Health Plan Strategies to Improve Public Health

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  • 1. Health Plan Strategies to Improve Public Health CDC Heart Disease and Stroke Prevention Annual Meeting September 15, 2009 Lisa M. Latts, MD, MSPH, FACP VP, Programs in Clinical Excellence
  • 2. Agenda
    • Introduction to WellPoint
    • Challenges to Improving Health
    • Member Health Index
    • State Health Index
    • Health Disparities
    • Local/National Partnerships to Improve Health
    • Physician Partnerships to Improve Cardiovascular Health
    • Childhood Obesity A Case Study
  • 3. WellPoint, Inc. 34 Million Members Across the United States, 1 in every 9 Americans covered by WellPoint Plans Blue Cross or Blue Cross Blue Shield UniCare >100K members
  • 4. The State of U.S. Population Health Obesity Physical Activity Smoking Stress 66% obese or overweight 28% inactive 23% smokers 36% high stress Key Drivers of Health Status Aging 22% > 55 years, aging population Driver Prevalence Population health status continues to deteriorate Schroeder S. N Engl J Med 2007;357:1221-1228
  • 5. Prevalence of Chronic Illnesses More than 130 million Americans suffer from chronic conditions Population in Millions % of Population Chronic Condition Prevalence in America Annual Cost Diabetes 16 million
    • $105 billion in health expenses
    • 11 million lost work days
    Heart Disease 60 million
    • $300 billion in health expenses
    • 1 million deaths
    Asthma 14 million
    • $5.1 billion in medical expenses
    • 2.1 million missed work days
    Depression 17 million
    • $43 billion
  • 6. Inconsistent Quality in Care Delivery 64.7% Hypertension 63.9% Congestive Heart Failure 53.9% Colorectal Cancer 53.5% Asthma 45.4% Diabetes 39.0% Pneumonia 22.8% Hip Fracture % of Recommended Care Received Source: Elizabeth McGlynn et al, RAND, 2003 Nearly one-half of physician care not based on established best practices Patients do not receive care in accordance with best practices Patients receive care in accordance with best practices 45% 55%
  • 7. Health Care Quality Defects Occur at Alarming Rates Defects per million level (% defects) U.S. Industry Best-in-Class Anesthesia-related fatality rate Airline baggage handling Outpatient ABX for colds Post-MI b-blockers Breast cancer screening (65-69) Detection & treatment of depression Adverse drug events Hospital acquired infections Hospitalized patients injured through negligence 1 (69%) 2 (31%) 3 (7%) 4 (.6%) 5 (.002%) 6 (.00003%) Source: modified from C. Buck, GE Overall Health Care in U.S. (RAND)
  • 8. Measuring Health Improvement: WellPoint Health Indices Mission Health Indices Domains Maternity and Prenatal Care Lifestyle Mortality and Morbidity Clinical Outcomes Care Management Patient Safety Preventive Care Prevention and Screening Member Health Index State Health Index Improve the lives of the people we serve and the health of our communities
  • 9. WellPoint Member Health Index: Improving Population Health Screening and Prevention
    • Diabetes ER visits
    • Congestive heart failure ER visits
    • Asthma ER visits
    • Select hospital admissions
    • Select 30-day readmis s ions
      • Diabetes compliance
      • Hypertension compliance
      • Behavioral health follow-up
      • Controller medications for asthma
      • Appropriate treatment for upper respiratory infection
      • Participation in disease management programs
    Patient Safety Clinical Outcomes Care Management
    • Breast cancer screening
    • Cervical cancer screening
    • Colorectal cancer screening
    • High cholesterol screening
    • Childhood immunizations
      • Patient safety hospital structural index
      • Patient safety outcome index
      • Persistent medication monitoring
    4 Domains of health care services covering 20 Clinical Areas; comprised of 40 Measures
  • 10. Screening and Prevention: Why these measures?
      • Preventive screenings decrease cancer and heart disease mortality
      • Early diagnosis of breast, cervical and colorectal cancer significantly decrease treatment costs
      • Timely colorectal cancer screening can prevent colorectal cancer
      • High cholesterol is major risk factor for cardiovascular disease
      • Childhood immunization is the most important intervention to prevent childhood illness and reduce costs
    Breast cancer screening % getting mammography Cervical cancer screening % getting pap smear Colorectal cancer screening % getting screening High cholesterol screening % getting cholesterol test Childhood immunizations % getting full series for six immunizations
  • 11. Care Management: Why these measures?
      • 40% - 50% of health care costs attributed to five chronic diseases
        • Diabetes, asthma, congestive heart failure, hypertension, and coronary artery disease
      • Clinical guidelines are not consistently followed 45% of the time (RAND)
      • Chronic illnesses prevalence increasing
        • More prevalent in African Americans and Latinos
      • Established methods for measuring results
      • DM programs are designed to improve care guideline compliance
    Diabetes compliance A1c lab testing Cholesterol lab testing Eye exams Kidney disease monitoring Hypertension compliance % on antihypertensive drugs % getting cholesterol tests Behavioral health follow up % getting follow up care Controller meds for asthmatics % getting controller meds Appropriate treatment for URI % getting antibiotics HMC participation % high intensity participating HMC Blood Pressure control % that know their BP % that have a controlled BP
  • 12. Clinical Outcomes: Why these measures?
