Also in this Issue

p 3 Defining Medical Home StatusLearn about a new set of criteria to recognize physician practices as medical homes.

p4 One Way to Increase DM ParticipationFind out how disability integration made a difference in one company’s participation rate.

p5 What differentiates Matria’s nurseline?Get the scoop on an exciting new development.

Headlines inHealth & ProductivityThe latest health & productivity news brought to you by Matria SPRING 2008

integrationinformation innovation

Do you have a clear understanding of the “medical home”?

To make your opinion count, visit http://tinyurl.com/ysfzpc and fill out the survey!

Want to see survey results from the previous issue?

Visit page 8.

Share and Compare

Hope for U.S. Healthcare System

The advanced medical home model of care could improve the way primary and principal care are delivered and financed.

Find out how this model of care works and how it supports and benefits health enhancement, in an article by Michael S. Barr, M.D., M.B.A., FACP, and Jack Ginsburg, both of the American College of Physicians. (page 2)

Advanced Medical Home Model of Care Offers Hope for Ailing Healthcare System

By Michael S. Barr, M.D., M.B.A., FACP and Jack Ginsburg, M.P.E.

The U.S. healthcare system is poorly prepared to meet the current, let alone the future, healthcare needs of an aging population. Healthcare costs are continuing

to grow faster than the economy, and employers, government agencies and individuals are straining under the financial burden.

In this environment, physicians are pressured to see more patients in less time1 as they are inundated with administrative paperwork and regulatory requirements. In addition, they have the added pressure of staying current with an overload of information in a medical environment that is increasingly more technical and complicated, and they struggle to keep their practices afloat in the face of declining revenues and increasing costs.

Trusting, intimate relationships with patients have suffered as physicians and patients struggle with the financial and bureaucratic complexities of public and private insurance coverage issues, which can cause substantial stress within patient-physician relationships.2

Physicians also must stay current with ever-expanding medical knowledge and technology in accord with evolving medical standards of quality. To make matters worse, insufficient numbers of young physicians are entering careers in primary care, and increasing numbers of older physicians are dissatisfied with their careers and indicate that they will soon discontinue practice.

In too many instances, unnecessary or inappropriate healthcare services are provided because there is little coordination of patient care among providers or across sites of service.3

As a solution, the American College of Physicians (ACP) proposed the advanced medical home model which offers the potential to improve U.S. healthcare by focusing on strengthening and supporting the patient-physician relationship. Since the release of the policy paper in January 2006, the ACP, American Academy of Family Physicians, American Academy of Pediatricians and the American

Osteopathic Association have adopted a set of joint principles based on each organization’s respective policy.

As a result, the term now used by all of these organizations is the “Patient-Centered Medical Home” or PCMH. This model involves a central resource – the PCMH – as the foundation with a competent team of healthcare providers led by a personal physician, typically a primary care doctor. The team would include a physician with training in complex, chronic care management and coordination, and the team encourages active involvement by informed patients.

Widespread implementation of this model could result in positive fundamental changes in the way that primary care and principal care are delivered and financed. It recommends:

Provision of enhanced and convenient access to care not • only through face-to-face visits, but also via telephone, email, and other modes of communication;

Ongoing, coordinated medical care in partnership with • patients and their families;

Provision of feedback and guidance on the overall • performance of physicians and their practices;

Use of evidence-based guidelines and clinical decision • support tools to guide decision making at the point of care based on patient-specific factors;

Application of appropriate health information • technology;

A voluntary recognition process to identify primary care • and specialty medical practices that provide patient-centered care based on the principles of the chronic care model; and

Demonstration of the use of “best practices” to • consistently and reliably meet the needs of patients while being accountable for the quality and value of care provided.

This article is an excerpt from a policy monograph titled “The Advanced Medical Home: A Patient-Centered, Physician-Guided Model of Healthcare” available on the American College of Physicians Web site at www.acponline.org.

(See “Medical Home” on page 7)

1Journal of General Internal Medicine, “The Ethical Significance of Time for the Patient- Physician Relationship”, 20052American College of Physicians, “Medical Professionalism in the Changing Health Care Environment: Revitalizing Internal Medicine by Focusing on the Patient–Physician Relationship,” 20053Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century, 2001

Michael S. Barr, M.D., M.B.A., FACPVice President, Practice Advocacy and ImprovementDivision of Governmental Affairs & Public PolicyAmerican College of Physicians

Jack Ginsburg, M.P.E.Director, Health Policy Analysis & ResearchAmerican College of Physicians

2

A new set of criteria has been developed to recognize physician practices as patient-centered medical homes. The traditional medical home concept is a model of care with long-term physician-patient relationships at the center of a coordinated system of care.

