs; and special considerations for evaluating mature programs. For the first time, DMAA made the report freely available on its Web site, www.dmaa.org, demonstrat-ing its commitment to best practices and standardization in program evaluation.
Ensuring a Focus on Quality
Measuring and improving quality are integral to the popula-tion health improvement model. Population health supports a fully connected health care system that provides the health care team with tools for proactive, coordinated, high-quality care. With that perspective, DMAA launched significant initiatives last year to promote quality improvement across the continuum of care. In 2009, DMAA:
( Dedicated programming at its annual meeting to quality improvement, including a keynote by Agency for Health-care Research and Quality Director Carolyn Clancy, MD, and a Quality Impact awards presentation.
( Created a Quality in Population Health Improvement Web site to recognize the industry’s contributions to im-proving quality and to provide a single source of DMAA research publications, online tools and other resources for improving care.
( Launched a Quality Improvement Case Studies Registry under the quality site to collect accounts of program suc-cesses in a searchable, online database.
Moving Forward
As 2009 came to a close, DMAA turned to important new projects, including publication of a second market analysis, a next phase of the Outcomes Guidelines Report and work to update a DMAA dictionary of population health management terminology.
reseArCh
9
DMAA: The Care Continuum Alliance is the premier inter-national membership organization representing the full con-tinuum of care, including wellness, disease and case manage-ment. Our more than 200 corporate and individual members include established and emerging leaders in all aspects of population health management, including:
( Wellness, disease and care management organizations
( Physicians, nurses and other health care professionals
( Employers
( Health plans
( Pharmacy benefits managers
( Pharmaceutical manufacturers
( Health information technology and biotechnology innovators
( Researchers and academicians
( Hospitals
( Laboratories
DMAA meets the needs of this diverse membership with leadership in advocacy, research, education and business development. Our work on behalf of members heightens the visibility of population health management and care coordi-nation among policy makers, health care providers, purchas-ers and payers, consumers and other key constituencies.
In 2009, DMAA demonstrated the value of membership with:
( A new Population Health Resources Directory, a search-able, online database of DMAA member services and products available as a tool for prospective clients and other visitors to the DMAA Web site.
( Expanded online access to the DMAA peer-reviewed journal, Population Health Management.
( Creation of a unique “DMAA member” logo for the ex-clusive use of members to demonstrate industry leadership and commitment to quality and value.
( Webinars – free or at substantially reduced rates for members – on emerging legislative and regulatory issues in population health management.
( Significant discounts on DMAA educational meetings and publications.
( New opportunities to participate on committees and work groups that shape industry research and advocacy.
our MeMBersDMAA added 26 new organizational members in 2009, including those representing physicians and other health professionals, home health care providers and health informa-tion technology innovators. DMAA membership reflects the breadth of population-based care and the industry’s growing diversity:
( Population Health Management Organizations - Organizations that provide wellness, disease or care management or population health services or education to patients, either directly or via telehealth applications. Also health plans and integrated delivery systems, includ-ing insurers; HMOs/PPOs; Medicare Advantage plans, physician-hospital organizations; Medicaid plans; and management service organizations.
( Population Health Management Support Organiza-tions - Includes organizations providing support services to population health management providers, including software solution providers, health information technolo-gy innovators, remote patient monitoring device manufac-turers, electronic medical record systems, personal health record suppliers, predictive modeling and other stratifica-tion services.
( Individual Members - government employees, academi-cians, independent specialty consultants, independent nurse consultants, case managers, pharmacists and psy-chologists, full-time students.
( Partner Organizations - Includes employers; insurance companies (life, disability and re-insurance); academic medical centers; trade associations, accrediting organiza-tions; physician groups; executive search firms; consul-tants; and investment brokers and bankers.
( International Organizations
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the VALue of DMAA MeMBership
International
Population Health
Management Organizations
Individual
Population Health
Management Support
Organizations
45%
24%
8%
9%
Partner14%
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Accordant A CVS Caremark Company
ActiveHealth Management Inc.
Aetna Inc.
Alere
AllOne Health Management Solutions
almeda GmbH
American Medical Group Association
American Specialty Health
Ameritox, Ltd.
AnyCare GmbH
APS Healthcare Inc.
AxisMed Gestao Preventiva Da Saude SA
BioMedCom Consultants, Inc.
Blue Cross Blue Shield Association
Blue Cross Blue Shield of Arizona
Blue Cross Blue Shield of Louisiana
Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield of Michigan
Blue Cross Blue Shield of Minnesota
Blue Cross Blue Shield of Rhode Island
BlueCross BlueShield of Kansas City
BlueCross BlueShield of South Carolina
BlueCross BlueShield of Tennessee
Bluegrass Family Health
Blue Shield of California
CalorieKing
Capital Blue Cross
Care Management Technologies
CareGuide
CareSource Management Group
The Catholic Health Assoc. of the United States
Central Virginia Health Network
Children’s Mercy Family Health Partners
Christus Health
CIGNA HealthCare and CareAllies
Coventry Health Care Inc.
Daman National Health Insurance Company
Deloitte Svcs. LLP Life Sciences & Health Care
Direct Connect Solutions
Disease Management Association of India
Focused Health Solutions Inc.
