Improving Care for Chronic Obstructive Pulmonary Disease (COPD) Coalition Grant Program PROJECT OVERVIEW & RECOMMENDATIONS

Transcription

1 Improving Care for Chronic Obstructive Pulmonary Disease (COPD) Coalition Grant Program PROJECT OVERVIEW & RECOMMENDATIONS

2 Executive Summary Chronic Obstructive Pulmonary Disease (COPD) is a common chronic condition that adversely affects many adults within the working age population, and can be caused or exacerbated by exposure to harmful workplace lung irritants and other environmental factors. Because these issues may contribute to high insurance costs, lower productivity and increased absenteeism, COPD is a priority condition for employers. However, awareness about the risks of COPD is low among patients and employers. Over the course of a yearlong grant period, employer coalitions affiliated with the National Business Coalition on Health explored ways that their members could positively impact care for employees with COPD. The Improving Care for COPD Patients coalition grant program, funded by the COPD Foundation, allowed coalitions to educate employers about the clinical and cost impact of COPD and to design interventions to identify and address COPD within their populations. This report summarizes the grantee coalition projects, including challenges and successful outcomes, as well as key themes identified from the group s efforts. Based on the outcomes of the grant program, this report offers recommendations to help make COPD care improvement a broadly achievable goal for other employer coalition markets. 2

3 Table of Contents Program Overview... 1 Background... 1 Application and Selection Process... 2 Project Timeline & Activities... 2 Grant Projects Overview... 3 Dallas Fort Worth Business Group on Health... 3 Montana Association of Health Care Purchasers... 5 Key Findings... 6 Recommendations

4 Program Overview Background 1 Chronic Obstructive Pulmonary Disease (COPD) is a mostly preventable and treatable disease state, characterized by airflow limitation that is not fully reversible. While estimates show that 15 million people in the U.S. have been diagnosed with COPD, with another 12 million undiagnosed or developing COPD, it has received less attention from policymakers and health care purchasers relative to other chronic conditions, such as diabetes and cardiovascular disease. 2 out of 5 COPD patients retire prematurely, causing $316,000 in lifetime income loss 1 In 2010, the total estimated cost of diagnosed COPD was $49.9 billion, with $29.5 billion in direct costs and $20.4 billion indirect costs from morbidity and mortality. COPD is associated with additional costs of lost productivity and absenteeism in the working age population. In partnership with the COPD Foundation, the National Business Coalition on Health (NBCH) supported member coalitions, through the Improving Care for COPD Patients grant program, in developing and implementing strategies to engage employers in enhancing COPD care for their covered populations. The awarded coalitions used existing COPD care improvement tools to: Work with employers to conduct an assessment of the impact of COPD on the employers covered populations and review and select possible interventions to improve care Develop a strategic action plan and begin early implementation of the selected COPD initiatives To facilitate both phases of coalition project work, coalitions accessed and utilized materials available through the COPD Foundation s Employer Toolkit ( Available materials include: educational fact sheets, brochures, and fax templates and presentation slides, as well as documentation to support claims analysis, a COPD cost estimation calculator, a strategic planning tool and access to an online and printed five question screening tool ( with a unique URL to track aggregate results. In addition to the resources available through the employer toolkit, the COPD Foundation also provided logistical support for organization and execution of on site screening events for employees. Discern Health, a health care consulting firm focused on quality measurement, value based purchasing, and enhanced care delivery issues, also supported grant program operations and provided technical assistance to grantees. Technical assistance included responding to condition specific research inquiries, educating coalitions on COPD Foundation toolkit materials, and evaluating project results, including claims analysis. 1 Fletcher MJ et al. COPD uncovered: an international survey on the impact of chronic pulmonary disease [COPD] on a working age population. BMC Public Health 2011, 11:612 1