The criteria were developed by the National Committee for Quality Assurance (NCQA) in partnership with the Patient-Centered Primary Care Collaborative.

Seven principles comprise the characteristics of the medical home approach:

Personal physician1. – provides first contact and continuous care.

Physician-directed practice2. – one doctor leads a team at the practice level.

Whole person orientation 3. – physician coordinates care with other healthcare providers for all stages of life and levels of illness.

Coordinated care across all the health system4. – this includes specialist care, subspecialty care, hospitals, home health agencies, nursing homes, etc. and is facilitated by technology and health information exchange. The goal is to have the historical information necessary to make better health decisions.

Quality and safety5. – healthcare decisions are based on evidence-based medicine guiding decision-making and utilization of healthcare technology.

Enhanced access to care 6. – this involves new options for communication between patients, their personal physicians and practice staff and includes such measures as open scheduling and expanded hours.

Reformed payment system 7. – the payment structure should be revised to support the cost for meeting the standards of a medical home practice.

During the summit, NCQA’s Greg Pawlson, M.D., M.P.H., executive vice president, described the program as a “blueprint for the patient-centered medical home” for physicians to follow.

Pawlson also stressed that the program would not work without adequate payment for physicians to cover the costs for enhanced access to care and communication, rewards for higher value, expanded administrative, technical and clinical support, and the promotion of active patient and family involvement.

For more information, visit the PCPCC website at www.pcpcc.net.

Sources: American Medical News, April 9, 2007 and News Now, Nov. 7, 2007

Program Recognizes Medical Home Physician Practices

Industry News

Behind the MedicalHome ConceptIn an effort to improve patient-provider relations and create a more efficient model of healthcare delivery, several large employers collaborated with the government to form the Patient-Centered Primary Care Collaborative (PCPCC). The PCPCC is a coalition of large national employers, health benefits companies, trade associations, profession/affinity groups, academic centers, healthcare quality improvement associations and the major primary care physician associations representing 333,000 physicians.

The PCPCC promotes the patient-centered medical home model of care and provides a forum for healthcare stakeholders to work together to improve the healthcare system. It also provides education to physician practices and Congressional representatives of the federal and state governments on the patient-centered medical home model as a superior form of healthcare delivery.

For more information, visit www.pcpcc.net.

3

Matria Healthcare has been selected to enter into a strategic relationship with Microsoft Corporation to support HealthVault, Microsoft’s newly

launched Internet-based health platform.

HealthVault is a consumer-based product that allows users to search and discover answers to health questions, confidentially store information regarding their own health and act on the information to improve their health. Data gathered by users is secured against theft and loss through Microsoft’s optimized security platform, and users can designate accessibility by either a physician, hospital or other healthcare provider.

HealthVault also allows users to upload health-related data from numerous biometric digital devices-such as blood pressure cuffs, heart rate monitors and blood glucose monitors. Matria’s role in the partnership initially is to

leverage its technological expertise to gather and cleanse disparate sources of medical data to deliver a clear and concise personal health record to HealthVault’s users.

Says Microsoft’s Peter Neupert, corporate vice president for the Health Solutions Group: “Matria Healthcare’s technology solutions in total population health enhancement have played a significant role in improving the health of individuals.”

“When combined with Matria’s proven ability to integrate and cleanse disparate sources of data from multiple health information systems and identify care gaps through products such as our Physician-Patient Care Alerts,” says Ron Loeppke, M.D., executive vice president and chief strategic officer for Matria, “we are confident that HealthVault will provide consumers with the tools necessary to help manage and improve their health.”

To maximize the reach and impact of its existing health enhancement programs, Matria client Becton, Dickinson and Company (BD), a worldwide

supplier of medical devices, decided to integrate a new absence management program with its existing disease management program.

BD first launched its disease management program with Matria Healthcare in January 2006 and later formed a three-way partnership with Unum Corporation – a disability and absence management provider – in November of the same year.

The purpose was to identify employees with chronic conditions earlier, leverage a “teachable moment” to educate workers about BD’s available health resources and promote timely outreach to employees, explains Nancy Lang, vice president of Health Enhancement at Matria Healthcare.

