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Basic business principles Presenting your ideas

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0 American Association of Diabetes Educators
“The Business Case for Diabetes Education” Donald Fetterolf, MD, MBA, FACP Executive Vice President, Health Intelligence Matria Healthcare, Inc.

1 Basic business principles Presenting your ideas
Outline Overview Introduction Basic business principles Presenting your ideas Making the business case for diabetes education Conclusion References

2 Overview

3 The Go Bag What is a Go Bag? What is a Go Bag For?
Several bottles of water A compass A hunting knife A bar of soap and some clean underwear Several bags of trail mix A roll of toilet paper Your teddy bear What is a Go Bag For? Surviving the first week or two of the post-apocalypse What is the business equivalent?

4 Introduction: Case Study
The CEO/CMO of your company has made friends with the Vice President of marketing of a national company that claims that it can provide diabetes education effectively using a cool web based tool his company has designed. The two have gone golfing, have had dinner together, and have had several “high-level” discussions about having the vendor replace your program staff with the vendor's web site. Two of your organization’s senior vice presidents, in totally unrelated areas and who have no knowledge of clinical issues, think the proposal might be a viable option. The vendor claims that he can give your company an “8 to1 return on investment,” and will ”guarantee” it. You are now approached by the CEO/CMO, who admits that he might dissolve your area, but offers to give you 20 minutes to talk him out of it. He is interested in the value/return that you get now. What do you tell him? Your answer should address both an analytic approach and recognition of the various political factors that may influence your choices. Paraphrased and restated from Fetterolf, AJMQ Jan/Feb 2003.

5 The Issue: Making the Business Case
Making the business case to someone or some entity that you should be paid for your valuable services is difficult for anyone. Money is tight everywhere. You were trained as a clinician, not a business person. So, how do you put a price on quality or clinical improvement? What is the strategy to convince a potential nonclinical payer of diabetic education services that they are worth it? Do your services create a “value proposition” for your services? How do you construct the approach and the arguments for the government, health plans and clinics that create a compelling case in your favor in the mind of a business person?

6 Takeover of your company/hospital and a sudden visit by the new CEO
Your Business Go Bag You will need to collect all that you will need to have for a rapid, no thought needed response when you encounter: Takeover of your company/hospital and a sudden visit by the new CEO Sudden loss of your job and the need to find a new one Talking your boss into a 10% increase in your budget so you can “improve the quality of care” So, what’s in your go bag?

7 The Beginning…

8 The Big Committee on Medical Management
What they Say Patient education is very important to our company. Education is something we do at the individual level. Quality is the key ingredient to making our business a success. You are asked to present the results of three weeks worth of your work with others developing the medical management programs at your company. What they Do “Could you do pretty much the same thing with less? Could you just not do them for us, and give us a lower price?” “How much will all these initiatives inflate my costs?” “We’ll get to your report as soon as we get done with the important financial pieces of the agenda.” As you get up to speak, members of the board sneak a look at their watch. The CMO starts to look at his watch. Understand what they do carries the most meaning.

9 Are You Irrelevant, or Just Boring? Do you know…
Why are clinical staff often marginalized in the “management” role? If presentations aren’t interesting, how are you viewed by senior management? What happens to your budget when the company needs to make a cut? It is important to recognize the forces in business that direct you and the forces needed to advance the cause of your profession. You ignore them at your peril.

10 Understand the Problem: What they want you to do.
“Maximize profit, minimize loss.” Generate more revenue Lower PMPM costs Reduce administrative overhead Measurably raise patient care quality Make them look good to somebody Have real impact, not inconsequential activities

11 Basic Business Concepts
Accounting

12 Why Bother with Accounting?
It’s the language your boss speaks. e.g. What is the ROI? You won’t be a member of the “leadership team”. They will take advantage of you if you don’t participate. e.g. Internal cost transfers You’ll go to jail if you don’t fill in the forms right.