ForeSee Health
Geisinger Health Plan
GlaxoSmithKline
Hazelden Foundation
Health Care Service Corp.
Health Dialog Inc.
Health Integrated Inc.
Health Partners
HealthPartners
HealthFitness
HealthLines Services BC
HealthMedia Inc.
HealthSciences Institute
Healthways Inc.
Highmark Blue Cross Blue Shield
Holman Group
Home Access Health Corporation
Honeywell HomMed LLC
Hooper Holmes Inc.
Huntsville Hospital
IMetrikus Inc.
Independence Blue Cross
INSPIRIS Inc.
Intel Corp. Digital Health
InterComponentWare Inc.
Iowa Chronic Care Consortium
Johns Hopkins HealthCare
The Joint Commission
Kaiser Permanente Health Plan Inc.
KidneyTel
Liberty Dental Plan Corporation Inc.
LifeMasters Supported SelfCare Inc.
Lockton Companies LLC
Louisiana Health Care Review Inc.
Magellan Health Services Inc.
Mayo Clinic
McKesson Health Solutions
MEDai, Inc.
MedAssurant Inc.
Medco Health Solutions Inc.
Medybiz Private Limited
Meiji Yasuda System Technology Com-pany Ltd.
Mercer LLC
Merck & Co. Inc.
Milliman Inc.
Motion Picture & Television Fund
National Association of Manufacturers
National Committee for Quality Assurance
National Pharmaceutical Council
Nationwide Better Health
NaviNet Inc.
Neighborhood Health Plan of Rhode Island
North Highland Company
Novartis Pharmaceuticals Corp.
Nurtur
Partners HealthCare System Inc.
Pfizer Health Solutions Inc.
Pharos Innovations
Phytel Inc.
Practinet BV
PricewaterhouseCoopers LLP
PRTM Management Consultants, LLC
Providence Health & Services
QualityMetric
RAND
RMD Networks
Robert Bosch Healthcare
ROMIT Disease Management
sanofi-aventis
Scandinavian Health Partner
Silverlink Communications
Solucia Consulting
Sompo Japan Research Institute
State of Colorado Medicaid
StayWell Health Management
SummaCare
Swiss Center for Telemedizin MEDGATE
Sykes Assistance Services Corporation
Symcare Personalized Health Solutions
SynCare LLC
Tethys Bioscience, Inc.
Towers Watson
Tufts Health Plan
UMR Care Management
UnitedHealth Group
Unity Health Insurance
Universal American Financial Corp.
URAC
U.S. Preventive Medicine
ValueOptions
Vanderbilt Medical Center
Verisk Health Inc.
VitalHealth Software
WellDoc Inc.
WellMed
Wellpoint Inc.
XLHealth Corp.
Yukon-Kuskokwim Health Corporation
DMAA MeMBer roster
DMAA: The Care Continuum Alliance promotes a proac-tive, accountable, patient-centric population health improve-ment model featuring a physician-guided health care deliv-ery system designed to develop and engage informed and activated patients over time to address both illness and long term health. DMAA members believe that managing health requires the active, integrated involvement of all health care professionals coordinated with the patient and their caregiv-ers and families. We offer these principles to describe the elements of this fully-connected health system, leveraging teams of care providers, focused on proactive, coordinated, quality health care.
The population health improvement model highlights three components: the central care delivery and leadership roles of the primary care physician; the critical importance of patient activation, involvement and personal responsibility; and the patient focus and capacity expansion of care coordination provided through wellness, disease and chronic care manage-ment programs. The convergence of these roles, resources and capabilities in the population health improvement model ensures higher levels of quality and satisfaction with care delivery. Further, coordination and integration are important tools to address health care workforce shortages, individual access to coverage and care, and affordability of care.
The accountability for delivering and coordinating appro-priate cost-effective care and the credit for achieving tar-geted improvement and goals for population health must be explicitly recognized and proportionately rewarded. To this end, the population health improvement model envisions optimization of both physician office practices and other services that improve population health, where demonstrated to add value. To best achieve this, payers, purchasers, patients and their advocates and other members of the health care team must promote and ensure appropriate reimbursement schedules for cognitive services, care coordination, referral activities and adherence to desired processes, such as the use of evidence-based clinical guidelines.
Key components of the population health improvement model include:
( Population identification strategies and processes;
( Comprehensive needs assessments that assess physical, psychological, economic, and environmental needs;
( Proactive health promotion programs that increase aware-ness of the health risks associated with certain personal behaviors and lifestyles;
( Patient-centric health management goals and education which may include primary prevention, behavior modi-fication programs, and support for concordance between the patient and the primary care provider;
( Self-management interventions aimed at influencing the targeted population to make behavioral changes;
( Routine reporting and feedback loops which may include communications with patient, physicians, health plan and ancillary providers;
( Evaluation of clinical, humanistic, and economic out-comes on an ongoing basis with the goal of improving overall population health.