“BD was interested in Matria’s capacity to receive and process disability claims via data feeds, use the information to refer individuals to appropriate programs and then provide outcomes reporting,” Lang says. “BD believes employee health is crucial to the company’s success, and they want to do all they can to increase employee participation in their programs.”

At the beginning of the program, only 23 percent of individuals applying for short-term disability reported they were enrolled in a health enhancement program. Eight months later, 48 percent self-reported active engagement in a Matria program.

Other results included improved clinical outcomes across multiple targeted chronic conditions, reduced emergency room visits and hospital admissions, and increased participation among employees with high acuity chronic medical conditions. One-fifth of all disabled employees referred for condition management were first identified at the point of disability filing.

“No competitor has the sophisticated technological processes that Matria has in place,” Lang says. “Processing disability claims just gives us one more piece of data that enhances our ability to identify employees with chronic conditions and engage their interest in a health enhancement program.”

BD Increases Participation In Disease Management Programs Through Disability Integration

Matria Partners with Microsoft on Web-based Health Tool

Case Study

Industry News

4

The only agency that accredits call centers recently awarded accreditation to Matria Healthcare Nurse24SM, the company’s 24-hour nurse line service. URAC, a non-profit, independent accreditation agency, was so impressed with the nurse line that they offered three years of accreditation instead of the usual two.

URAC gave the program a perfect score and indicated they were impressed with what they considered to be excellent case reviews, strong reporting, knowledgeable and caring nurses and resourceful physicians. Surveyors were particularly impressed that Matria will be consistently auditing and making continual improvements to its program as it focuses on continual survey readiness (CSR).

“We strive to stay accreditation-ready and have already identified our quality activities for 2008,” says Tim Burke, M.S., R.N.C., assistant vice president of clinical operations for Matria. “We have always had high standards, and that starts with having a strong, highly-experienced and highly-trained staff. Our accreditation surveyor was really

impressed with our clinicians and non-clinicians because of their preparation for this accreditation. We could not have achieved the three-year accreditation without the people doing the job.”

Before the accreditation, Nurse24 was founded with telehealth standards developed and recommended by the American Association of Ambulatory Care Nurses, Burke says. This starts with a strong management structure, 24-hour access and the monitoring of phone calls, he adds.

“Accreditation sets us apart from other organizations, particularly because it is not required,” says Carol Dall, M.S., R.N., director of accreditation and external audits for Matria. “It shows that we have gone above and beyond expectations. The accreditation is a badge of excellence that assures our customers and the public that our program provides the highest standards of safety, quality and accountability.”

Nurse24 is a telephonic support program that provides immediate

clinical support for everyday health issues and questions to the entire population. The clinical support is available 24/7 through a toll-free nurse line service, staffed by highly trained, registered nurses. It offers a cost-effective solution for participants coping with chronic and acute illnesses, episodic or injury-related events, and other healthcare issues.

“When someone calls into the nurse line, they have a problem that needs to be addressed right away and that makes them ready to learn,” Dall says. “Our nurses use national guidelines of care to help callers and then, if necessary, refer them to appropriate Matria programs. The nurse line can hasten the identification process, which is an alternative to waiting for claims.”

Matria News

Peer Review SpotlightOver the past two years, Matria’s experts have published more than 70 ground-breaking and impactful research studies and articles in the nation’s most revered peer-review medical journals. Our research findings have appeared in such prestigious publications as the Journal of Occupational and Environmental Medicine, the American Heart Journal, and the American Journal of Obstetrics and Gynecology, among others.

Matria highlighted 39 important articles in a new book to provide a glance at the industry’s significant findings. To order your copy of Matria Insights PressBox: Summaries, Excerpts and Abstracts of Matria Published Articles on Disease Management, Cost Savings, Health and Productivity, and Maternity Management, please email your address to matrianews@matria.com or call (800) 456-4060.

Participant Engagement A Priority at Matria Matria works hard to enroll as many eligible employees and health plan members as we can reach, but sometimes attracting the interest of skeptical or hard-to-reach individuals can be difficult. That is why we recently formed a participant marketing team dedicated solely to developing targeted messaging and handling requests for participant communication materials.

From now on, this new team will focus exclusively on the promotion of all print and electronic communications, including launch, campaign, enrollment, challenge and announcement materials for both the standard and customized packages – all to successfully contact more individuals and help them understand how our services can improve their health and quality of life!