13 Financial Information and the Language of Business
Typical Forms of Financial Information Financial statements Annual reports Budgets Invoices Bank statements Sales forecast results Financial forecasts Claims payment records Billed and paid premium records General ledgers Investment reports Financial models Cost accounting reports Actual versus budget results for provider risk pools Medical loss ratio and expense ratio reports Utilization statistics reports Payroll records Accounting Concepts Financial Accounting Balance Sheet Income Statement Statement of Cash Flows Management Letter Managerial Accounting Contribution Income Statement Financial pro formas Statutory Accounting DOI Forms Annual Statement GAAP Source: Academy for Healthcare Management. Health Plan Finance and Risk Management

14 Income Statements Form of a Regular Income Statement Revenues
Revenues Revenues $ 100 Expenses Variable Expenses $ 60 Fixed Expenses $ 20 Profit (Loss) $ 20 Important: Are you a profit center or a cost center? How are costs assigned to you?

15 Income Statement: ABC Medical Corporation Income Statement For 2002
Revenues Patient Revenues $ 1,575,000 Consulting Income ,000 Investment Income ,000 Total Revenues $ 1,662,000 Expenses Salary of Partners ,347 Staff Wages ,645 Laboratory Fees ,583 Administrative Expenses ,495 Interest Expense ,453 Insurance ,453 Total Expenses $ 1,223,976 Net Income $ ,024 Income Statement: ABC Medical Corporation Income Statement For 2002 Revenue means a bigger organization and more visibility for your boss.

16 Form of a Contribution Income Statement
Income Statements Form of a Contribution Income Statement PMPY* Total Members Affected ,000 Revenues Variable Revenues $ 7 $350,000 Expenses Variable Expenses/Unit $ -5 $250,000 Contribution Margin $ 2 $100,000 Fixed Expenses $46,000 Profit (Loss) $54,000 __________ ­­­*PMPY = Per member per year. Note also the relationship with a “breakeven analysis” – you need at least 23,000 members. Why?

17 Income Statements: Activity Based Cost Accounting – “ABC”
Example of activity-based cost accounting. Product A B C Total Revenue Variable Revenue $50 $50 $20 $120 Expense Expense $30 $ 5 $ 5 $ 40 Fixed Expense $15 $30 $ 5 $ 50 Profit (Loss) $ 5 $15 $10 $ 30

18 Basic Business Concepts
Finance

19 Discounted Cash Flow Analysis
Finance Cost of Capital Opportunity cost Discounted Cash Flow Analysis Future Value = Present Value x (1 + Interest Rate) Net present value (NPV) calculations Budgeting Annual Budget Capital Budget

20 Other General Principles

21 Other General Principles
Creation of business plans Project management Financial pro forma statements Organizational psychology Know when to get and ask for help

22 Business Plans Key elements of a business plan, each typically described in a few paragraphs, include: An overview of the industry or company and a description of any products that are being produced or are under consideration An evaluation of the current market, including the advantages of the proposed initiative over competitors’ initiatives A formal outline of the proposed initiative and the opportunities that it provides to the company Marketing research that identifies the potential target market and the projected costs and revenues for the initiative A formal design for implementing the initiative and a development schedule An overall operations plan that uses standard project-management approaches A profile of an accountable lead person and the credentials of the management and operations teams An overview of the economics surrounding the business and the initiative including general profitability, sales potential, and so on. Anticipated risks and problems that could result in less-than-optimal outcomes Financing arrangements and pro forma financial statements that outline return and costs over a period of several years Estimated contracts, terms, agreements, and other items that must be negotiated Exit strategy: the process for ending or discontinuing the program

23 Business Planning

24 Financial Pro Forma

25 Presentations

26 Presentation Advice From the Experts
Fetterolf, D.. "Commentary: Presenting the Value of Medical Quality to Nonclinical Senior Management and Boards of Directors.." American Journal of Medical Quality. (18)1. Jan/Feb pp

27 Tip: Don’t Get Lost in Your Stuff!
Convert complex concepts into the elements of their world. Your job is not to turn them into clinicians or statisticians. Your job is to interpret for them in their world what you are doing in yours, and why it is important to them.

