The New Innovators in Healthcare - Solutions for Engaging Consumers

Transcription

1 The New Innovators in Healthcare - Solutions for Engaging Consumers Prepared for the Texas Association of Health Plans November 14, 2016 Dr. Karen Amstutz, MD, MBA, FAAP Chief Medical Officer, Magellan Health

2 A healthcare management company focused on delivering solutions to manage complex populations and conditions across the healthcare continuum M lives Commercial - Behavioral 24.8 M lives Commercial - Specialty 5.3 M lives Government 12.4 M lives Medical Pharmacy 1.7 M lives Commercial PBM 25 states & DC State Medicaid PBA ü Behavioral healthcare management and employee assistance program services ü Specialty healthcare management, including musculoskeletal, cardiac and advanced imaging management ü Integrated management for special populations ü Full-service value-driven PBM ü Total Specialty Drug Management Distribution & Engagement Formulary Management Medical Pharmacy ü Medicare Part D Prescription Drug Program (PDP) Covered lives are as of June 30,

3 Digital Solutions in Behavioral Health: Better treatment, Better experience, Better Outcomes 3

4 What is Digital Health? A case for change: banking Teller New modalities & data capture A case for change: healthcare House Calls ATM Tele Conference Virtual Group Therapy Office Visits Internet Smartphone Smart Screener Text Therapy Entirely new care options Telephone Triage Computerized Therapy Smart Pay BH Specialist Targeted Virtual Therapy Text Therapy Concierge Navigator 4

5 Digital Therapy: A History of Excellence CCBT = Computerized Cognitive Behavioral Therapy Well developed Our CCBT programs have over 20 years of development behind them. Originally made for stand-alone personal computer use but since developed for use on the Internet and mobile devices in both English and Spanish. Well studied Our CCBT programs have undergone clinical trials involving more than 1000 patients and received endorsements and recognition from the American Academy of Sleep Medicine (AASM), the United Kingdom s National Institute of Clinical Excellence (NICE - UK), Accreditation Canada, and SAMHSA s National Registry. Widely used Since 2006, our programs have been implemented online in primary care settings as a standard form of care. The program is currently being used through Magellan in a variety of settings. 5

6 CCBT is effective for common behavioral conditions These conditions make up > 90% of behavioral health complaints And are present in >25% of all adults 4 out of 5 improve sleep Reduces specialty care by two-thirds Improves workplace performance 52% reduction in depression severity High satisfaction ratings 63% reduction in symptoms of fear and panic 49% reduction in direct costs 72% reduction in hazardous use Significant reduction in binge drinking 3.4 hours per day reduction in time ritualizing and obsessing Our programs comprise the most studied suite of CCBT software with more than two decades of research and nearly a dozen randomized controlled trials. 6

7 CCBT is more effective than care as usual Recent research on efficacy, adoption, engagement In an NIMH study (released May 12, 2016), researchers found that providing CCBT software is a more effective care for anxiety and depression than doctors' usual primary care. The study included 704 participants 83% adopted the use of a CCBT software program On average, participants completed 5.3 sessions At 6-month follow-up, participants reported significant improvements in depression and anxiety symptoms. Another study (results published December 1, 2015) conducted by VA researchers in a veteran-specific outpatient setting for substance use, found that 67% of participants who used one CCBT program agreed they would engage in another CCBT program in the future. Research specific to older adults, suffering from insomnia, anxiety, and/or depression, are willing to engage with CCBT and more likely to adhere than younger cohorts. 7

8 CCBT Program Receives Highest Rating from SAMHSA s NREPP Program Review Our CCBT software, reviewed by The Substance Abuse and Mental Health Services Administration [SAMHSA] is the only program of its kind to be included in SAMHSA s National Registry of Evidence Based Programs and Practices and to receive its highest rating EFFECTIVE without reservation. 8

9 CCBT: The Patient Experience When CCBT frequency rates are compared to outpatient services, results indicate a much higher level of engagement for the software programs. 9

10 CCBT: Meaningful improvement What percentage report that they get better? 69% * show meaningful improvement within 30 days. The majority of members report they are getting better within 30 days of starting a CCBT program. *To calculate meaningful improvement we measure the difference between the First Score and the Last Score on the clinical scales built into the program sessions, and analyze the percentage of members who report a positive difference ( Decrease ) from the First Score to the Last Score. This is aggregate health plan member data. 69% of health plan members participating in CCBT report they get better within 30 days. 10

11 CCBT: How much better are patient getting? Severe Moderate PHQ 43% * PHQ** 44% GAD*** 48% WSA**** 38% Mild 8.0 GAD None Average symptom reduction None Mild Moderate Severe Average First Score Average Last Score Average First Score Average Last Score WSA *To calculate symptom reduction we average both the First Score" and the Last Score". Next we calculate the difference ("Decrease") between the First Score Average" and the Last Score Average (Average Decrease = First Score Average - Last Score Average), and then divide the "Decrease Average" by the First Score Average" and multiply the answer by 100 % (Average Decrease = Average Decrease First Score Average 100). **Patient Health Questionnaire (a self-report questionnaire for severity measuring of mental health symptoms) ***Generalized Anxiety Disorder Scale (a self-reported questionnaire for severity measuring of anxiety symptoms) ****Work and Social Adjustment Subscale (a self-reported questionnaire of functional impairment attributable to an identified problem) These standardized measurement tools (above) are embedded in the CCBT programs. On average, health plan members who initially report as severe or moderate are improving one or two full clinical ranges (i.e. many members go down from severe to mild) when engaged in two or more sessions. 11

12 The Primary Care Experience: Smart Screening & Practice Guidance Color code system for the patient overview page so that medical staff can quickly triage and refer patients using the administrative portal from their workstations Data-plan enabled devices (ipads that maintain connectivity) are set up and delivered to reception/bh/medical staff who are trained to deliver screening on the devices Access and send screening results for BH/medical staff who are trained on the color code system and how to access, print, and/or electronically send results 12

13 Linking Patients to CCBT: SmartScreener Refer and Engage Technology Identification of patients with behavioral health problems About 33% of patients who are screened in primary care clinics using our software screen positive for a condition Incomplete None Mild Moderate Severe 2% 65% 17% 6% 10% Referral to CCBT 65% About 80% of patients screened are deemed appropriate Severe by the screening tool and the clinicians to be referred to CCBT %; of those who are referred will engage in the program 10 50% of those who engage will continue with the program (2 or more sessions) And of those who do 2 or more sessions, 10%-20% will complete the programs Patient feedback 90% of engaged participants rate the programs as helpful and useful. 75% of individuals actually prefer a non-medication care option when asked. 6% 17% 2% 10% Incomplete None Mild Moderate 13

14 Thank you!