Talking to Health Plans Making the CDSMP Case as a Community Benefit

Transcription

1 Talking t Health Plans Making the CDSMP Case as a Cmmunity Benefit Opprtunity t be assciated with a prestigius, respected and strng evidence-based educatinal/self-management prgram with a natinal reputatin. Opprtunity t better align health plan cmmunity benefits prgramming with internal medical management bjectives and pririties. Opprtunity t build rbust public/private and nn-prfit strategic relatinships and partnerships ARRA Funding creates an excellent pprtunity t apprach plans In this health care refrm mment, educated and empwered individuals practicing self-management experience imprved health status, use fewer health resurces, and make the health care system mre efficient and effective. Jhn White, Vice President f Integrative Wellness, EmblemHealth 1

2 Talking t Health Plans Making the ROI Case 42% f Americans are living with a chrnic medical cnditin; this number is expected t increase 20% by % f peple ver age 65, have ne chrnic disease cnditin; 63% have tw r mre. 95% f Medicare spending is attributed t beneficiaries with chrnic cnditins. Causes are: Fragmented inadequate care Pr cmmunicatins amng primary prviders, specialists, patients and family caregivers Weak adherence by patients Inability t flag prblems early Acute care rientatin f health care system vs. grwing chrnic care needs f ppulatin Jhn White, Vice President f Integrative Wellness, EmblemHealth 2

3 Talking t Health Plans Making the ROI Case fr CDSMP 3 types f interventins fr Medicare beneficiaries with multiple chrnic cnditins have been shwn t be especially effective in maintaining r imprving health utcmes, reducing csts and preventing avidable hspitalizatins: Transitinal care interventins (Naylr and Cleman) Crdinated care interventins (Select sites frm the Medicare Crdinated Care Demnstratin) Self-management educatin interventins (Lrig and Wheeler) (Randall Brwn et al/mathematica) Jhn White, Vice President f Integrative Wellness, EmblemHealth 3

4 Talking t Health Plans Making the ROI Case fr CDSMP The ptimal evidence-based care crdinatin mdel? Augment effective nging care crdinatin with a transitins in care prgram; invlve family caregivers Offer CDSMP and ther strng evidence-based self-management prgrams CDSMP Supprted by ver 25 years f federally-funded research frm AHRQ, NIH, CDC Prminently featured in AARA Funding dcuments Fcus n individual patients gals/needs Jhn White, Vice President f Integrative Wellness, EmblemHealth 4

5 Talking t Health Plans Making the ROI Case fr CDSMP Frm payer perspective DM impact and ROI is difficult t demnstrate. There are prpsals befre cngress t enhance the influence f the Medicare Advantage STARS prgram that reprts health plans perfrmance n a number f quality measures. Managing chrnic cnditins is a majr measure. There are prpsals befre cngress t extend pay fr perfrmance (P4P)/quality incentives t Medicare Advantage health plans. MA quality incentives and STARS ratings create an imperative fr health plans t imprve their HEDIS results. CDSMP and ther prgrams under discussin at this cnference have an pprtunity t leverage these dynamics. Jhn White, Vice President f Integrative Wellness, EmblemHealth 5

6 Talking t Health Plans Making the ROI Case fr CDSMP Need t demnstrate hw CDSMP r the prgram yu are advcating fr can help plans imprve their perfrmance at a reasnable cst while imprving member satisfactin and retentin and ptentially save mney. Csts need t be reasnable and apprpriate t expected utcmes. Jhn White, Vice President f Integrative Wellness, EmblemHealth 6