5 Application and Selection Process NBCH used a competitive application and review process to select participants. NBCH released a Request for Proposals to NBCH all coalition members in May Coalitions submitted proposals in June of 2013 and a panel of independent reviewers scored the proposals on the following criteria: Coalition experience and skills Stakeholder and community support Proposed project activities Outcomes and evaluation Staffing & budget Overall impression In September of 2013, NBCH awarded two grants of $55,000 each to the Dallas Fort Worth Business Group on Health (DFWBGH) and the Montana Association for Health Care Purchasers (MAHCP). In addition, NBCH awarded two advisory stipends of $5,000 each to the Employers Health Coalition and the Virginia Business Coalition on Health. Advisory stipend recipients participated in the program in an advisory capacity during quarterly learning/sharing discussions with NBCH and the grantees. Topics for discussion included: strategies to engage employers on COPD; assessment of data specific to the impact of COPD on covered populations; review and selection of COPD intervention strategies; and plans for implementation. Table 1. Awardees Role Grantee Advisory Stipend Recipient Organization Dallas Fort Worth Business Group on Health (DFWBGH) Montana Association of Health Care Purchasers (MAHCP) Employers Health Coalition Virginia Business Coalition on Health (VBCH) Project Timeline & Activities The grant program s period of performance was 12 months, extending from October 2013 to October In addition to specific project activities, grantees participated in monthly check in calls with NBCH and Discern Health to provide project status updates and discuss key issues. Quarterly, both the grantees and advisory stipend recipients participated in Advisory Group calls to further support coalition activities. Grantees also participated in a workshop session about the projects during the NBCH Annual Conference on November 10,

6 Grant Projects Overview An overview of each of the two grantee projects follows below. Dallas Fort Worth Business Group on Health Project Location: North Central Texas Project Overview DFWBGH s objective through the Improving Care for COPD Patient s grant was to use the COPD Foundation Employer Toolkit tools to evaluate the current impact of COPD and to identify and implement interventions to improve outcomes for employees at three coalition employers: Atmos Energy City of McKinney Greyhound Lines Upon project initiation, DFWBGH met with the employers to provide them with educational materials from the COPD Foundation (including informational fact sheets on COPD diagnosis, treatment and cost impact) as well as access to the COPD Foundation Cost Calculator. During this phase of the project, DFWBGH provided health plans with data requests for diagnosis and procedure codes, as well as pharmacy utilization, to identify the financial impact of COPD on the employer s population. Using the COPD ICD 9 sheet from the COPD Foundation Employer Toolkit, in conjunction with recommended secondary diagnosis codes and pharmaceuticals provided by Discern Health, DFWBGH provided health plans with requested data. Data received from the health plans was not comprehensive and difficult to interpret. Initial summary results indicated a wide variation between the results predicted using the COPD Cost Calculator tool (intended to estimate potential costs for specific industries based on analysis of a large claims data set). Final reported data indicated significantly lower costs for members with a COPD diagnosis than average member costs. These results were in opposition to expectations, and resulted in a barrier for employer interest and investment in addressing the disease state. In parallel to DFWBGH s claims analysis efforts, the coalition worked with each employer to organize and execute screening events integrated with existing health fairs and safety meetings. Employers utilized the five question COPD screening tool, available through the Toolkit, to assess employees risk for COPD. With support from the COPD Foundation and the American Association for Respiratory Care (AARC), DFWBGH offered spirometry services to those employees identified at high risk. In order to promote the five question screener, DFWBGH used wellness incentives (wellness dollars, raffles, etc.) to motivate employees to participate. 3