The population health improvement model:
( Encourages patients to have a provider relationship where they receive on going primary care in addition to specialty care;
( Complements the physician/practitioner and patient relationship and plan of care across all stages, including wellness, prevention, chronic, acute and end-of-life care;
( Assists unpaid caregivers, such as family and friends, by providing relevant information and care coordination;
( Offers physicians additional resources to address gaps in patient health care literacy, knowledge of the health care system, and timeliness of treatment;
( Assists physicians in collecting, coordinating and analyz-ing patient specific information and data from multiple members of the health care team including the patients themselves;
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ADVANCiNg the popuLAtioN heALth iMproVeMeNt MoDeL
our MissioN
We believe the highest achievable health status is
attained through the promotion and alignment of
population health improvement by:
( Promoting a proactive, patient-centric focus across
the care continuum;
( Convening health care professionals across the care
continuum to share and integrate practice models;
( Emphasizing the importance of both healthful be-
haviors and evidence-based care in preventing and
managing chronic conditions;
( Promoting high quality standards for and defini-
tions of key components of wellness, disease and,
where appropriate, case management, and care
coordination programs as well as support services
and materials;
( Identifying, researching, sharing and encouraging
innovative approaches and best practices care
delivery and reimbursement models;
( Establishing consensus-based outcomes measures
and demonstrating health, satisfaction, and finan-
cial improvements achieved through wellness, dis-
ease and case management, and care coordination
programs;
( Supporting delivery system models that ensure
appropriate care for chronic conditions and coor-
dination among all health care providers includ-
ing strategies such as the Chronic Care Model,
the physician-led medical home concept, and the
disease management model;
( Encouraging the widespread adoption and interop-
erability of health information technologies;
( Advocating the principles and benefits of popula-
tion health improvement to public health officials,
including state and federal government entities;
( Underscoring the level of commitment to popula-
tion health improvement and timeframes necessary
to realize the full benefits.
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( Assists physicians in analyzing data across entire patient populations;
( Addresses cultural sensitivities and preferences of indi-viduals from disparate backgrounds;
( Promotes complementary care settings and techniques such as group visits, remote patient monitoring, telemedi-cine, telehealth, and behavior modification and motivation techniques for appropriate patient populations.
Accountable measurement of progress toward optimized population health should include:
( Various clinical indicators, including process and out-comes measures;
( Assessment of patient satisfaction with health care;
( Functional status and quality of life;
( Economic and health care utilization indicators; and
( Impact on known population health disparities.
DMAA: The Care Continuum Alliance supports this popula-tion health improvement model to provide the elements of a fully-connected health care system to provide all members of the health care team essential tools to ensure proactive, coordinated, quality health care.
Our Vision: All stakeholders in the health
care continuum are aligned toward
optimizing the health of
populations.
The more than 200 members of DMAA: The Care Continuum
Alliance represent leaders in all aspects of population health
management. Their experience and expertise, documented
in the peer-reviewed literature and on display annually at The
Forum, Integrated Care Summit and other DMAA educational
events, advances understanding of established approaches to
chronic condition prevention and care and promising new strat-
egies to improve health care quality and value.
In the pages that follow, we chronicle the accomplishments of
DMAA members and other innovative organizations dedicated
to improving population health and to evaluating outcomes
with measures born of best practices and industry consensus.
Explore population health management’s valuable contributions
to care through these brief case studies and selected abstracts
from the DMAA peer-reviewed journal, Population Health Man-
agement, and other respected publications. Learn how wellness,
disease management and other population-based interventions
in diverse settings, from the workplace to the physician’s office,
improve health, mitigate risk and lower costs.
popuLAtioN heALth MANAgeMeNt: profiLes iN CAre QuALity & VALue
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Lancaster County Business Group on Health BRiDGE Project
The Lancaster County Business Group on Health, GlaxoSmithKline and American Pharmacists Association partnered on the BRiDGE Project, a cost-effective, patient-centric model that brought significant savings, reduced absenteeism and improved health when employees received tools to take control of their disease and rewards for doing so. Key factors are the role of the pharmacist, who provides one-on-one coaching, and referrals to local community resources through the attending physician, thereby improving medica-tion adherence and improved diet and exercise.
ResultsOne year results of The BRiDGE Project show an average net total cost savings of $5,812 per patient. On average, A1c levels dropped 8.1 percent to 7.3 percent. LDL levels of less than 100 (an American Diabetes Association goal) increased from 38 percent to 67 percent.
Hands-On Care for the Frail Elderly
Easy Care, a community-based care management program, collaborates with HealthSpring, a Medicare Advantage coordinated care plan, in caring for the sickest and most frail Medicare patients living in the community. Lessons learned include the importance of implementation management; early and regular communication to network physicians and members and between teams; coordination with all vendors; and establishing data sets early.
ResultsOver almost three years, hospital admissions have decreased by more than 30 percent, and the medical loss ratio (MLR) for this group has fallen by 56 percent. Cost reductions of more than 30 percent have continued over time.
Targeted Chronic Disease Care in the Advanced Medical Home
MeritCare Health System’s award-winning diabetes man-agement program conducted in conjunction with BlueCross BlueShield of North Dakota uses the advanced medical home model of care delivery. This novel approach enhances the coordination of care provided to primary care patients and intensifies the care of patients with chronic medical condi-tions to reduce complications.
ResultsMeritCare Health System improved outcomes for patients, as evidenced by decreased hospitalizations and decreased emer-gency department visits, saving more than $500 per patient per year; and improved hypertension, LDL cholesterol and hemoglobin A1c control.
