Disease Management Update

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Disease Management Update RAC March 2009
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The Goals of ACCESS Plus

• To improve access to primary care and provide a
  medical home for children and adults
• To improve access to health care services for
  Medical Assistance recipients
• To improve the quality of health care available
  to Medical Assistance consumers
• To stabilize Pennsylvanias Medical Assistance
  spending
• To provide access to disease management (DM) and
  care coordination

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ACCESS Plus Service Area
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ACCESS Plus Disease Management

• McKesson will provide Disease Management services
  to Enrollees with the following conditions
• Asthma
• Diabetes
• Chronic Obstructive Pulmonary Disease
• Coronary Artery Disease
• Congestive Heart Failure

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Why Disease Management?
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Disease Management Goals

• Increase the proactive self-management skills
• Support the Provider-Patient relationship
• Optimize medical management
• Coordination of care
• Establish Medical Home
• Measurably reduce avoidable utilization
• ED
• Inpatient
• Improve quality of life

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DM Program Enrollees Introductory Mailed
Materials

• Personalized letter
• 4th grade reading level
• Magnet with Toll Free number
• Easy to read educational pamphlet
• Mail or hand delivered

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DM InterventionsProactive Nurse Contacts

• Outbound telephone calls from DM nurses
• Frequency based on risk stratification
• Disease-specific education
• Care plan compliance monitoring
• Special needs coordination
• Symptom assessments
• Field visits
• For enrollees appropriate for face-to-face care
  management
• Provide same components as telephone-based
  nursing
• Special needs coordination

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DM Interventions Personalized Action Plan for
Enrollees

• Prevention
• Education
• Screening and testing
• Medication reminders
• Warning signs and symptoms

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Physician CommunicationsIntroductory Mailing

• Cover letter with list of physicians patients
  eligible for enrollment
• Program Information
• Clinical guidelines

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Physician Alerts

• Clinical alerts faxed to office/clinic and/or
  nurse calls office

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Medical Care Coordination
Intense Medical Case Management Transplants,
neonatal ICU cases, burns, etc
DM-related Care Coordination Clinical and
resource coordination needs
General Care Coordination Transportation, DME,
community services
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Telephone Triage Services

• Eligible ACCESS-Plus clients enrolled in a DM
  Program with asthma, diabetes, heart failure,
  CAD, and COPD
• DM enrolled clients call a toll-free number with
  symptom(s) and/or health questions
• Nurse makes a disposition recommendation based on
  structured clinical interview

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Program Effectiveness

• Cost savings of DM program-
• 27 million in year 1
• 35 million in year 2

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Program Changes

• September 2007
• Link more closely to primary care physicians
• Use predictive modeling to focus on sicker
  patients
• Reach out to build relationships with patients

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The Data
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More Data
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Effects of Changes

• Patients get greater attention and support.
• Physicians can better direct the nurses to the
  patients most important clinical areas.
• Patient satisfaction strong
• Provider satisfaction improved
• One consequence, fewer patients engaged.
• Good that we dont spend time with patients who
  are doing well.
• But, are we getting enough support to all the
  patients who need help?

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Questions?