28 Tips: Insights Don’t emphasize the fact you are highly trained, or very qualified. It makes you different. Remove clinical or foreign technical words e.g. glycohemoglobin, skedastic Don’t use big words or sound too scholarly. Focus on their number one objectives Watch the unneeded detail. It goes in a report appendix. No sudden surprises. They frighten easily. Slide in the bad news but be truthful and unbiased. Don’t be intimidating. Fetterolf’s First Rule: Assume nothing.

29 Developing the Value Proposition
Create a multidimensional approach to economic return. Operational Clinical Economic/Financial Intangible and Social Productivity and workforce impacts Productivity Absenteeism Presenteeism Disability Anecdotal

30 Tip: What Not to Include in the Final Presentation to Senior Management.
Glycohemoglobin levels. Diabetic foot exams. All things that are abbreviated with more than 3 letters. 8 ways to do the ROI methodology How would you explain this to a 15 year old boy in a way he would find interesting and compelling?

31 Example: Problem Presentations
“Diabetic foot exams increased under our new program.” – Pointless clinical statistic “We spent $1 million generating the HEDIS statistics this year.” – High cost for something that isn’t necessary anyway “If we had more people in my area, we could really improve care.” – Adding still more resources to an already bloated concept

32 Better Our HEDIS measurement is now a necessary component of our NCQA quality accreditation. The Intergalactic Business Group on Health is comparing our results with ABC Health, our biggest competitor. (smugly) Ours are better in 7 of 10 areas. Our scores have been improving, which will be useful marketing information. Our scores are good compared with national benchmarks and our competitors, so if any one asks you, they are a good thing. While the cost to produce this information is high at $1 million dollars, the result will assure our competitive position with respect to accreditation and compliance needs. Actually, the value is higher – for every point we increase mammography rates alone for example, economists estimate that we will experience $500,000 less costs in breast cancer treatment over the next 5 years.

33 Actual Report Construction -- Tips from the Experts

34 Report Format Executive Summary Analytic Pages Summary and Conclusions
6 or 7 Bullet points Analytic Pages Graph Data Text Summary and Conclusions Recommendations Choices and Solutions Addenda Methods Codes used Supporting material

35 Short length reports, larger fonts. Use primary colors.
Tip: Report Tips Always have bullets in an executive summary. No more than six (eight max). Short length reports, larger fonts. Use primary colors. No more than two bars on a bar graph. Reading level at or below 12th grade level. Make both “high level” and specific recommendations so they can chose what course of action they can comfortably claim is theirs.

36

37 Organizational Psychology

38 Tips: Identification with the Aggressor
Convert being a staffer discussing boring issues into being a co-executive solving the problems of the company with them. Build in marketing for your presentation Branding Ease of use The bathroom test Ease of access to retrieve your report Give them some slides for their boss; make your case easy to fund or present.

39 Tips: Organizational Psychology
Brevity and concise reporting. Clarity is job 1. Smile often but appropriately. How can they use what you have to look good themselves? How is your stuff more interesting than what they are thinking about. Don’t EVER add to their problems without preparing solutions. Tie what you are presenting into something they relate to: media coverage personal life “Inside, you are their lap dog; outside you are their bull terrier.” Keep track of what you told them previously

40 End Results “I’ve learned something about our complex business and its problems. The quality program is advancing the company. This person understands the issues well. We needn’t worry - he handled the problems from last time. I’m sure glad they are handling it. You want someone three levels above you to be upset if you threaten to go.

