Selected Results from Chronic Disease Management and Behavioral Health Laura Jacobus-Kantor, Ph.D. The Michigan Purchasers Health Alliance September 21, 2006

2 Ensuring Solutions to Alcohol Problems Located at George Washington University Medical Center Funded by The Pew Charitable Trusts Goal: Improving access to alcohol treatment How: Providing research-based materials through targeted outreach to business leaders, policy makers and advocates

National Business Coalition on Health (NBCH) & eValue8 More than 80 state and regional business coalitions made up of 10,000 employer members nationwide employing over 34 million covered lives eValue8 RFI is a uniform, annual assessment of the quality of care for a range of health concerns provided by health plans to employees Survey conducted by businesses for business – purchasing, accountability, incentives and penalties

2003 eValue8 Participating Plans

2006 eValue8 Participating Plans Key: Participating States

Michigan Plans Surveyed in 2006 Aetna HMO Aetna PPO Blue Care Network HMO BCBS PPO Care Choices HMO Care Choices PPO HAP HMO HAP PPO Health Plus HMO Humana PPO M-Care HMO Physicians Health Plan HMO Physicians Health Plan South MI HMO Priority Health HMO

7 Chronic Disease Management Mean CDM Score Michigan PlanNon-Michigan Plan 79%63%

8 HEDIS Trends: Asthma- Appropriate Medication

9 HEDIS Trends: Cardiovascular

10 HEDIS Trends: Diabetes

11 Asthma Disease Management 29% Asthma is a vendor program 96% have a DM program in place 87% structured as an opt-out 6% structured opt-in 3% opt-in or opt-out 89% plan wide and available to all members

Who Has Alcohol Problems? 11.1% of full-time workers ages 18 – 49  Approximately 12.3% of MI workers Twice as many men (13.7%) as women (7.4%) Prevalence by age:  (18.9%)  (12.5%)  (7.8%)

Here is the Problem: Source: Office of Applied Studies. (2004). Results from the 2003 National Survey on Drug Use and Health: National findings. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Secondary Causes of Disease (Ages 35 and Older) Cancer Lip, Mouth and Pharynx Esophagus Larynx Liver and Bile Ducts Stomach 50% (men) 40% (women) 75% 50% (men) 40% (women) 15% 20% Diabetes5% Gastrointestinal Disease20% Injuries Attributable to Alcohol Motor Vehicle Fatalities Injuries 41% 9% Violence (Including Homicide)46% Problem Drinking Causes Disease and Injury

How do alcohol problems cost businesses? Lower productivity Lost workdays Extra health care use Other costs:  Workers compensation and disability  Accidents and damage  Turnover and worker replacement  Diverted supervisory and co-worker time  Workplace friction  Family disruption

Spending by Insurers Chart Source, SAMHSA, 2005

Spending by Insurance Source Chart Source, SAMHSA, 2005

Employment-based health benefits  treat addiction as if it were an acute illness or willful bad behavior General medical system  unprepared and un-paid to identify or treat alcohol problems early Specialty substance use treatment system  hampered by low insurance reimbursement, acute care model Many people with alcohol problems do not want the primary treatment goal offered:  abstinence Current State of Treatment

Behavioral Health Overview Mean BH Score Michigan PlanNon-Michigan Plan 69%53%

20 Alcohol Disease Management 64% Alcohol is managed by an MBHO 57% BH is accredited by NCQA or JCHAO < 1% Have no BH program 75% Alcohol screening plan-wide and available to all members 80% Alcohol treatment plan-wide and available to all members

Recent estimates suggest that almost 8% of the US population has an alcohol problem 92% 8% Estimated Percentage of Plan Members with an Alcohol Problem

92% 8% Less than 1% of Michigan members are identified. How many get Identified?

Recent estimates suggest that almost 9% of the US population has a major depressive disorder 91% 9% Estimated Percentage of Plan Members with Depression

91% 9% 4.3% of Michigan members are identified. How many get Identified?

Alcohol5% Depression47% Diabetes65% Hypertension70% I dentification Rates for Other Health Conditions

Alcohol Screening Instruments for Primary Care Providers

Alcohol Screening Instruments for Behavioral Health Providers

Depression HEDIS Collected

Behavioral Health Comparisons Disparities between behavioral health and non- behavioral health are evident: Identification rates  Use of data elements to identify affected members Rate of communication between plans Rate of activities that encourage follow-up with identified or high-risk individuals

What more can be done? Employee Assistance Programs Work with other businesses and health care providers Use EAP and Health Plan data to build the case for the effectiveness of employment-based alcohol treatment in business terms:  Avoidable health care costs  Avoidable productivity losses  Avoidable absenteeism

What Businesses Can Do to Make Their Workplaces Safer, Healthier and More Productive Comprehensive Health Insurance Benefits  Average cost of upgrading is around $5 per beneficiary per month  Equitable co-pays, deductibles, limits. Co-pays less than $10/session.  It is being done! Managing health plan benefits  National Business Coalition on Health’s eValu8 RFI at  Confidential screening and brief intervention  Encourage primary care screening and treatment  Monitoring utilization and outcomes

Looking forward: The 2007 eValue8 RFI Investigate eValue8 scales-both within and between sections:  Section scales  Summary scales  eValue8 total scale What are the properties of these scales? Do they accurately measure what we want them to? Which items do not contribute any unique variance to scales and can be eliminated from future versions of the RFI?