7 Table 2. DFWBGH COPD Screening Results Employer Employees Screened High Risk Employees Employees with Abnormal Spirometry Atmos City of McKinney Greyhound Lines TOTAL Now that we are more aware of the impacts of COPD on employees and the bottom line, we can take steps to educate employees, reduce risk and promote appropriate care for those with COPD. Tyneeta Morris, HR Director, Greyhound Lines, Inc. 2 Additional screening events, tied to lunch and learn presentations facilitated by DFWBGH and hosted by AARC and COPD Foundation staff, occurred later in the project period. Content presented at the lunch and learns was based on the presentation slides accessed through the Employer Toolkit. As an outcome of the lunch and learns, DFWBGH conducted pre and post presentation surveys to gauge participant learning. Participants were particularly interested in the mortality risk associated with COPD, and the ability to influence COPD risk for themselves and for friends and family through smoking cessation. While screening events did not demonstrate significant risk, employees attending learning events were strongly engaged. 2 Upon completion of the claims analysis, DFWBGH met with employers during one on one meetings to determine strategies for implementing direct COPD interventions. As an outcome of the low impact reflected in the claims results, in addition to competing health priorities and other demands on HR management time, employers were reluctant to devote significant resources toward interventions that would address COPD. Selected interventions focused on promoting general awareness and education, and supporting increased utilization of the COPD five question screener. Examples include: Continuing to provide COPD information and education at employer health fairs Publishing COPD educational material on Human Resources/wellness company web pages Linking COPD materials to smoking cessation resources on wellness webpages Linking to unique employer five question online COPD screener via COPD Foundation Employer Toolkit DFWBGH conducted additional outreach to engage physicians through Independent Practice Association (IPA) support and dissemination of COPD materials obtained through the COPD Foundation website. Challenges Lack of actionable data to present a compelling case for COPD interventions and employer action. Difficulty collecting and interpreting claims data resulted in limited commitment to HR resources. 2 Dallas Fort Worth Business Group on Health (DFWBGH). Increasing COPD Awareness and Improving Care for COPD Patients Accessed via the web at: 4

8 Limited resources available from participating employer HR staff. Multiple and competing priorities reduced investment in COPD strategies and interventions. Coordination with health plans. Employers changed health plans mid project which impacted levels of support. Successes Met project milestones and completed projected activities. Screening events, claims analyses and lunch and learn events were completed within the project timeframe. Increased awareness of COPD for employer HR departments. Greater awareness led to ongoing commitment to messaging about COPD and attention to data. Project outcomes valued by employees and employers. End of project evaluations showed employees and employers valued the project, as it raised awareness about COPD, both for employees interested in learning more about lung health, and for HR staff who gained knowledge of resources available to the employers. Next Steps At the conclusion of the 12 month program year, DFWBGH will survey participating employers to understand and evaluate project results and discuss final plans and next steps. Separately, for the employers who implemented a unique employer five question screener link, DFWBGH will work with COPD Foundation to track and monitor employee results. On November 19 th, DFWBGH hosted a Corporate Benefits Forum for its employer members and disseminate project results to all attendees. DFWBGH published a report (hyperlink) with employer case studies for its local audience, available through the coalition website. In addition, DFWBGH will conduct an evaluation survey of participants in the Corporate Benefits Forum to determine interest in the topic and plans for further engagement around COPD. Montana Association of Health Care Purchasers Project Location: Northwest Montana Project Overview Through its grant, MAHCP s objective was to identify employees potentially benefitting from COPD interventions by leveraging employee diagnoses and pharmaceutical prescribing available through its All Payer Claims Database (APCD). Through this process, MAHCP intended to enroll members in pharmacist led education and outcomes evaluation to improve member self management of COPD. MAHCP collaborated with three coalition employers for this intervention: City of Missoula Missoula County Montana University System (MUS) University of Montana (UM) Missoula Because of MAHCP s unique data resource, the coalition was able to provide detailed claims analysis for its participating employers prior to the program inception. MAHCP s initial analysis identified 60 eligible program participants (i.e., participant employees with a COPD diagnosis). Upon further review and discussion with NBCH, COPD Foundation and Discern Health, MAHCP expanded their data review to 5