41 Now, The Business Case for Diabetic Education

42 Connecting the Dots: the value of treating disease in a systematic way
The “evidence based medicine” literature forms the essential scientific underpinnings behind disease management interventions. Evidence based literature solidly establishes that certain interventions produce significant economic value generally, in many cases, in excess of amount spent. Economic value is defined broadly, to include administrative/operational, clinical quality, clinical utilization, and productivity outcomes as well as pure accounting “ROI”. Medical management programs seek to mirror in the commercial arena activities that have been proven in larger multicenter, randomized trials. Direct evidence exists linking the specific activities of disease management programs and clinical, financial and productivity outcomes in many areas and across many diseases. Medical management programs use comprehensive modern management tools to deliver programs in a systematic, monitored and outcomes focused manner. Medical management programs additionally bring to bear expertise in behavior change that increases yield over standard clinical trial approaches, by targeting key levers in human behavior modification. (Prochaska, Bandura) Structuring the Defense of Disease Management Strategies -- How does one answer the challenge that the business case needs to be made for disease management? A number of key points need to be logically structured for laying out the path for the doubting observer. The conceptual map should include the following points: The “evidence based medicine” literature forms the essential scientific underpinnings behind disease management interventions. A solid foundation of evidence based medicine exists for all of the diseases generally considered in disease management programs, and for many other conditions as well. While this is not to say there is a wide variety of opinions outside of these guidelines, there is a substantial body of work that supports it. Comprehensive listings are available in web based and textbook form.[i] [ii] Evidence based literature solidly establishes that certain interventions produce significant economic value generally, and in many cases, in excess of amount spent. The interventions described and executed in formally defined and executed disease management programs administer well established interventions known to create economic value when administered at the population level. Evidence based guidelines exist for most of the conditions addressed by disease management programs. Some examples include: Diabetes – Guidelines created by the American Diabetes Association. Congestive Heart Failure— Coronary Artery Disease Hyperlipidemia Etc. <Include all appropriate linkages from Dr. Hodach and the QI team> Direct evidence exists linking the specific activities of disease management programs and clinical, financial and productivity outcomes in many areas and across many diseases.[iii] DM programs seek to mirror in the commercial arena activities that have been proven in larger multicenter, randomized trials. They seek to create a supportive infrastructure that will similarly execute these activities in the populations under consideration. DM programs additionally bring to bear expertise in behavior change that increases yield over standard clinical trial approaches, by targeting key levers in human behavior modification. Economic value is defined broadly, to include administrative/operational, clinical quality, clinical utilization, and productivity outcomes as well as pure accounting “ROI”. The value of DM in economic terms is more broadly based in terms of clinical wellbeing, future health savings, productivity and conformance to national clinical health quality standards. DM programs use comprehensive modern management tools to deliver programs in a systematic, monitored and outcomes focused manner. In conclusion, disease management programs build on the philosophical base of evidence based medicine, incorporating proven techniques and treatments to deliver value on a population basis that was proven and established in the medical literature, using effective, well executed systems of delivery that rival organized clinical trials. The outcomes have been linked to deliverable activities and create direct as well as long term and indirect value. [i] Tovey, D. et al. Clinical Evidence Concise. BMJ Publishing Group A compilation of clinical guidelines also available at the website, [ii] The National Guidelines Clearinghouse. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now America's Health Insurance Plans [AHIP]). [iii] Evidence of specific interventions typically used in DM programs linking with positive outcomes includes: -- Denberg, T; Coombes, J; Byers, T: Marcus, A; Feinberg, L; Steiner, J; and Ahnen, D "Effect of a Mailed Brochure on Appointment-Keeping for Screening Colonoscopy A Randomized Trial." Annals of Internal Medicine. (145)12. December 19, pp 895- 900. -- Denelsbeck, S. "Engaging Employees in Health and Wellness: the Healthy Pfizer Program." The American Journal Of Managed Care. (12)Spec Issue. December, pp SP40- -- Fetterolf, D. and Olson, M. "Measuring The Total Impact Of Disease Management Programs." Health and Productivity Management. ()Special Supplement. September, -- Kessler, R. and Stang, P.. Health and Work Productivity. Chicago, IL. University of Chicago Press pp . -- Loeppke, R. and Hymel, P. "Good Health is Good Business." Journal of Occupational and Environmental Medicine. (48)5. May pp -- Mary S. Mittelman, DrPH; William E. Haley, PhD; Olivio J. Clay, MA; and David L. Roth, PhD "Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease." Neurology. (67) pp -- Morrison, J.C.; Roberts, W; Jones; et al. "Frequency of nursing, physician and hospital intevention in women at risk for preterm delivery.." J of Maternal and Neonatal Med. (16). pp -- Orr, P; Hobgood, A.; Coberley, S; Roberts, P; Stegall, G; Coberley, C; and Pope, J. "Improvement of LDL-C Laboratory Values Achieved by Participation in a Cardiac or Diabetes Disease Management Program." Disease Management. (9)6. December, 2006. -- Otis J; Attridge, M; Rosenberg, T; Pederson, D.. ROI ValueMax 2.0: Right Care at the Right Time at the Right Place: The Optum Care-Path Longitudinal Methodology for Nurse Triage January 2006. -- Ozminkowski , R; Goetzel, R; Santoro, J; Saenz, B; Eley, C. "Estimating Risk Reduction Required to Break Even in a Health Promotion Program." American Journal of Health Promotion. (5)18. Mar/Apr pp 4. -- Sackett K, Pope RK, Erdley WS. "Demonstrating a Positive Return on Investment for a Prenatal Program at a Managed Care Organization. An Economic Analysis.." J Perinat Neonatal Nurs. 2004;18:117– (18) pp -- Schwerner, H.; Mellody, T; Goldstein, A. et al "Evaluating the Impact of a Disease Management Program for Chronic Complex Conditons at Two Large Northeast Health Plans Using a Control Group Methodology." Disease Management. (9) pp -- Vickrey, B; Mittman; B. Connor, K; et. al. "The Effect of Disease Mangement Intervention on Quality and Outcomes of Dementia Care." Annals of Internal Medicine. (145)10. November 12, pp -- Vollmer, W; Kirshner, M; Peters, D; Drane, A; Stibolt, T; et al. "Use and Impact of an Automated Telephone Outreach System for Asthma in a Managed Care Setting." Am J Manag Care.. (12) pp