      • Immediate results from better management of chronic illnesses
        • Common, expensive, manageable
      • Improving compliance with evidence-based clinical guidelines results in:
        • Better outpatient management of chronic diseases
        • Decreases ER visits and inpatient stays
      • Care management of specific diseases after acute hospitalization reduces unnecessary readmissions
        • Coordinated care
        • Pharmaceutical compliance
        • Follow-up visits
    Diabetes ER visits ER visits/1000 for diabetes complications CHF ER visits ER visits/1000 for congestive heart failure complications Asthma ER visits ER visits/1000 for asthma complications Select hospital admits Acute myocardial infarction Stroke TIA (mini-stroke) Select 30-day readmits Congestive heart failure Diabetes Asthma
  • 13. Patient Safety: Why these measures?
      • Serious patient safety events increase
        • 1.18 million to 1.24 million of 40 million Medicare hospitalizations
        • Cost to Medicare $8.6 billion 2003-2005
      • Computerized order entry and e-prescribing reduce errors
      • Adequate ICU physician staffing reduces risk of death by 40%
      • Certain medications require monitoring of side-effects and toxicity
        • Over-use can cause death
        • Under-use is ineffective and wasteful
    • Patient Safety Hospital Index
    • % publicly reporting to and meeting LeapFrog
      • Critical care physicians in ICU
      • Required electronic ordering tests and treatments
    • Patient Safety Outcome index
    • % hospital improvement 3 AHRQ measures
      • Post operative infection
      • Post operative DVT/PE
      • Acquired infections
    • Persistent Meds Monitoring
    • % patients getting recommended lab tests
      • Seizure, digoxin for heart failure, diuretics for heart failure, ACE/ARB for diabetes and kidney disease
  • 14. The Member Health Index The MHI was created to demonstrate WellPoints commitment to health improvement and care management and to measure our success Reduction in Quality Gap MHI Timeline 2005-2006
    • MHI concept developed and implemented
    • Initial baseline determined
    • First year of enterprise-wide measurement
    • MHI/HEDIS workgroups identify and implement improvement projects
    • 2007 results announced
    • 770 million total impressions
    • Streamlined Reporting methodology (EDL)
    • Enhance MHI with focus on new WellPoint programs
  • 15. WellPoint Health Status and State Health Index WellPoint Health Status Rankings Current Performance for the composite State Health Index is 77.6 (out of 100 points). Red Italicized Measures = SHI measures
  • 16.
  • 17. State Health Index: Local Health Improvement Collaboration
      • Analyze state-specific results
      • Identify improvement opportunities with government and community leaders
      • Develop state-specific improvement plans
      • Deploy collaborative programs
    Anthem shares our commitment to improving public health Well have the greatest impact on public health when the private, public and non-profit sectors work together. Judy Monroe, M.D., Commissioner of the Indiana State Department of Health. It is important that we continue to see faster and safer access to flu and pneumococcal vaccines for Georgians...The donation of these vaccines will aid in the overall wellness of the citizens of our state. Georgia Lt. Governor Casey Cagle. Collaborative, Multi-Faceted Approach: Legislative Initiatives Local Initiatives and Health Departments Clinical & Health Services Research Community Partnerships Improvement in State Health
  • 18. State Health Index Example: California
      • Team with the American Lung Association of California
      • Targeting smokers for quit smoking programs
      • Advocating for an increased state tobacco tax to enhance funding for prevention
      • Blue Cross to raise awareness of programs and support tobacco tax
    Opportunities Smoking
  • 19. SHI Example: Georgia HealthMPowers is a unique, coordinated initiative designed to build the supportive environment necessary for students to choose health-enhancing behaviors by working in collaboration with students, school staff and families. March of Dimes Centering Pregnancy program: A significant number of women (estimated at 11.3%) continue to receive inadequate or no prenatal care. African-American women are nearly three times as likely as non-Hispanic whites to receive late or no prenatal care. This program will improve health outcomes for all women and their children, but also has the greatest potential to reduce racial disparities in poor birth outcomes. Safe, fun, highly-supportive coaching process at the YMCA. Participants learn to start and stick to an exercise regimen, reduce health risks associated with obesity (Class II) and improve energy levels. Participants are supported by a personal wellness coach who will teach them how to exercise, eat for results and achieve long-term weight loss.
  • 20. The Call to Address Health Inequalities Of all the forms of inequality, injustice in health care is the most shocking and inhumane Dr. Martin Luther King, Jr.
  • 21. Reducing Health Disparities: WellPoints Multi-Faceted Approach Associates Physicians Employers Members Coordinated Strategies Culturally-tailored approaches produce increased patient knowledge and understanding for self-care, decrease barriers to access, and improve multiple areas of cultural competence for health care providers.
  • 22. Connecting with Physicians to Improve Community Health Geographic Information System and decision support tools enable identification of quality and disparity Hotspots
    • Racial / Ethnicity demographic data linked to quality data to examine performance of different communities
    • Target high performing and low performing medical groups to evaluate and analyze success factors and gaps in care
    • Provide medical groups with population and patient-specific information to improve screening and outcomes
  • 23. Mapping Highlights Health Disparities and Opportunities for Interventions
  • 24. Analysis of MHI Health Disparities and Unscreened Members by Volume
  • 25. Physician Strategies: Provider Portal Disparities Resource Center On-Line Resource for Network Physicians
    • Health disparities facts and myths
    • Cultural and linguistic CME seminar and conferences
    • Health promotion and disease specific tools
      • Asthma
      • Diabetes
      • Breast / Cervical Cancer
      • Immunizations
      • Arthritis
      • Obesity
      • Heart Health
  • 26. Collaborative Partnership: Alliance for a Healthier...


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