A Physician-Directed Population Management Strategy
OptumHealth Inc. tested the concept of physician-directed population management in three primary care physician practices, involving 546 patients exhibiting claims markers for coronary artery disease (CAD), diabetes and hyperten-sion. Critical components of the pilot included physician management of evidence-based medicine opportunities, ac-tive physician referrals into disease management and wellness programs and a pay-for-outcomes risk factor management incentive.
ResultsPhysicians planned to take action, took action or actively closed 63 percent of 1,421 evidence-based opportunities forwarded. Physicians referred 80 of 187 eligible members to health and wellness programs, and 43 members actively enrolled in the programs. A net of 96 distinct risk factor im-provements were achieved during the study period, compared with nine risk factor improvements in the six months prior to the study period.
Point of Service Population Health Management
Geisinger Health Plan and Geisinger Community Prac-tice have implemented ProvenHealth Navigator (PHN) to redesign primary care practices, providing population health management services at the point of service. A central feature of the model is disease and case management for patients with chronic, comorbid conditions, such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), dia-betes, CAD and chronic kidney disease, with case managers embedded into the primary care office.
ResultsQuality indicators related to diabetes, hypertension, CAD and preventive care screenings have improved. PHN also is associated with a 17 percent lower admission rate, a 14.5 percent lower readmission rate, a 15 percent lower inpatient expense per member per month (PMPM), and an 11 percent lower pre-drug medical expense PMPM. In addition, reduc-tions in acute admissions per 1,000 for CHF (-16 percent), COPD (-17 percent) and diabetes (-14 percent) were noted.
CAse stuDies: improving the health of populations
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Reducing Tobacco Use and Exposure to Second-Hand Smoke
One component of Blue Cross’ comprehensive approach to reducing tobacco use and exposure to second-hand smoke is stop-smoking support. The program’s success can be attrib-uted to access to pharmacy claims data for tobacco treatment medications, ease of physician referrals to smoking cessation programs and rewards for provider groups that offer quitting assistance. The Minnesota Adult Tobacco Survey (MATS) measured the prevalence of smoking from a random sample of Blue Cross members in Minnesota. Using enrollment, disenrollment, current and former smoking prevalence and smoking-related disease prevalence data, Blue Cross calcu-lated annual health care cost and productivity savings over five years, from 2003 to 2007. ResultsThe MATS demonstrated tobacco use among members de-clined significantly, from 14.7 percent in 1999 to 10.9 percent in 2007 (p<.01), a decline of 26 percent since 1999. Among all Minnesotans, smoking rates declined from 22.07 percent in 1999 to 17.0 percent in 2007. For all plan types, cumulative total savings over five years were $126.8 million from reduced health care costs, and $17.1 million from reduced productivity losses. Savings per additional nonsmoker over five years were $5,335 in health care costs savings, and $721 in productivity savings.
Lowering Costs Through Comprehensive Health Promotion
Highmark offered a comprehensive health promotion pro-gram to all its employees beginning in summer 2002. The Highmark Wellness Program offers health risk assessments (HRAs); online programs in nutrition, weight management
and stress management; tobacco cessation programs; onsite nutrition and stress classes; and various promotional campaigns to increase fitness participation and awareness of disease prevention strategies.
ResultsThe program yielded a return on investment of $1.65 for every dollar spent on the program. Four-year expenditures were $808,403, and savings were $1,225,524. Health care expenses per person per year were $176 lower for participants, and inpatient expenses were lower by $182.
Best Practice vs. Standard Practice Program Design
The goal of this case study is to better understand the preva-lence of best practice program elements among StayWell Health Management customers and to explore the differences in engagement rates and health risk change based on use of “best practice” versus “standard practice” program designs. Best practices based on nine components were identified in published literature and by industry experts. Information on the use of best practices was collected from standard reports, internal documentation and structured interviews with ac-count management staff. Companies were rated on the extent of their implementation of best practices and assigned a total score. Standard definitions were used to calculate engagement rates and health impact measures.
ResultsCompanies using recognized best practices in the industry demonstrate superior program engagement rates and health risk reduction when compared with standard practice compa-nies. More research is needed to determine influence of other factors on these measures (e.g., organizational culture, pro-gram maturity). Forty-eight percent of those who completed a telephone-based weight control program lost weight.
CAse stuDies: promoting health and Wellness
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Value-Based Drug Benefit Design at Marriott
Observational and prospective studies show that by selectively reducing the cost disincentive, value-based insurance drug benefit design improves appropriate chronic medication use. Marriott International and ActiveHealth Management worked together to discover why employees are not compliant and how to incentivize people to take the most essential drugs.
ResultsMarriott reduced copayments for members in five specific drug classes and for those not on a treatment but with a high-risk profile, resulting in improved adherence and medical savings that offset costs from subsidies and increased drug use. Members appropriately starting a new drug showed a 24.95 percent increase for all drug classes. Adherence (defined as a medication possession ratio greater than or equal to 75 percent) increased for all five drug classes by 27.42 percent. Savings from averted clinical adverse events was calculated at $1.17 per member per month (PMPM) and cost from subsi-dies and increased drug use, at $0.96 PMPM for a net savings of $0.21 PMPM.