43 Health Plan CMO I have $5 million more in my budget this year for reimbursing medical services. I thought I would spend it on a new program for wellness health risk assessment and/or oncology disease management. You want me to increase coverage for diabetes education. Why should I do that instead of the other two things? Sound a little like you need a go bag here too?

44 The Business Case: Why do you do it?
Evidence based literature, as seen in suggests it is the optimal thing to do. AADE supports/accelerates the logic of disease management Government mandates Demands by the payer/business/consultant community Financial effect Lower effort is more expensive Estimated economic impact from econometric attempts Trade off between value of accreditation and lower costs Social goals. It is a worthy thing to do.

45 Multidimensional Categories of Impact
Can you relate your impact across a broader spectrum in a value statement? Does your organization use a “Balanced Scorecard” approach? Categories: Operational Clinical Financial Productivity Intangible Social/Political

46 DSME Standards and Outcomes
AADE Define minimum data set of diabetes education outcomes Identify appropriate measurements Create an outcomes measurement tool to facilitate collection of education specific outcomes Proof of concept for educator and program tools Add the following Demonstrate economic value to patients and organizations who used the services of AADE members Link the changes in behavior created with desirable clinical and economic outcomes.

47 Things to Consider: AADE7TM
Healthy eating Being active Monitoring Taking medication Problem solving Healthy coping Reducing risk How do these things meet the CMO’s needs?

48 Health Care Outcomes Continuum
DSME Outcomes Measures Immediate Outcomes Learning Knowledge Skill Acquisition Behavior Change Intermediate Outcomes Improved Clinical Indicators Post-Intermediate Outcomes Improved Health Status Long Term Outcomes Health Care Outcomes Continuum

49 Revenues and Costs Revenues: Direct Sources of Revenue
Understanding coding and billing Sales of consulting services Sales of materials Web page fees or advertising Grants, research, and donations Revenues: Indirect Sources of Revenue Value of risk reduction: Edington model Dee Edington approach and risk tiers Long term care cost aversion Glycohemoglobin vs changes in A/K Costs: Direct costs Salaries Equipment Supplies

50 The Bureaucracy : Resources from AADE
On Line Webcast and similar materials Private Payor and Medicare Coverage Medical policy Coverage policy Payment policy Appeals and special case items Coding for Diabetes Education CPT Codes E&M services Incident to a visit Devices and therapy/training HCPCS Codes ICD9CM Codes Billing for Devices and Related Therapies AADE. Diabetes Education Services: Reimbursement Tips for Primary Care Practices. 2008

