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Improving outcomes for the moderate risk cohort: Can information technology can help? Neal Kaufman, MD, MPH Chief Medical Officer, DPS Health Professor.

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Presentation on theme: "Improving outcomes for the moderate risk cohort: Can information technology can help? Neal Kaufman, MD, MPH Chief Medical Officer, DPS Health Professor."— Presentation transcript:

1 Improving outcomes for the moderate risk cohort: Can information technology can help? Neal Kaufman, MD, MPH Chief Medical Officer, DPS Health Professor of Medicine and Public Health UCLA November 21, 2014

2 Improving outcomes for the moderate risk cohort Outline of talk Why should we care? What are the characteristics of individuals in the moderate risk cohort? What are their disease trajectories? What is the opportunity? – Clinically – Economically How can technology help? How can you impact their outcomes? 2

3 From Advisory Board “… without intervention, nearly one-fifth of moderate-risk patients will move into the high-cost category each year.” Can add a new chronic condition every 3-5 years while staying moderate risk 3

4 One or more pre-chronic or chronic conditions without end organ damage Elevated costs primarily outpatient (not inpatient or ER) Sicker from own self-management & lifestyle behaviors 10-15 % per year become high cost Progress to additional chronic disease every 3 to 5 years Last years with functional and cognitive limitations What defines the Moderate Risk? 4

5 Why should we care about the moderate risk? Health is a resource for every-day life Performance span more important than lifespan Trajectories for our life being reset every day How we live our lives determines when and how we die Medical care prioritizes lifespan…should also focus on performance span Individual, social, clinical & business reasons to focus on moderate risk individuals before it is too late 5

6 Moderate Risk: Sick without Complications and Low Risk for Hospitalization Example: Medicare Population Analysis from CareMore 6

7 Moderate Risk: Sick without Complications and Low Risk for Hospitalization Example: Medicare Population Analysis from CareMore Moderate Risk 7

8 Moderate Risk: Increasing Number of Early Stage Chronic Conditions 8

9 Chronic conditions in patients with diabetes at office-based physician visits increases with age 9

10 Population Average BMI (average)34.9 Diabetes %19.7% High blood pressure %55.2% High lipids %46.5% Arthritis %12.0% Depression %24.8% Example Moderate Risk Population (average age 55) Disease Burden 10 *Source: DPS Health

11 Claims Type Average Yearly Cost Outpatient Claims $6,826 Pharmacy Claims $1,840 Inpatient Claims $2,458 Claims by Percent of Moderate Risk Population Inpatient 10.2 % Sleep Apnea Outpatient 15.6 % Joint Related Outpatient 26.8 % Example Moderate Risk Population Healthcare Utilization *Source: DPS Health 11

12 Example Moderate Risk Population Costs increase with number of chronic conditions 12 *Source: DPS Health

13 13 Example Moderate Risk Population Increasing Chronic Conditions 2010 - 2012 (N=990) *Source: DPS Health

14 Trends Favoring Moderate Risk Population Health Approach  Emphasis of Affordable Care Act  Evolving from fee-for-service to risk-bearing  Demand from employers and payers  New models of healthcare delivery  Move to quality payments to providers  Rise of healthcare consumerism  Scalable & affordable approaches emerging Opportunity: Engage the moderate risk to improve short and long-term health, improve patient experience, and reduce healthcare costs 14

15 The Moderate Risk Cohort: Current Approaches Population doesn’t receive specific or targeted interventions Wellness approaches not intensive enough Disease management primarily addresses wrong issues (Hospitalization & Emergency Department use) Not enough resources to make a significant impact with current approaches 15

16 The Moderate Risk Cohort: Opportunities Impact through evidence based, long-term, individualized interventions with education, goal setting, monitoring performance, social support, & assistance from peers & coaches Successful approaches combine low intensity outreach with automated reminders and information, with the use of health coaches (online and on-the-phone) Digital delivery can lower the cost and help programs go to scale 16

17 What Drives Increasing Morbidity in the Moderate Risk Cohort 1.Own self-management behaviors 2.Lifestyle behaviors and obesity 17