Encouraging Beta Blocker Use to Reduce Subsequent AMI
The goal of this study, by Blue Cross Blue Shield Associa-tion and BlueCross BlueShield of Tennessee, was to reduce subsequent acute myocardial infarctions (AMIs) in patients admitted for an AMI by encouraging the use of beta blockers. The intervention consisted of providing educational materi-als to physicians and patients, counseling on the importance of continuing the beta blocker medications and coordinating physician services.
ResultsParticipants displayed better compliance with beta blocker medication and experienced fewer subsequent AMIs than non-participants, even though their average risk score would
have predicted more events. For avoiding additional inpatient stays, the estimated savings provided a return on investment (ROI) of $1.52 per $1 spent. For reducing the number of AMI episodes, the estimated savings provided an ROI of $2.25 per $1 spent.
Enhancing Statin Therapy Efficiency for At-Risk Patients
The goals of this study, by Blue Cross Blue Shield Associa-tion and BlueCross BlueShield of Texas, a division of Health Care Service Corporation, were to increase utilization of statins among at-risk patients and to increase generic statin utilization. The health plan identified members within a large employer group who were at risk of a major adverse cardiac event (MACE) and recommended that providers initiate a statin regimen for those without a statin claim. In addition, all members of the plan were required to try a generic before a brand statin.
ResultsThe program resulted in an increase in overall statin usage and an increase in use of generic statins. For every 17 mem-bers at risk of MACE, one member initiated statin therapy during the three-month follow up. The intervention group’s generic market share increased to 51 percent, while the control group’s generic market share increased to 32 percent. Plan PMPM payments for the drug class decreased $0.58 in the intervention group, and the control group decreased $0.53.
Integrated Diabetes Disease Management in the Medical Home
To support the Medical Home Model, Blue Cross Blue Shield of Massachusetts partnered with an alliance of physi-cian groups, Atrius Health, to increase patient activation and integrate diabetes disease management. Strategies included an evaluation of active member participation, as well as an examination of areas of overlap between individual disease management activities to identify opportunities to leverage unique core competencies and reduce redundancies through integration.
ResultsThe results of the Collaborative Chronic Illness Care pilot have been an increase in member engagement from 23 per-cent to 47 percent and more efficient care delivery, resulting in improved clinical outcomes, exceptional care and a flexible project structure with high portability potential.
CAse stuDies: Managing Chronic Conditions
Cummins – Application of Six Sigma
Cummins Inc. has successfully applied Six Sigma principles to the execution of onsite clinics, wellness programs and disease, case and utilization management programs. Six Sigma allows the company to align with the business strate-gies of reducing costs, increasing customer satisfaction and producing superior financial results. Six Sigma principles and methodology can be applied to the design, implementation, delivery and measurement of comprehensive health manage-ment programs. This innovative approach provides structure, discipline and accountability, resulting in significant savings over a relatively short period.
ResultsCummins has effectively executed a complex, incentive-driven health management program with impressive results, including a 13 percent decrease in risk for excessive utiliza-tion and a 7 percent decrease in medication compliance risk after only 12 months. From a behavior change perspective, Cummins wanted to ensure that employees had access to the right medications and that the medications were used at the right medication possession ratio (MPR). As a result of the SHPS Inc. programs, the baseline MPR measure started at 0.55 in 2007, and dropped to 0.51 for the current population (baseline population still employed).
Overcoming Barriers to Enrollment and Engagement
To improve a program’s opt-in rate, HMC developed dis-ease management engagement process models to understand the attributes that lead to successful operational outcomes. HMC analyzed three binomial logistic regression models, with dependent variables that included member permission to participate, or enrollment; member assessment follow-ing enrollment, or engagement; and member engagement on the first call following enrollment. Independent variables included ZIP code-level demographic factors, internal data, operational factors, and health plan factors. ResultsHMC found that it was most successful at enrolling members who have socioeconomic, educational or geographical barri-ers to regular, proactive care. By identifying such attributes with a high level of statistical certainty, HMC can focus on reducing barriers to enrollment by customizing marketing strategies for certain subgroups to drive stronger operational outcomes.
Impact of Adherence to Optimal Lifestyle Metrics
Adherence to four specific, lifestyle-related health behaviors (physical activity, non-tobacco use, moderate alcohol use and consumption of five fruits and vegetables per day) has been associated with increased longevity (as much as 14 years) and improved functional health status. This investigation, by HealthPartners’ JourneyWell division and AB3Health LLC, studies the impact of adherence to varying levels of this opti-mal lifestyle metric (OLM) and incidence of chronic condi-tions among employed adults. Improved understanding of the impact of lifestyle-related health behaviors may hold signifi-cant potential for population health improvement strategies.
ResultsAdherence to three or four components of the OLM, com-pared with none or one component, showed a reduction in risk for diabetes (66 percent), heart disease (45 percent), cholesterol (17 percent), hypertension (15 percent), back pain (43 percent) and cancer (24 percent). As adherence to OLM components improves, two-year incidence rates fall by 15 percent for hypertension and 66 percent for diabetes.
Prospective vs. Annual Requalification ID
Population health management evaluation is impacted by measurement approaches tied to identification methods: “requalification” vs. “prospective.” It is hypothesized that the prospective evaluation approach to measurement produces inaccurate savings calculations due to the effect of regression to the mean.