9 include employees who met other criteria potentially indicative of undiagnosed COPD (spirometry testing, adult diagnosed asthma, ER utilization for upper respiratory infection), bringing the total eligible population to 175. MAHCP partnered with the University of Montana (UM) Skaggs School of Pharmacy to provide clinic services to eligible program participants. MAHCP incentivized employees to participate by offering a copay reduction for clinic visits. In order to take advantage of the program, eligible participants were required to have a physician diagnosis of COPD. Focused interventions included: COPD disease state management Longitudinal monitoring Self management education Medication therapy management (MTM) Outcomes data collection Upon project inception, MAHCP initiated contact with the eligible employees to educate them on the pharmacy led intervention opportunity and promote enrollment. In parallel, MAHCP utilized Employer Toolkit materials to disseminate educational materials to employees. COPD educational materials included flyers, brochures, break room posters and blasts. Throughout the course of the program, MAHCP incorporated COPD information and screening into existing employer health fairs and COPDcentered lunch and learns. MAHCP leveraged these events to further promote the pharmacist led intervention. MAHCP experienced specific challenges associated with recruitment for the pharmacist led intervention. Barriers identified at project inception included geographic limitations for intervention participants (i.e., needing to travel significant distances to the clinic for the intervention) and outreach limitations (i.e., recruitment limited to mailing only). Additional challenges during the course of the program included: Obtaining confirmation and approval from health plans to outreach to plan members Targeting outreach to at risk members or members with COPD diagnoses during on site events With regard to the second bullet above, MAHCP hosted or participated in a number of employer events to promote COPD screening, awareness, and education about the pharmacist intervention. While a significant number of employees expressed interest in the program, very few met the eligibility criteria for the program. At the end of its fiscal year in June, MAHCP conducted an additional data sweep based on the initial project criteria to identify new COPD diagnoses and possible program participants, as well as to analyze utilization and pharmacy prescribing for those employees who participated in the pharmacy intervention. Out of a total number of 175 eligible employees, defined by claims criteria, 35 responded to outreach from MAHCP with interest to participate in the pharmacist intervention, and 12 employees met all eligibility criteria and completed clinic visits. Based on the lower than expected utilization of the pharmacist led intervention, MAHCP reapplied funds attributed in its budget for co pay incentives to purchase respiratory screening materials for the clinic. In October, MAHCP further revised its approach to incorporate a screening and spirometry testing event, with support from the COPD Foundation and local resources. As an incentive for employees to 6

10 participate, MAHCP raffled a Kindle Fire. Of the 110 employees screened, 15 were identified as high risk and received follow up spirometry. Challenges Outreach and employee engagement. Significant administrative challenges outreaching to employees eligible to participate in program, with limitations to mailing paired with co pay waiver incentive. Employer interest and management. Competing priorities for employer time delayed employee mailing and outreach. Successes Increased awareness among employers and employees. Utilization of Employer Toolkit materials and screening events resulted in increased employee awareness and counseling for COPD. Employer engagement with local lung health resources. Through health fair screening events, participating employers were connected with local lung health resources, establishing relationships to facilitate ongoing education and interventions. Next Steps MAHCP will conduct an in depth analysis of the claims data for participants in the pharmacist led intervention to evaluate return on investment (ROI) in terms of additional diagnoses, prescribing and utilization of healthcare services. MAHCP will use the APCD data to monitor new diagnoses for the employees who participated in the October screening and spirometry event, and who were recognized as high risk, to understand the impact of screening and whether or not it influences an employee s willingness to follow up with a physician. The lead pharmacist for the program will continue to counsel asthma patients and disseminate Employer Toolkit materials to pharmacy enrollees. Key Findings Over the course of the grant period, key themes surrounding coalition project implementation emerged. Of note, all coalitions participating in the program noted the importance of capturing employers attention with regard to COPD burden. While coalition employers did participate in the program, coalitions noted difficulty in communicating the potentially significant impact of the condition, especially in the absence of compelling data. Coalitions also identified access to educational materials, screening tools, and expert support as essential, low cost tools for promoting COPD awareness. Specifically, materials in the toolkit that had practical applicability (i.e., and fax blasts, poster templates, and presentation slides) were all cited 7

