IHA Presentation

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• IHA - Presentation
• November 15, 2006

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Agenda

• McKesson Overview
• Your Healthcare Plus Overview
• Staff Hospital Placement
• Opportunities to Work Together
• Questions

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McKesson History and Overview

• Worlds largest supply management and healthcare
  information technology company
• 80B billion in revenue, Fortune 20, SP 500
• Unique healthcare products and services for
  providers, payors, pharmacies and manufacturers
• Broadest national customer base in healthcare
• Market leadership in the payor market
• 25,000 employees
• Proven strength and stability over 170 years

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McKesson Comprehensive Strategy
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McKessons Existing Footprint in Illinois

• As of September 2006, McKesson had 900 employees
  living and working in Illinois, serving over
  2,000 customers.

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McKesson Health Solutions
Care Mgmt. Workflow
Analytic Software
InterQual Products
CareEnhance Installed Solutions
CareEnhance Services

• Most clinically robust and flexible workflow
  solutions on the market
• 2000 case managers using CCMS
• New web-based provider tool links with payors

• More than twice the size of nearest competitor
  with 50 market share
• Largest medical call center software developer
  and distributor in the world

• DM provider for 8 state Medicaid plans
• Chronic Care Improvement Medicare pilot program
  awardee
• Top 5 chronic care mgmt company
• 1 provider of 24/7 Nurse Advice Line services

• 30 million covered lives
• Market leader in provider profiling and analytic
  tools
• Largest vendor of HEDIS reporting software

• Covering 100 million lives
• Used to help assure NCQA/JCHO accreditation
• Used by CMS, Department of Defense and VA
• Nationally recognized used and accepted by
• 2000 hospitals
• 750 MCOs

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Chronic Care Management Leader

• Core competency addressing the needs of
  vulnerable populations
• Medicaid FFS 70 of the outsourced market
• Over four years of DM experience in FFS Medicaid
• One of 8 CMS Medicare Health Support Programs
• Accredited and certified by NCQA, URAC and JCAHO
  since 1998
• Leader in peer-reviewed publications
• Disease Management Association of America,
  Executive Committee

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Care Management Programs

• McKessons program structure includes
  interventions for
• Asthma
• Diabetes
• Heart Failure
• CAD
• COPD
• Schizophrenia
• Depression
• Chronic Pain
• Complex case management, including conditions
  such as hemophilia, HIV, metastatic cancers, etc
• Frequent ED utilizers

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McKessons Medicaid FFS Clients
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McKesson Health Solutions
Medicaid ABD TANF
HFS
Advocacy Groups Community Coalitions Disease
Coalitions Volunteers Service Providers
Physicians Facilities
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Agenda

• McKesson Overview
• Your Healthcare Plus Overview
• Staff Hospital Placement
• Opportunities to Work Together
• Questions

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HFS Disease Management Program

• With the assistance of a Disease Management
  Vendor, HFS implemented a Disease Management
  Program starting July 1, 2006.
• DM contract was awarded to McKesson Health
  Solutions (MHS)
• Program name Your Healthcare Plus
• Program announcements were mailed the week of
  July 5th to DM program enrollees and selected
  clinicians who have provided care in the last year

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Your Healthcare Plus (YHP)

• Goal
• Improve health outcomes reduce avoidable costs
• Program Design Concepts
• Reduce inappropriate and unnecessary utilization,
  especially ED use
• Reduce avoidable medical admissions through
  better community-based care
• Establish a medical home to minimize fragmented
  care and improve continuity of care
• Improve coordination of care
• Increase member compliance with treatment plan
  and improve self-management skills
• Improve adherence to national, evidence-based
  clinical practice guidelines
• Use data and IT tools to better monitor, report
  and improve clinical outcomes

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YHP Who is Eligible to Participate?
Three Distinct FFS Medicaid Populations
Non-Dual Aged Blind
Disabled
Total about 165,000 Enrollees
Family Health
Institutionalized (8800)
PERSISTENT ASTHMA
1
2
(N 48,700)
CHRONIC CONDITIONS
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FREQUENT ED USERS
(N 101,700)
(N 14,200)
Participation is voluntary. Individuals can
opt out.
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Medicaid Populations Excluded

• Participants enrolled in HFS voluntary managed
  care program
• Pregnant and postpartum women and infants
• Children and adolescents whose care is subsidized
  by DCFS (foster care, adoption assistance,
  subsidized guardianship)
• Participants with primary medical insurance
  through another carrier (those with significant
  third party liability coverage as determined by
  HFS)
• Participants involved in hospice care
• Participants enrolled in the Home and
  Community-Based Waiver program
• Participants eligible only on a short-term basis,
  such as the spend-down population

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Population Profile Non-Dual ABD
Non-DualAged Blind Disabled

• Cost to HFS last year 1.2 billion

Institutionalized (8800)
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CHRONIC CONDITIONS
(N 101,700)
Non-dual means disabled individuals who
qualify for Medicaid but do not quality for
Medicare benefits.
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Disease Prevalence
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Mental Health Diagnoses

• 24 of non-institutionalized ABD have a primary
  mental health diagnosis
• Over 41,200 YHP enrollees have one or more mental
  health diagnoses1
• Depression 25,572
• Bipolar 7,677
• Schizophrenia 17,190
• Other psychoses 7,130
• Substance abuse 9,406

1Source Internal McKesson claims analysis
August 2006. Note. The breakdowns by disease
category include counts of individuals with each
diagnosis. Some individuals have more than one BH
condition.
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Program Staff Use Holistic Approach