ResultsPrevalence and its trend are higher for the prospective cohort than the requalified cohort. Average monthly cost decline is higher for the prospective group compared with the requali-fied group. Therefore, average monthly savings are higher for the prospective group vis-à-vis the requalified group. The average risks profile also is lower for the prospective group compared with the requalified group. Given higher savings and prevalence for the prospective group, the total savings is higher and, therefore, return on investment (ROI) is higher in that group. The difference in ROI narrows in subsequent years, but still, a substantial absolute difference in ROI persists between prospective and requalified group.
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CAse stuDies: proven Approaches to program evaluation and Design
How Employers Use Incentives to Keep Employees Healthy: Perks, Programs and Peers
Medical BenefitsCapps K, Harkey J.Vol. 26, No. 23, 15 December 2009
Objective: To review the 2009 survey of small, medium and large employers’ health and wellness programs in the United States
Conclusion: More than two out of three companies in all sizes offer formal health and wellness or disease management programs and incentives to encourage employee participa-tion. Smoking cessation programs are the most popular, fol-lowed by weight management and physical activity programs.
Obesity Management Interventions: A Review of the Evidence
Population Health ManagementYaskin, J., Toner, R.W., Goldfarb, N.Vol. 12, No. 6, 2009
Objective: To provide an overview of the full range of methods and models for weight loss, including some available without medical supervision.
Conclusion: Combination approaches – surgical or pharma-cologic, combined with a behavioral intervention – were most likely to be effective.
Using an Ounce of Prevention: Does It Reduce Health Care Expenditures and Reap Pounds of Profits? A Study of the Financial Impact of Wellness and Health Risk Screening Programs
Journal of Health Care FinancePhillips, JF.Vol. 36, No. 2, Winter 2009
Objective: To understand the impact of wellness and health risk screening programs on an employed population.
Conclusion: The research suggests that active participation in wellness and health risk screening programs may be a fac-tor in the health care costs for the individuals studied, which was lower than the overall per-capita health care costs in the United States.
Worksite Health Promotion: The Value of the Tune Up Your Heart Program
Population Health ManagementChung, M., Melnyk, P., Blue, D., Renaud, D., Breton, M.Vol. 12, No. 6, 2009
Objective: To evaluate Tune Up Your Heart, a Daimler-Chrysler Canada Inc. (DCCI) program aimed at improving workforce cardiovascular disease (CVD) risk.
Conclusion: Program participants demonstrated significant improvements in CVD risk, weight, body mass index, blood pressure and adherence to recommended exercise and diet regimens.
An Ounce Of Prevention More Than A Pound Of Cure
Financial ExecutiveLadd S.Vol. 25, No. 8, October 2009
Objective: To discuss corporate wellness programs.
Conclusion: Nearly 60 percent of companies queried offer wellness programs. In addition, 80 percent make available to employees health risk assessments and 56 percent use health coaches. Effective programs involve a holistic commitment to wellness that embraces management, employees and service providers.
Impact of Decision Support in Electronic Medical Records on Lipid Management in Primary Care
Population Health ManagementGill, J.M., Chen, Y.X., Glutting, J.J., Diamond, J.J., Lieberman, M.I.Vol. 12, No. 5, 2009
Objective: To examine the impact of lipid management tools integrated into an electronic medical record (EMR) in primary care practices.
Conclusion: This study showed few differences in quality of lipid management after implementing an EMR-based disease management intervention in primary care settings. How-ever, a team approach to care in which ancillary staff identify patients in need of testing or more aggressive management could increase the tools’ effectiveness.
ABstrACts
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Incorporating Tailored Interactive Patient Solutions Using Interactive Voice Response Technology to Improve Statin Adherence: Results of a Randomized Clinical Trial in a Managed Care Setting
Population Health Management Stacy J, Schwartz S, Ershoff D, Shreve M.Vol. 12, No. 5, October 2009
Objective: To study the impact of a behavior change pro-gram to increase statin adherence using interactive voice response (IVR) technology.
Conclusion: Results of this study suggest that a behavioral support program using IVR technology can be a cost-effec-tive modality to address the important public health problem of patient non-adherence to statin medication.
Initial Implementation of a Depression Care Manager Model: An Observational Study of Outpatient Utilization in Primary Care Clinics
Population Health ManagementAngstman, K.B., DeJesus, R.S., Williams, M.D.Vol. 12, No. 5, 2009
Objective: Follow-up care, medication adherence and comor-bid condition management can challenge optimal depression care in the primary care setting. This study evaluated the impact of using a depression care manager model to address these issues.
Conclusion: This study found that initial use of a depres-sion care manager model significantly increased utilization of health care resources for any reason and, specifically, for depression.
Health Risk Appraisals: How Much Do They Influence Employees’ Health Behavior?
Health AffairsHuskamp HA, Rosenthal MB.Vol. 28, No. 5, September/October 2009
Objective: Examine the characteristics associated with voluntary completion of a health risk assessment (HRA) for enrollees of an employer-sponsored health insurance plan.
Results: The study found that there were some differences in HRA completers and non-completers. In addition, when comparing the two groups, results show that an HRA can improve quality of care.