51 Diabetes - COHORT - Risk Profile -- Edington model
Lo Mod High Sum Stay same Actual 230 180 192 1,085 $541 $477 $2,208 $586,985 $895,529 175 353 136 664 $438 $354 $1,821 $235,056 $449,268 213 156 217 586 $668 $655 $2,838 $1,663,068 $860,310 2335 $2,485,109 $2,205,107 Taking the number of individuals in each risk group, and multiplying times the PMPM for that group, costs are lower when compared to what might have happened if the group had stayed at the original risk level and incurred costs at that risk level in the new period. 51

52 Outcomes: Integration of Diabetes Education and Disease Management
Friedman et al: Programs with comprehensive, diabetes disease management can result in substantially improved patient outcomes. (American College of Physicians Online; publications/ecp/augsep98/diabmgmt.htm) Sidorov et al: Incorporating diabetes education into disease management programs can, in the short-term, yield significant improvements in glycemic control in patients being treated for diabetes. (Am J Manag Care Nov;6(11): ) McCullough et al: Patient and provider satisfaction improved as did rates of retinal eye screening, documented foot examinations, testing for microalbuminuria and hemoglobin A1C. (American College of Physicians Online; Rothman et al: Diabetes education led to improvement in diabetes knowledge and satisfaction. The American Journal of Medicine® (Am J Med Dec;118(12):1444-5; author reply ) Greisinger et al: Diabetes education sessions reduced risk of hospitalization risk in patients with controlled blood glucose levels. (Dis Manag Winter;7(4):325-32)

53 Imputing Savings Specific Activity or Outcome
Economic Refernce within Guidelines Scientific Finding Linking Clinical and Economics Health Plan’s Impact Commercial Health Plans Impact Medicare Population Affected Financial Impact Increase the pct who receive nephropathy screening Perkins, et al. NEJM 348: CRF can essentially be prevented if gotten early. $53, 860 PMPY. Prevelance of nephropathy is 30% in DM Increases rate screening from to 60.4%, a 42% change. Increased screening from 60.1 to 62.28%, a 2.18% change. 2515 additional screened commercial, 456 Medicare $28, 707, 565

54 Any other ideas? Case found that not following post partum protocols for gestational diabetes contributes to increased cost, and that diabetes education can play a role. Diabetes Educ. 32(6): Nov-Dec 2006 DSME can reduce DM costs within 1 yr in Medicaid populations Balumarugan et al Diabetes Educ. 32(6): Nov-Dec 2006 The literature supports the notion that diabetic education, coupled with DM programs, can be highly effective.

55 Return on Investment in Medical Management
Hard Soft Intangible P = Probability of Outcome $$$ Profitability/Impact of the Initiative

56 Conclusions

57 What’s In Your Go Bag? A brief PowerPoint overview of what you do. 5 slides max. An economic impact analysis of your area on the corporate functions and/or your customers. 5 slides max. Samples of achievements in the past 12 months. 3 slides max. Microsoft project plan for creating impact in the next 12 months. One page. Your budget and financial plan for next year. One page. Back pocket -- Your CV

58 Questions?

59 References

60 Bibliography – Used in Presentation
Fetterolf, D.. "Commentary: Presenting the Value of Medical Quality to Nonclinical Senior Management and Boards of Directors.." American Journal of Medical Quality. (18)1. Jan/Feb pp Fetterolf, D. and West, R."The Business Case for Quality: Combining Medical Literature Research with Health Plan Data to Establish Value for Nonclinical Managers.." American Journal of Medical Quality. (19)2. Mar/Apr pp Tufte, Edward. The Visual Display of Quantitative Information. Graphics Press