• Identify and assess
• Core conditions and co-morbidities, health
  perception and psychosocial resources
• Prioritize
• Medical risk, Stage of Readiness, Maslow
  hierarchy, Motivational Interviewing
• Educate, Coach and Coordinate
• Empowerment, self-management, health system
  navigation, advocacy
• Physician Integration
• Care plan input
• Workflow support
• Care Coordination
• Reinforce Medical Home

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Multidisciplinary Care Team Model
Initial Patient Management Contact
Additional Care Team Members
Lay Health Educator - Clinic
Case Mgmt RN - Hospital
Complex Case Mgmt RN Institut.
Institutionalized (10k)
Care Coordination, Referrals to DM Nurse or
Social Worker, DocSite use
ED Case Mgmt Discharge Follow-up Referrals to
Social Worker or DM Nurse
Complex Case Mgmt RN - CB
Pharmacist
Social Worker
Blind/Disabled (90k)
Pharmacist to MD Mental Health Rx Issues
Support Care Mgrs for Specific Case Needs
DM RN Work_at_ home CBRN
Behavioral Health Pharmacist
Behavioral Health Specialist
Persistent Asthma (50K)
Lay Community Educator
Field Resource Coords for McK staff
Health Resource Coords - inbound
Lay Community Educators function as locators,
care coordinators and can manage patients for
low-risk interventions like the ED program
Frequent ED Users (15K)
Call Center Inbound-call Handlers
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YHP Collaborative Care Model
Expanded Services/Support for Patients

• Review patient rosters
• Enroll eligible patients
• Co-develop care plans

Telephonic Coaching/education
In-home assessments
Customized care plan for Mrs. Jones
Customized care plan MRS JONES

• Teach/reinforce self-management skills
• Identify/address barriers to adherence to
  treatment plan
• Support/coach for behavior change

• Schedule regular chronic disease tune up visits
• Urgent office evaluations as needed
• Adjust treatment plan as needed to meet goals

Care coordination
24X7 nurse triage line
Call 1-800-973-6792
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Agenda

• McKesson Overview
• Your Healthcare Plus Overview
• Staff Hospital Placement
• Opportunities to Work Together
• Questions

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Hospital-Based Case Management

• Nurses will be located in the hospital (ER and
  inpatient) who work with hospital discharge
  planners.
• Placed in 10-12 high Medicaid volume hospitals.
• Major Focus Areas
• Finding people that cant otherwise be found
• Helping transition patients across the settings
  of care
• Obtain a copy of the discharge plan in order to
  facilitate adherence and check for satisfaction
  of condition-specific clinical metrics

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Daily Activities Related to Admissions

• Begin planning for discharge on day of admission
  by
• Attending rounds with treating physician for self
  understanding of plan and future communications
  (both physician, member, family, etc) 
• Reviewing chart daily for opportunities to
  follow-up with physician orders and encourage use
  of Personal Health Record
• Transition to home with appropriate out-patient
  services (if needed)
• Education in self care warning signs

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Care Transitions Intervention(CTI)

• University of Colorado (CU) Model
• Patient-centered
• Quality improvement / cost containment
• Complex needs
• Across settings of care

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CU Model Baseline Survey

• Feedback from CU study members
• Did not feel prepared
• Did not understand their role
• Received conflicting information
• Did not know who to contact
• Did not know how to do things for themselves

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Four Pillars Approach

• Medication self-management
• Use of dynamic patient-centered record
• Primary Care and Specialist follow-up
• Knowledge of Red Flags

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CTI Illinois
Parry, et al, 2003
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CU Model

• Select diagnoses based on anticipated need for
  post-hospital follow-up

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Hospital Visit

• Introduction
• Program overview
• Use of PHR
• Prepare for discharge

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Home Visit

• Within 24-48 hrs
• Medication reconciliation
• PHR review, update instruction
• Emphasize importance of follow-up
• Red Flags education

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CU Outcomes

• Lower readmission rates

8.3 v 11.9
16.7 v 22.5
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CU Outcomes

• Lower readmission rates (for same condition)

5.3 v 9.8
8.6 v 13.9
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CU Outcomes

• Annualized cost savings

295,594
based on 375 patients over 180 days
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CTI Illinois

• What it is
• Coaching program
• Time limited
• A bridge
• Focuses on 4 key areas
• Integrated

• What it is not
• UM
• Discharge planning
• Long-term management
• Home care substitute
• Comprehensive DM / CM
• Standalone

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Current Challenges

• Attitudinal, Organizational, Structural barriers
• Data input (admissions)
• Difficulty getting acutely ill to take charge
• Behavioral Health

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Current Strengths

• Patient-centered and Collaborative
• Skills that are sustainable
• Low cost of implementation and support
• Standardized program for any chronic condition
• Reduces patient-care costs
• Improves quality of care delivered

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Agenda

• McKesson Overview
• Your Healthcare Plus Overview
• Staff Hospital Placement
• Opportunities to Work Together
• Questions

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Opportunities to Work Together

• Data sharing on program participants receiving
  care at your hospital
• Opportunities to provide more community follow-up
  post-discharge, focusing specifically on those
  areas that result in re-admissions.
• Improve efficiency and reimbursement in
  outpatient clinics

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What We Need From You?

• Agreement on the concept of Your Healthcare Plus
  placing someone on site at your location.
• Agreement to encourage your team to share data
  and information.
• Provide a small workspace that our nurse can use,
  ideally with an internal phone line, so that
  departments such as discharge planning and the ED
  have a way to contact the RN.
• Agree to meet on a regular basis to discuss
  program effectiveness and next issues?

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Agenda

• McKesson Overview
• Your Healthcare Plus Overview
• Staff Hospital Placement
• Opportunities to Work Together
• Questions