The Application of Disease Management to Clinical Trial Designs
Population Health Management Puterman J, Alter DA.Vol. 12, No. 4, August 2009
Objective: To evaluate the extent to which clinical trials incorporate disease management as a minimum standard of care for both the intervention and control groups.
Conclusion: The application of disease management pro-grams has increased over time as a viable intervention in clinical trial design, but there is opportunity for increased use.
The Effects of a Computer-Tailored Message on Second-ary Prevention in Type 2 Diabetes: A Randomized Trial
Population Health Management Adams SY, Crawford AG, Rimal RN, Lee JS, Janneck LM, Sciamanna CN. Vol. 12, No. 4, August 2009
Objective: To test the effect of computer-generated, tailored feedback on the quality of chronic disease management for type 2 diabetes when provided to a patient prior to a sched-uled physician visit.
Conclusion: Although there were no significant differences in the percentage of participants who received intensified care or routine tests between the control and intervention groups, the results indicate that more directed messaging may be needed to help patients effectively manage their diabetes. Patients might benefit from directed feedback, providing them with specific questions to ask their physician that can lead to improved care, rather than receiving general and edu-cational informational messages.
Integrating Pay for Performance with Educational Strategies to Improve Diabetes Care
Population Health ManagementFoels, T, Hewner, S.Vol. 12, No. 3, 2009
Objective: To improve consistency of adherence to evidence-based diabetes guidelines, to engage physicians in critical re-view of their practice patterns around care of diabetic patients and to change office systems to improve care.
Conclusion: The program achieved significant improvement in comprehensive diabetes care at the physician practice site level. Success is attributed to engagement of physicians, ac-tionable reports, office-based education, written action plans and alignment with internal disease management.
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The Effects of a Disease Management Program on Self-Reported Health Behaviors and Health Outcomes: Evidence From the “Florida: A Health State (FAHS)” Medicaid Program
Health Education & BehaviorMorisky D, Kominski G, Abdelmonem A, Kotlerman J.Vol. 36, No. 3, June 2009
Objective: To measure the effects of a disease management program on physiological and behavioral health indicators for Medicaid patients in Florida.
Conclusion: Patients in the disease management program benefited through better control of hypertension, asthma symptoms and cholesterol and blood glucose levels.
Urban-Rural Differences in the Effect of a Medicare Health Promotion and Disease Self-Management Program on Physical Function and Health Care Expen-ditures
The GerontologistMeng H, Wamsley B, Liebel D, Dixon D, Eggert G, Nostrand J.Vol. 49, No. 3, 2009
Objective: To evaluate the impact of a multi-component health promotion and disease self-management intervention on physical function and health care expenditures among Medicare beneficiaries and to determine if these outcomes vary by urban or rural residence.
Conclusion: The intervention offered a promising strategy for reducing decline in physical function and potentially low-ering total health care expenditures for high-risk Medicare beneficiaries, especially for those in rural areas. Future stud-ies need to investigate whether the findings can be replicated in other types of rural areas through a refined intervention and better targeting of the study population.
Health and Productivity as a Business Strategy: a Multiemployer Study
Journal of Occupational and Environmental MedicineLoeppke R, Taitel M, Haufle V, Parry T, Kessler RC, Jinnett K.Vol. 51, No. 4, April 2009
Objective: To explore methodological refinements in mea-suring health-related lost productivity and to assess the busi-ness implications of a full-cost approach to managing health.
Conclusion: A strong link exists between health and pro-ductivity. Integrating productivity data with health data can help employers develop effective workplace health and human capital investment strategies. More research is needed to understand the impacts of comorbidity and to evaluate the cost-effectiveness of health and productivity interventions from an employer perspective.
The Relationship Between Modifiable Health Risk Factors and Medical Expenditures, Absenteeism, Short Term Disability, and Presenteeism Among Employees at Novartis
Journal of Occupational and Environmental MedicineGoetzel RZ, Carls GS, Wang S, Kelly E, Mauceri E, Columbus D, Cavuoti A.Vol. 51, No. 4, April 2009
Objective: To examine the relationships among employee health risks and medical care and productivity outcomes, and to quantify the differences in these outcomes when compar-ing high-risk with lower-risk employees.
Conclusion: Three group factors were created from the study data that statistically grouped risks into three catego-ries: high biometric laboratory values, smoking and alcohol use, and emotional health risk. The study results showed a significant association among the health risks associated with the categories and increased presenteeism.
Cholesterol Measurement as a Workplace Health Promotion Intervention
Occupational HealthFritsch M, Montpellier J, Kussman C.Vol. 61, No. 3, March 2009
Objective: To determine the impact of education and coach-ing on lifestyle choices and lipid values among employees with hyperlipidemia.
Conclusion: Total cholesterol and low-density lipoprotein values improved during the intervention. Positive lifestyle changes were made involving exercise and diet. Appropriate physician visits and continuous health care increased. Lipid-based interventions at the worksite can elicit positive changes in lifestyle, appropriate health care use and improved lipid values.
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Do Employee Health Management Programs Work?
American Journal of Health PromotionSerxner S, Gold D, Meraz A, Gray A.Vol. 23, No. 4, March/April 2009
Objective: To explore the various aspects of a population health management program, including measurement of such a program, best practice program characteristics and a review of the literature for recent real world program outcomes.