61 Bibliography --Academy for Healthcare Management. Health Plan Finance and Risk Management. Atlanta, GA. Academy for Healthcare Management --Baker, Judith. Activity-Based Costing and Activity-Based Management for Health Care. Aspen Publishers --Berwick, D. Curing Health Care. New Strategies for Quality Improvement. San Francisco. Jossey-Bass --Blissenbach, H. "Use of Cost-Consequence Models in Managed Care." Pharmacotherapy. (15) pp. 59s-61s. --Brigham, E. and Gapenski, L. Financial Management. Theory and Practice. 6th Ed. Chicago. The Dreyden Press --Carey, R. and Lloyd, R. Measuring Quality Improvement in Healthcare. New York. Quality Resources --Centers for Medicare and Medicaid Services. Health Care Industry Market Update. Managed Care. Washington, DC. Centers for Medicare and Medicaid Services. March 24, 2003. --Clancy, C. and Kamerow, D. "Evidence-Based Medicine Meets Cost-effectiveness Analysis." JAMA. (276)4. July 24/31, pp --Corrigan, J.; Greiner, A.; and Erickson, S. "Fostering Rapid Advances in Health Care: Learning from System Demonstrations." --Coddington, D. Making Integrated Health Care Work. Center for Research in Ambulatory Health Care Administration. Englewood, CO --Couch, JB. Health Care Quality Management for the 21st Century. Tampa, FL. Hillsboro Printing Co for the American College of Physician Executives

62 Bibliography --Crosby, P. Quality is Free. New York. New American Library --Crosby, P. Quality Without Tears. New York. McGraw Hill Book Company --Donabedian, A. Explorations in Quality Assessment and Monitoring. Volume II. The Criteria and Standards of Quality. Health Administration Press. Ann Arbor --Dornbursch, R. and Fischer, S. Macroeconomics, Fifth Ed. New York. McGraw Hill --Drummond, M. and McGuire, A. Economic Evaluation in Health Care. Merging Theory with Practice. Oxford University Press --Drummond, M., O'Brien, B., Stoddart, G. and Torrance, G. Methods for the Evaluation of Health Care Programmes, 2nd Ed.. New York. Oxford Medical Publications --Eisenberg, J "Clinical Economics. A Guide to the Economic Analysis of Clinical Practices." JAMA. (262)20. November 24, pp --Fetterolf, D. "Commentary: Presenting the Value of Medical Quality to Nonclinical Senior Management and Boards of Directors." American Journal of Medical Quality. (18)1. Jan/Feb pp --Fetterolf, D. Costs from a Third Party Payer Perspective, Chapter 20 in Quality and Cost in Neurological Surgery. Philadelphia. Lippincott, Williams and Wilkins --Fetterolf, D. and West, R. “The Business Case for Quality: Combining Medical Literature Research with Health Plan Data to Establish Value for Non-Clinical Managers.” American Journal of Medical Quality. (19)2. March/April pp --Gafni, A. "Willingness to Pay in the Context of an Economic Evaluation of Healthcare Programs: Theory and Practice." Am. J. Man. Care. (3(suppl))S21-S

63 Bibliography --Galvin, R. "The Business Case for Quality. Developing a business case for quality will require a deliberate approach, with all economic parties at the table.." Health Affairs.Nov/Dec pp --Gladowski,P., Fetterolf, D, Beals, S., Holleran, MK, and Reich, S. “Analysis of a Large Cohort of HMO Patients with Congestive Heart Failure.” American Journal of Medical Quality. (18)2 April 2003. --Gold, M. et. al. Cost Effectiveness in Health and Medicine. (Report of the U.S. Public Health Service Panel on Cost Effectiveness in Health and Medicine.). Oxford University Press --Haddix, A., Teutsch, S., Shaffer, P. et al. Prevention Effectiveness: A Guide to Decision Analysis and Economic Evaluation. New York/Oxford. Oxford University Press --Hubbell, W. "Combining Economic Value Added and Activity Based Management." Journal of Cost Management. Spring pp --Jacobs, P. The Economics of Health and Medical Care. Gaithersburg, MD. Aspen --Kaplan, R. and Cooper, R. Cost and Effect: Using Integrated Cost Systems to Drive Profitability and Performance. Harvard Business School Press --Kohn, L., Corrigan, J., and Donaldson, M.. To Err Is Human - Building a Safer Health System. Washington, DC. National Academy Press pp --Langley, P. "Is Cost Effectiveness Modeling Useful?." The American Journal of Managed Care. (6)2. February pp --Litvak, E., Long, M., and Schwartz, S. "Cost-Effectiveness Analysis Under Managed Care: Not Yet Ready for Prime Time?" The American Journal of Managed Care. (6)2. February pp

