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School Employees Health Care Board Conference Chronic Condition Support (Disease Management) March 3, 2009 David Epstein, MD – Market Medical Executive.

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Presentation on theme: "School Employees Health Care Board Conference Chronic Condition Support (Disease Management) March 3, 2009 David Epstein, MD – Market Medical Executive."— Presentation transcript:

1 School Employees Health Care Board Conference Chronic Condition Support (Disease Management) March 3, 2009 David Epstein, MD – Market Medical Executive Connie Wallace – Director of Sales Operations CIGNA HealthCare

2 Who Is Impacted By Chronic Conditions?  More than 90 million Americans – nearly 1 in 3 – live with a chronic condition  7 of every 10 Americans who die each year, more than 1.7 million people, die to a chronic condition  The medical care costs of people with chronic conditions account for more than 75% of the nation’s $1.4 trillion medical care costs According to the Centers for Disease Control and Prevention (CDC):  Every percentage point drop in A1C blood test results reduces the risk of eye, kidney, and nerve diseases by 40%  Blood pressure control reduces the risk of heart disease or stroke among persons with diabetes by 33% to 50%, and the risk of eye, kidney, and nerve diseases by approximately 33%  Improved control of cholesterol and blood lipids (i.e. HDL, LDL, and triglycerides) can reduce heart complications by 20% to 50% Self-care management is critical to managing chronic conditions

3 More Than 30 Conditions Addressed Via Eight Programs Oncology High-Risk Maternity Plus: Asthma Diabetes Emphysema Bronchitis Low Back Pain CAD CHF Angina I.B.D. Osteoporosis Pressure Ulcers Atrial Fibrillation Arrhythmia Stroke Prevention Acid Reflux Peptic Ulcer Gastric Bleeding Colitis Crohns Disease Urinary Incontinence Osteoarthritis Fibromyalgia Hepatitis C Hypertension Dyslipidemia High-Risk Obesity Metabolic Syndrome Depression Anxiety Bipolar Disorder 6: Weight Complications 7: Depression 1-5: “Core 5” 8: Targeted Conditions

4 Finding Them – Identifying Appropriate Candidates DentalBehavioral Other Carriers’ Data Pre-Auths Disability Predictive Algorithms Case MgmtMember Services Providers CIGNA Expertise Lifestyle Coaches Health AdvisorsSelf Referral HRAPharmacy Claims Medical Claims CIGNA Analytics Why Multiple Sources Matter  Multiple sources finds more people  Corroboration decreases false positives  Prioritizes initial outreach  Connect multiple insights into a person’s health status  Creates a more holistic view of the patient’s needs Integrated Care Mgmt Database Find Outreach Engage Coach Improve Report

5 Team Approach Empowers the Participant  Promotes independence and self-reliance of members, decreases chance of dependence on one nurse  Continuity and transparency of interactions is fostered through the clinical information system  Reaches more of your population, quicker, resulting in greater effectiveness  Provides for efficient and scalable workforce management – deeper penetration into diseased population translates into greater touch and better outcomes  Higher quality  Peer review for clinical excellence and mentoring is possible with team involvement in a case - including other skill sets as well (dietitians and respiratory therapists)  Broader knowledge through multiple resources:  Different nurses with different backgrounds manage participant as a “whole person;” individuals with co-morbid conditions receive the benefit of nurses from multiple specialties  Each call focuses on ALL of the participant’s conditions  Allows for multiple perspectives and experiences of clinical group to help motivate and inspire behavior change - consistent messaging through different styles Find Outreach Engage Coach Improve Report

6 Best-Practice Clinical Guidance For example, from our Diabetes program Education Empowerment Support Find Outreach Engage Coach Improve Report

7 Reinforcing the Coaching  Ongoing “care calls” to check in  Helps navigate participant to necessary services  Coaches for behavior change  Provides motivation to help participant reach goals  On-demand RN access  24x7 toll-free telephone access for participant and physician  Multiple channels of outreach  Print materials mailed to home  Online information and tools  Telephonic question support  Routine preventive care reminders for participant and physician Find Outreach Engage Coach Improve Report

8 Expected Outcomes  Education on condition and importance of care  Improved clinical measures  Regular screenings and preventive testing  Behavior changes  Sense of empowerment  Compliance with doctor’s plan of care  Less acute care episodes like emergency room visits or inpatient stays  Increased productivity  Absenteeism and presenteeism down Bottom Line: Quality of life and satisfaction improved Find Outreach Engage Coach Improve Report

9 Changing Behavior, Improving Health  Engage the entire diseased population  Right amount of support at the right time  Integration allows us to manage the whole person  HRA, CBH, Case Management, Member Services, Health Information Line, Health Advisor, physician or self-identified  Daily expedited manual add to reach people at “teachable moments”  Experienced RNs build trust channels  73% have 10+ years experience, 40% of our nurses have 25+ years experience  Science and innovation focus on change behavior  Prochaska’s model of behavior change, goal setting techniques, empathy training  Team model offers 24/7 availability and diversity of specialties  Support the participant’s physician: depression screening, medication reports, Gaps in Care alerts  Technology scales the human connection  PopWorks, dialer, home monitoring

10 What’s Different about CIGNA?  Elite management and operations team  Pioneers in disease management – helped establish DsM  Deep bench strength, most experienced leadership  High touch, Full Service – not just FYI mailings  Analytics – CIGNA’s Clinical Insights team  High-powered informatics talent  Deep analysis of customer’s unique needs and comprehensive reporting  World-class partnerships  Healthways is one of the foremost disease management companies  CIGNA Behavioral is a leading behavioral specialist  Exclusive integration and collaboration, dedicated business units More than 1500 manual client analyses since 2005 !

11 What’s Different about CIGNA? (continued…)  Unique programs – e.g. weight complications and depression  Integration  Multiple care touch points  One-stop shopping for customers  More efficient  Results - Proven track record, published results  Industry-leading Quality Compass® scores (NCQA) – six years running!  Aggressive investment in programs. Continuous process improvement  Asthma re-design, cardiac re-design - each program is scrutinized  Engagement specialists, Pharmacist tie-in, numerous clinical enhancements

12 In Summary  High medical cost trend  Adverse health outcomes  Lost productivity  Absenteeism and presenteeism  Diminished employee quality of life  Need for guidance on addressing chronic illness Opportunity  Full service, high touch program  Sophisticated identification data models  Extensive program portfolio  One-on-one condition management coaching  24 x 7 support  Highly trained nurses and clinicians  Member empowerment  Best practices guidance  World class partners to deliver quality  Insightful deep dive reporting Solution  Mitigated medical cost trend  Improved compliance with physician plans of care  Avoidance of adverse health outcomes  Improved productivity  Absenteeism and presenteeism reduction  Improved employee quality of life  Validated and published results  Strong guarantees  Best in class programs to address chronic illness Value Awards, Accreditations, and Endorsements


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