24-Hour Nurse Line Earns URAC Accreditation

5

In the current healthcare environment, care is fragmented, patients are being seen by multiple physicians,

and physicians find it difficult to stay abreast of ever-expanding evidence-based knowledge. Avoidable errors and safety issues are common; health care outcomes contrast poorly with other industrialized nations. To make matters worse, the healthcare system is not adequately prepared to meet the needs of a rapidly growing population of elderly individuals with chronic multiple conditions.

Several new “medical home” proposals are gaining momentum to deal with these issues. All endorse the greater role of the primary care physician, a patient-centered approach handled by a coordinated team of healthcare providers, emphasis on coordinated care, improvement in outcomes and better electronic connectivity to support these efforts.

But the medical home proposals are not without challenges. Only 28 percent of physician practices are currently equipped with electronic medical records. Many are not capable of receiving and managing multiple data feeds, nor do they have the staffs to support the team approach. Other hurdles include the lack of decision support tools and having to handle multiple payers. Despite these obstacles, the interest is strong among payers and physicians, and there are likely to be more evaluations and pilots over the next couple of years by interested health plans and integrated delivery systems.

Matria has become a well-established leader in bringing patients and physicians together with impactful, actionable health information and is well-positioned to support the medical home concept. Matria’s technology allows us to provide periodic automated reports and quality care gap alerts to physicians with relevant health information about their patients gathered from various sources and stored in our patient electronic records. This information includes data from medical, pharmacy, and lab claims as well as self-reported data collected by our clinicians during the delivery of our telephonic education, compliance monitoring and health coaching services.

Our Care Alerts and individual and population reports inform physicians when their patients are not meeting nationally recommended guidelines of care. The system is programmed with technical algorithms to identify patients with health risks, patients who have been diagnosed with chronic conditions by other physicians, or patients with chronic conditions not receiving national standards of care who are not accessing the system.

Everything we are doing at Matria complements what physicians want to provide in their practices. A partnership with Matria is an extension of their practices, allows physicians to meet the standards of the medical home as well as improve the health and quality of lives of their patients.

Keeping Participants,Clients Up-to-DateBuilding upon the company’s technological expertise, Matria is now using Web technology to provide monthly live interactive educational webinars for clients and participants in our programs, as well as recorded webcasts of relevant educational events. Live webinars from client and participant sessions also are recorded as webcasts to Matria’s Web site for later viewing.

The first monthly client webinar was held in November on “Health & Productivity Management: How to Enhance and Maximize Your Efforts” by Ron Loeppke, M.D., executive vice president and chief strategic officer for Matria, and Thomas Parry, Ph.D., president of the Integrated Benefits Institute (IBI).

Our second client webinar was hosted live from the Matria Institute in January featuring Newt Gingrich, founder of the Center for Health Transformation and former Speaker of the U.S. House of Representatives. Newt discussed his vision for the future of the ailing healthcare system, stressing the important role that technology will play in bringing the healthcare system into the 21st century.

Matria Insights via the Web also includes exciting webcasts on the most pressing health and productivity management issues. Now available on Matria’s Web site is our first webcast series, “The Bottom Line: Making the Financial Case for Health Enhancement, Parts I and II,” in which experts from MGM MIRAGE, IBI and Matria discuss the financial benefits of investing in health and productivity.

Matria’s participant webinars so far have featured discussions by distinguished and highly experienced specialist physicians on how to reduce the risk for a heart attack or stroke, depression and pulmonary rehabilitation for chronic lung disease. Future webinar topics include bleeding and clotting disorders, managing work and life disruption and smoking cessation in March.

All Matria Institute sessions are recorded and available as webcasts following the gathering. To view the webcasts, visit Matria online (www.matria.com) and click on Resources, then Matria Insights. A link to the Newt Gingrich webcast is available from the homepage. You can’t miss it!

Technology FacilitatesMedical Home Practice

Richard Hodach, M.D., Ph.D., MPH

SVP, Chief Medical OfficerMatria Healthcare

Matria News

6

As part of the value that Matria brings to its clients, we participate in industry associations and conferences. Here’s a glimpse of past and future activities.

4th Annual Hispanic Health Professional Student Scholarship Gala DinnerIn November, Matria showed its support for the National Hispanic Health Foundation by participating as a sponsor of the gala dinner, held Nov. 29 at the New York Marriott Marquis Times Square.

IHPM Health Management ConferenceMarch 31 – April 2, 2008Hyatt Regency Grand CypressOrlando, Fla.http://www.ihpm.org/

Milken Institute Global ConferenceApril 28-30, 2008The Beverly HiltonBeverly Hills, Calif.http://www.milkeninstitute.org/

Virtually everyone agrees that the centerpiece of a successful healthcare ecosystem is the trusted primary care physician-patient relationship.