11 as important resources. Both coalitions utilized the online and printed version of the five question screener during on site screening events. Further, both coalitions expressed strong appreciation for the availability of free consulting services, including screening and spirometry testing available from the COPD Foundation, and noted that presentations from AARC staff and local resources facilitated by the Foundation resulted in a high level of interest from employees. Recommendations Recommendations based on the project results and key findings follow below, to help make COPD care improvement a broadly achievable goal for other employer coalition markets. Implement COPD education and web based risk screening as a low cost strategy for improving employee understanding of risk and ways to take action Coalitions participating in the Improving Care for COPD Patients grant program demonstrated that providing education on COPD is a low cost strategy for potentially influencing employee behavior. Publicizing the potential and often hidden risk of COPD was effective in attracting employer participation and integrating COPD interventions into existing programs and activities minimized the burden on HR staff and budgets. Where feasible, employers should develop and execute a dissemination strategy to inform employees about the risks and effects of COPD through existing HR web materials, mailings, health events or lunch and learns. Employers may wish to use existing resources, such as the COPD Foundation s Employer Toolkit, which includes a robust set of educational materials, available to employers through the Employer Toolkit, including break room posters, brochures, and fax templates, and slides. Further, free consultation and support provided by the AARC, in coordination with the COPD Foundation, was highly beneficial to coalitions conducting educational forums and combined screening and spirometry testing events. Other patient resources are available through the American Lung Association, the National Heart, Lung, and Blood Institute, and the American College of Chest Physicians. Focus on coordination with health plans, or utilize existing APCD capabilities, to access and analyze claims data Claims data is increasingly utilized to inform and understand quality in health care, and access to this data will continue to help inform purchaser decisions about how to focus wellness programs. In order to fully understand the impact of COPD on an employer s covered population, coalitions should support engagement with the employer s health plan(s) to facilitate extraction and interpretation of data. Where coalitions have existing access to data (i.e., through an APCD), they should proactively support education and transfer of data for employers on COPD diagnoses and pharmacy/medical utilization costs. 8

12 Grant program results demonstrate that there is a need for a clearly defined protocol for identifying populations impacted by COPD, which should include diagnoses, procedures, pharmacy and medical care utilization data. Development of such a tool should be informed by stakeholder input, including health plan, health provider and pharmaceutical company representatives to ensure the accuracy and replicability of the tool. A fully developed protocol should be disseminated from a single national resource to local coalitions. Incorporate COPD screening and, if feasible, spirometry into existing health fairs and safety meetings Health fairs and safety meetings offer important opportunities to engage employees about health risks and chronic diseases. For many employers, this structure is in place, and may already offer other types of screening and education. Coalitions should consider promoting the addition of a COPD screening booth, utilizing a tool such as the COPD five question screener. Where resources exist, employers should consider pairing screening with on site spirometry. Employers should tie screening to health fair incentives (raffles, wellness dollars, etc.) where possible. As demonstrated in the grant pilots, the COPD Foundation s support to employers seeking to integrate screening and spirometry into health events was one effective strategy for informing and impacting employees. Leverage existing physician or pharmacy relationships to influence improved screening and interventions Where coalitions and/or employers have existing relationships with physician groups or pharmacies, they should leverage these relationships to communicate the risks and costs of COPD, and support improved screening and management of the disease. Employers can access physician education materials from sources like the COPD Foundation website, among others, which can be disseminated through local physician newsletters or other channels, with support of coalitions. Employers with on site clinics should prompt physician outreach to high risk employees, determined through screening, to support diagnoses and proper health management. Tie COPD education and screening to existing respiratory health resources Because risk for COPD is closely tied to other and more common respiratory health topics (such as asthma or smoking cessation), employers can integrate educational materials on the risks and effects of COPD with these resources. Employers who have dedicated smoking cessation resources available through an HR webpage should consider attaching COPD education or a COPD five question screener. Employers who provide services in industries with added risk for respiratory health issues (factories, chemical plants, etc.) should integrate available COPD materials and screening tools into their health risk educational programs. Existing resources can also be improved to align more closely with tobacco cessation and air quality improvement messaging. 9