Maureen Mangotich, MD, MPH Medical Director

Transcription

1 Maureen Mangotich, MD, MPH Medical Director Prepared for the National Governors Association Healthy America: State Policy Leaders Meeting, December 2005

2 Delivering value from the center of healthcare Pharmaceutical & medicalsurgical distribution to all sites Solutions for medication safety Information systems for hospitals, payors, home care, and physicians Retail pharmacy automation Inpatient automation Drug cards for seniors Specialty pharmaceuticals Pharmaceutical repackaging Disease management

3 McKesson s products and services McKesson Pharmaceutical #1 in U.S., Canada, and Mexico Large Rx repackaging Leading generics provider #1 in retail pharmacy automation Specialty distribution & patient services for manufacturers #1 in medical management software and services for payors #1 in disease management for Medicaid agencies McKesson Medical-Surgical #1 in primary care #1 in extended care Total supply solution in acute care Private label product offerings Rapid growth in physician office pharmaceuticals and equipment McKesson Provider Technologies 63% of health systems 51% of hospitals with 200+ beds Leader in clinical, revenue cycle, and resource management solutions More Best in KLAS products than any other vendor #1 in robotic hospital pharmacy dispensing #1 in bedside scanning

4 Disease management today What is disease management (DM)? How DM can help States Why DM is important to State Medicaid What a DM provider should offer Commercial, Medicaid, Medicare DM: McKesson s role, expertise Commercial results Oregon Medicaid results Medicare Health Support

5 What is disease management? Evidence-based health education, selfmanagement counseling Chronic-illness management Delivered telephonically and/or face-to-face by registered nurses Educational mailings for participants Improves medication compliance, health and wellness Program works closely with providers, assists in practice improvement Prevention recommendations Flu, pneumonia vaccine reminders Comorbidity management Diet, nutrition recommendations Physical activity encouragement Smoking cessation Disease-specific action plan

6 What is disease management? 24/7 nurse advice Recommendations for acute conditions Avoidable admissions; self-care Facilitates better communication and interaction between Program participant and Provider Provided to State employee programs Commercial health plans Medicaid Medicare Veterans Administration

7 How DM can help States Designed to improve the quality-of-care for people with chronic illnesses Includes co-morbid condition management Disease prevention Helps participants adhere to physician care plan, obtain needed medical care, reduce health risks Reduces unnecessary hospital stays, ED visits Helps increase adherence to evidence-based care, avoids costly and debilitating complications Self-management can lead to improved health, wellness, quality-of-life

8 Why DM is important to State Medicaid In 2003, Medicaid provided coverage 1 to: 25 million children 14 million adults (primarily low-income working parents) 5 million seniors 8 million people with disabilities 39 percent of Medicaid enrollees have one or more chronic condition 2 About 80 percent of Medicaid resources spent on people with chronic conditions 2 1 The Medicaid Program at a Glance, The Kaiser Commission on Medicaid and the Uninsured, January Chronic Conditions: Making The Case for Ongoing Care, Prepared by Partnership for Solutions, Johns Hopkins University for The Robert Wood Johnson Foundation, December

9 What a DM provider should offer Holistic approach to care management for any population should incorporate Cultural and language sensitivity Rural outreach Establishment of medical home Co-morbid chronic illness management Service coordination among multiple local and regional agencies and community support systems Third-party validated clinical, behavioral, financial results

10 What a DM provider should offer Face-to-face, telephonic and written interventions to identify, engage high-risk, highcost beneficiaries 24/7 nurse advice line to help beneficiaries identify alternatives to avoidable ER, urgent care use Collaborative care management delivery through local nurses, provider outreach coordinators to work with community leaders, providers Local program delivery Program accredited by JCAHO, URAC Adept at facilitating public/private partnerships

11 Commercial, Medicaid, Medicare DM: McKesson s role, expertise Commercial BlueCross Blue Shield of Texas Federal Employee Program Group Health Cooperative of Eau Claire Medicaid Colorado, Florida, Mississippi, Montana, New Hampshire, Oregon, Pennsylvania, Texas, Washington Medicare Health Support (formerly known as CCIP) Launched in Mississippi McKesson one of only eight organizations nationwide to launch pilot through this initiative Authorized by MMA

12 Commercial results Study Asthma matched control (Commercial PPO) Diabetes historical control (Commercial HMO) One-year reduction in inpatient hospitalizations One-year reduction in ED visits Net savings per person per annum Return on investment 35.6% 32.5% $ to % 44.8% $ to 1

13 Oregon Department of Human Services Oregon Health Plan members better managed chronic illnesses and helped the state save $6 million in the first year Launched October 2002 with more than 11,000 asthma, diabetes and congestive heart failure beneficiaries The $6 million in avoided costs is only part of the story. We also saw patients doing a better job of managing their disease, making fewer visits to hospital emergency rooms and smoking less. There's no question that these patients' quality of life improved because they had more control over their chronic disease. Barney Speight, State Medicaid Director, Oregon Department of Human Services

14 Medicare Health Support in Mississippi Three-year, voluntary pilot program in Mississippi 20,980 Medicare beneficiaries will participate 10,000 Medicare beneficiaries in control group Heart failure and/or diabetes plus nurse triage access Community- and call centerbased nurses Provider-centric program Overseen by the Centers for Medicare & Medicaid Services

15 Questions and comments Thank you. Contact information: Maureen Mangotich, MD, MPH Medical Director McKesson Health Solutions