Conclusion: Research suggests that programs using the outlined best practice characteristics have positive return on investment with substantial impact on health care costs over two to three years.
“Dial-an-ROI?” Changing Basic Variables Impacts Cost Trends in Single-Population Pre-Post (“DMAA Type”) Savings Analysis
Population Health ManagementJuster IA, Rosenberg SN, Senapati D, Shah MR.Vol. 12, No. 1, February 2009
Objective: To understand if chronic (absent disease manage-ment) and non-chronic trends are similar.
Conclusion: Chronic and non-chronic trends are similar based on the criteria recommended in the DMAA Outcomes Guidelines Report.
How To Measure the Outcomes of Chronic Disease Management
Population Health ManagementLewis, A.Vol. 12, No. 1, 2009
Objective: To demonstrate a methodology for disease man-agement outcomes measurement that is valid, transparent, easy to apply and freely available in the public domain.
Conclusion: In the health plan community as a whole, disease management in the broadest sense is effective, as measured by the relative stability in the rate of adverse medi-cal events closely associated with common chronic disease at a time when prevalence of most common chronic conditions is increasing.
Impact of 2 Employer-Sponsored Population Health Management Programs on Medical Care Cost and Utilization
American Journal of Managed Care Mattke S, Serxner SA, Zakowski SL, Jain AK, Gold DB.Vol. 15, No. 2, February 2009
Objective: To estimate the overall impact of a population health management program and its components on cost and utilization.
Conclusion: Results suggest that the programs did not reduce medical cost in their first year, despite a beneficial ef-fect on hospital admissions. Although this study had impor-tant limitations, the results suggest that a belief that these programs will save money may be too optimistic and better evaluation is needed.
Using Qualitative and Quantitative Methods to Evaluate Small-Scale Disease Management Pilot Programs
Population Health ManagementEsposito, D., Taylor, E.F., Gold, M.Vol. 12, No. 1, 2009
Objective: To evaluate small interventions in the Medicaid Value Program (MVP), which targeted various subpopula-tions of recipients with multiple chronic conditions.
Conclusion: The combined evaluation of qualitative and quantitative data helps assess the potential promise of each intervention and identify themes and challenges common to all. The collective experiences of the MVP interventions sug-gest that well-conceived efforts to integrate care across a con-tinuum of services – primary care, mental health, substance abuse, long-term care – holds promise if properly targeted, standardized ahead of time and supported by key clinical staff and organizational leadership.
Obesity and the Workplace: Current Programs and Attitudes Among Employers and Employees
Health AffairsGabel JR, Whitmore H, Pickreign J, Ferguson CC, Jain A, K C S, Scherer H.Vol. 28, No. 1, January/February 2009
Objective: Survey employers and employees regarding the presence and effectiveness of weight loss programs in the workplace.
Results: Both employer and employee survey respondents view workplace weight management and obesity programs as effective and believe these programs succeed in lowering the rate of obesity in the workplace.
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about DMaa: the Care ContinuuM allianCe
DMAA: The Care Continuum Alliance convenes all stakeholders provid-
ing services along the care continuum toward the goal of population
health improvement. These care continuum services include strategies,
such as health and wellness promotion, disease management, and care
coordination. DMAA: The Care Continuum Alliance promotes the role
of population health improvement in raising the quality of care, im-
proving health outcomes and reducing preventable health care costs
for individuals with chronic conditions and those at risk of developing
chronic conditions. DMAA activities in support of these efforts include
advocacy, original research and the promotion of best practices in care
management.
DMAA: The Care Continuum Alliance represents more than 200 cor-
porate and individual stakeholders—including wellness, disease and
care management organizations, pharmaceutical manufacturers and
benefits managers, health information technology innovators, biotech-
nology innovators, employers, physicians, nurses and other health care
professionals, and researchers and academicians. Visit DMAA online at
www.dmaa.org.
offiCers
Chairgordon K. norman, MD, MbaChief Innovation Officer, Health ImprovementAlere
Chair-eleCtChristopher ColoianSenior Vice President, Global BusinessHealth Dialog
treasurerrose Maljanian, rn, MbaPresident and CEOStrategic Health Equations, LLC
seCretaryJerome v. vaccaro, MDPresident and Chief Operating OfficerAPS Healthcare
Chair: governMent affairsJan e. berger, MDPresident and CEOHealth Intelligence Partners
Chair: Quality & researChtehseen salimi, MD, MhaVP, Customer Medical SynergiesGlobal Medical & Regulatory Affairssanofi-aventis
at-largesusan b. riley
tracey MoorheadPresident & CEO, Ex Officio
DireCtors
Chris behlingPresidentHooper Holmes Inc.
Katie brooklerStrategic ProjectsColorado Department of Health Care Policy and Financing
gail borgatti Croall, MDChief Medical OfficerOptumHealth Inc.
D.W. edington, PhDDirector, Health Management Research CenterUniversity of Michigan
Jeffery gruen, MDDirectorPRTM Management Consultants
Diverse strategies, innovative solutions
2009 annual report
DMaa: the Care Continuum alliance701 Pennsylvania Ave. N.W. • Suite 700 • Washington, D.C. 20004-2694(202) 737-5980 • (202) 478-5113 fax • [email protected] • www.dmaa.org