64 Bibliography --Luehrman, T. "What’s It Worth? A General Manager’s Guide to Valuation." Harvard Business Review. May-June pp --Mansfield, E.. Economics, 6th Ed. New York. WW Norton --McCulloch, David "Managing Diabetes for Improved Health and Economic Outcomes." American Journal of Managed Care. (6)21, sup.. November pp. S1089. --McLaughlin, C. and Kaluzny, A. "Continuous Quality Improvement in Healthcare." 1999. --Millenson, M. America's Health Care Challenge: Rising Costs. A report commissioned by the American Association of Health Plans. Washington, DC. AAHP. 1/22/2002. --Montgomery, D. Introduction to Statistical Quality Control, Third Ed. John Wiley and Sons, New York --National Academy of Sciences "Priority Areas for National Action: Transforming Health Care Quality 2003." --National Committee for Quality Assurance. HEDIS National Committee for Quality Assurance. January 1997. --NCQA. The Business Case for Health Care Quality --Phelps, C. Health Economics. New York. Addison Wesley --Plocher, D. and Brody, R. "Chapter 31, Disease Management and Return on Investment. In Best Practices in Medical Management." pp Santerre, R. and Neun, S. Health Economics: Theories, Insights, and Industry Studies. Chicago. Irwin -- Santerre, R. and Neun, S. Health Economics: Theories, Insights, and Industry Studies. Irwin. Chicago --Scherer, F. M., and Ross, D. "Industrial Market Structure and Economic Performance. Third Edition." Dallas. Houghton Mifflin

65 Bibliography --Stephens, K. et al. "What is Economic Value Added? A practitioner's view. (corporate performance measure)." Business Credit. (99)4. pp. 39(4). --Taylor, T. "Economics (Part I and Part II) Audio Tape Course" --Torrance, G. "Preferences for Health Outcomes and Cost-Utility Analysis." The American Journal of Managed Care. (3(Suppl)) pp. S8-S20. --Walton, M. The Deming Management Method. New York, NY. Perigee Books --Weinstein, M., Siegel, J., et al. "Recommendations of the Panel on Cost-Effectiveness in Health and Medicine." JAMA. (276)15. October 16, pp Wessels, WJ. Economics. Second Edition 1993. --Wessels, WJ. Economics. Barron’s Business Review Series. New York

66 EDUCATIONAL OBJECTIVES
I. Articulate approaches and strategies that can be used to demonstrate that diabetes education is worthwhile. a. Where to find references b. How to reference key points from the literature to your advantage II. Describe your services in terms that are used by payers. a. return on investment ("ROI") b. value c. cost-effectiveness III. Use compelling arguments for increased access to and appropriate reimbursement of diabetes self-management education/training. CONTENT OUTLINE II. Describe and present your services in terms that are used by payers. EDUCATIONAL OBJECTIVES I. Articulate approaches and strategies that can be used to demonstrate that diabetes education is worthwhile. a. Where to find references b. How to reference key points from the literature to your advantage II. Describe your services in terms that are used by payers. a. return on investment ("ROI") b. value c. cost-effectiveness III. Use compelling arguments for increased access to and appropriate reimbursement of diabetes self-management education/training. CONTENT OUTLINE II. Describe and present your services in terms that are used by payers.

67 Slide Set Information Author: Don Fetterolf, MD, MBA, FACP
Executive Vice President, Health Intelligence Matria Healthcare, Inc. 1850 Parkway Place, 12th Floor Marietta, GA Phone: filename: AADE vx.ppt date: August 2008. date of this printout: April 8, 2017


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