Unfortunately, far too many Americans do not have a long-term primary care relationship. Moreover, for those that do, certain realities erode the potential power of that relationship, such as scheduling difficulty, limited visit time with the physician, lack of data and coordination among providers, and limited support systems available in the outpatient setting.

When you contrast inpatient and outpatient settings, certain powerful differences emerge. And those differences reflect the reality that America has built the world’s best sickness-repair ecosystem, but is just beginning to understand the infrastructure necessary for healthcare.

So, for instance, if a patient were to be admitted to the hospital with symptoms of a stroke, a multidisciplinary team working off a single medical record would be mobilized and coordinated by that primary physician. This team would likely include laboratory and diagnostic imaging resources, consultants, nurses, physical therapists, social workers and others.

Once diagnosed and treated, that patient and physician would likely meet again in the office, typically with limited connection to the information and stakeholders so important to the resolution of the acute illness. To the extent there would be an ongoing need for multidisciplinary care, with shared, timely information producing measurably better care, breakdowns would likely occur.

A positive step toward improved health outcomes and reduced cost, the medical home concept requires that primary care physicians drive the long-term coordination of care across all settings, leveraging all the necessary assets, including specialists, laboratory, pharmacy, social workers, health coaches, nutritionists, etc. This is where Matria can help!

By aligning our nurses, registered dieticians, physicians, social workers and health coaches around that doctor-patient relationship, we are able to assist in driving superior care and outcomes. Our software allows our staff to see errors of omission and departures from well-recognized standards of care, such as missed lab tests and non-compliance with prescribed medication. In the absence of such support, these errors might otherwise be missed in a world of paper medical records. There are better days ahead as Matria, patients and physicians drive the medical home concept to new heights!

Industry Presence A Matria Perspective: Driving Patients Back To the Medical Home

Contact UsIf you have questions or ideas for stories in our upcoming issues, give us a call at (866) 500-4580 or email us at matrianews@matria.com.

The ACP introduced the term “advanced medical home” to distinguish these practices and called for consideration and testing of this model of care with four policy positions. To read the policy, visit www.acponline.org.

The ACP believes that the advanced medical home model – now referred to as the Patient-Centered Medical Home – applied in the context of a revised reimbursement system – could revitalize the patient-physician relationship; stimulate practice-level innovation; allow practices to invest in systems-based care and measurement of that care; and enhance coordination of care across all domains of the healthcare system.

The concept has garnered significant attention from consumers, employers, payers, disease management companies and other stakeholders who are now working together through the Patient-Centered Primary Care Collaborative (www.pcpcc.net) to foster the changes necessary – including legislation, demonstration projects, and reimbursement reform – to help implement and test the model.

In addition, the National Committee for Quality Assurance (NCQA) just released a new version of their Physician Practice Connections’ recognition program-tailored with guidance from the ACP, AAFP, AAP and AOA to help identify practices that deliver care based on the Patient-Centered Medical Home model.

Medical Home Offers Hope(continued from page 2)

7

Share and Compare

Headlines inHealth & ProductivityThe latest health & productivity news brought to you by Matria SPRING 2008

integrationinformation innovation

In the last issue, we asked you if your organization is actively involved in improving health literacy in America and, if yes, to indicate types of involvement. One hundred percent of our respondents said yes to the first question while 80 percent said they invest in health enhancement.

1. My organization is actively involved in health literacy in America.

2. If yes, that involvement includes the following:

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Cost of Maternity

1 in 3 pregnant women develop complications

NICU costsfor preterm &complications

$80,000

= $6.6 billion

$41,610

$2,830

33%

40%

100%

Healthy Full-term

Internal programs, such as Health Enhancement,

wellness and disease management programs

Partnering with other organizations in health

literacy improvement efforts

Premature AverageCost of NICU

Yes100%

No0%

0

20

40

60

80

100

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Cost of Maternity

1 in 3 pregnant women develop complications

NICU costsfor preterm &complications

$80,000

= $6.6 billion

$41,610

$2,830

33%

40%

100%

Healthy Full-term

Internal programs, such as Health Enhancement,

wellness and disease management programs

Partnering with other organizations in health

literacy improvement efforts

Premature AverageCost of NICU

Yes100%

No0%

0

20

40

60

80

100