18 Self-Management Definition “Involves [the person with the chronic disease] engaging in activities that protect and promote health, monitoring and managing of symptoms and signs of illness, managing the impacts of illness on functioning, emotions and interpersonal relationships and adhering to treatment regimes.” Source: Center for the Advancement of Health (1996) Indexed bibliography on Self- management for People with Chronic Disease 18

19 Self-management Support Interventions Theory-based, evidence-proven, longitudinal programs helping individuals manage their condition(s) themselves Target participants’ relevant knowledge, attitudes, skills and behaviors Designed for each patient’s unique characteristics, changing needs, and performance over time 19

20 Adults with one or more chronic conditions in which daily self-management of the condition and associated co- morbidities is a critical element in the patient’s success. Examples include: Diabetes (any type) Ischemic Heart Disease Hypertension Hypercholesterolemia Obesity Cancer (e.g., associated with obesity) Arthritis Chronic pulmonary disease Chronic pain Kidney disease (early stage) 20 Which chronic conditions can benefit?

21 Examples of possible benefits to patients from healthier lifestyles and enhanced self-management Decreased progression from pre-condition to diagnosed chronic disease (e.g. T2DM) Fewer chronic disease complications Decreased rate of additional chronic diseases Improved depression Improved quality of life Improved work-related productivity 21

22 Example: Modest Weight Loss Improves Health (5-10 % of Body Weight) Increases lifespan Improves lung function lowers chances to get type 2 diabetes Improves arthritis symptoms Improve diabetes control Lowers blood pressure Improves blood lipids *Scottish Intercollegiate Guidelines Management of Obesity February 2010 22

23 1.Improve health 2.Reduce utilization and healthcare costs 3.Improve Quality Scores 4.Enhance member satisfaction 5.Drive member uptake of other offerings 6.Improve network relationships / services 7.Respond to customer demands 8.Respond to regulators / accreditation 9.Promote consumerism Value to Health Plans & Providers from Moderate Health Management Service 23

24 24 Characteristics of Effective Technology-enabled Solutions Provide personalized, easy-to-use, longitudinal, flexible programs using internet and cell phone Integrate education with goal setting, mitigating barriers, tracking, planning and communicating Support patients, clinicians, administrators and support networks Integrate with clinical care and HIT – portals, registries, medical records, biometric devices, etc.

25 Outreach & Education: through multi-channel print, email and telephonic communication. Partnership with TeleVox. Activation & Engagement: access significant video and article content and sign-up for monthly newsletters. Chat and ask-a-coach features. Leveraging partnerships with HealthDay and Milner Fenwick 25 Moderate Health Management Service TIER ONE: Healthy Engagement & Lifestyle Outreach Slide 25 Print MaterialsEmail Newsletters Automated Telephony Text MessagingWeb Portal

26 Moderate Health Management Service TIER TWO:Virtual Lifestyle Management (VLM) Year-long lifestyle change and weight loss directly from Diabetes Prevention Program’s (DPP’s) lifestyle intervention. Digital version developed by University of Pittsburgh; telephonic program developed at SUNY Upstate (Syracuse). Online or telephonic education - 16 weekly and 8 monthly lessons Dynamic behavior goal-setting, planning and tracking Digital or telephonic coaching 1. Education and Self-Discovery 3. Goal-setting, planning, tracking and reviewing 2. Coaching from trained clinicians 26

27 Moderate Health Management Service TIER TWO:Chronic Disease Self-Management Program Year-long disease self-management support developed by Stanford University. In-person delivery coordinated by local agencies. Trained peer led and facilitated group dynamics Interactive workbooks and educational content Action planning and reviewing Ongoing support from peers supervised by profession mentors Education on Key TopicsDynamic Action Planning Proven Online Version Parallels In-person CDSMP 27

28 VLM CDSMP bedded&v=xBDtBGck_JA 28 Tours of VLM and CDSMP

29 Thank you Contact information Neal Kaufman, MD, MPH 1539 Sawtelle Boulevard LA 90025 310 444 0636 ext. 111 29

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