Selected Results from Chronic Disease Management and Behavioral Health Laura Jacobus-Kantor, Ph.D....
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Transcript of Selected Results from Chronic Disease Management and Behavioral Health Laura Jacobus-Kantor, Ph.D....
Selected Results from Chronic Disease Management and Behavioral HealthLaura Jacobus-Kantor, Ph.D.
The Michigan Purchasers Health Alliance September 21, 2006
2
Ensuring Solutions to Alcohol Problems Located at George Washington University
Medical Center Funded by The Pew Charitable Trusts Goal: Improving access to alcohol treatment How: Providing research-based materials
through targeted outreach to business leaders, policy makers and advocates
www.ensuringsolutions.org
National Business Coalition on Health (NBCH) & eValue8 More than 80 state and regional business coalitions made
up of 10,000 employer members nationwide employing over 34 million covered lives
eValue8 RFI is a uniform, annual assessment of the quality of care for a range of health concerns provided by health plans to employees
Survey conducted by businesses for business – purchasing, accountability, incentives and penalties
Michigan Plans Surveyed in 2006
• Aetna HMO• Aetna PPO• Blue Care Network HMO• BCBS PPO• Care Choices HMO• Care Choices PPO• HAP HMO• HAP PPO
• Health Plus HMO• Humana PPO• M-Care HMO• Physicians Health Plan
HMO• Physicians Health Plan
South MI HMO• Priority Health HMO
8
HEDIS Trends: Asthma- Appropriate Medication
0%
20%
40%
60%
80%
100%
2002 2003 2004 2005 2006
5 to 9
10 to 17
18 to 56
9
HEDIS Trends: Cardiovascular 2002-2006
0%
20%
40%
60%
80%
100%
2002 2003 2004 2005 2006
Control BP
LDL Level
Beta Blocker
LDL Screen
10
HEDIS Trends: Diabetes 2002-2006
0%
20%
40%
60%
80%
100%
2002 2003 2004 2005 2006
Retinal Exam
Nephropathy
Poor HbA1c Control
HbA1c test
LDL Screen
11
Asthma Disease Management
29% Asthma is a vendor program
96% have a DM program in place
87% structured as an opt-out
6% structured opt-in
3% opt-in or opt-out
89% plan wide and available to all members
Who Has Alcohol Problems?
11.1% of full-time workers ages 18 – 49 Approximately 12.3% of MI workers
Twice as many men (13.7%) as women (7.4%) Prevalence by age:
18-25 (18.9%)26-34 (12.5%)34-49 (7.8%)
Here is the Problem:
Source: Office of Applied Studies. (2004). Results from the 2003 National Survey on Drug Use and Health: National findings. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Secondary Causes of Disease (Ages 35 and Older)
Cancer Lip, Mouth and Pharynx
Esophagus
Larynx
Liver and Bile Ducts
Stomach
50% (men) 40% (women)
75%
50% (men) 40% (women)
15%
20%
Diabetes 5%
Gastrointestinal Disease 20%
Injuries Attributable to Alcohol
Motor Vehicle Fatalities
Injuries
41%
9%
Violence (Including Homicide) 46%
Problem Drinking Causes Disease and Injury
How do alcohol problems cost businesses? Lower productivity Lost workdays Extra health care use Other costs:
Workers compensation and disability Accidents and damage Turnover and worker replacement Diverted supervisory and co-worker time Workplace friction Family disruption
Employment-based health benefits treat addiction as if it were an acute illness or willful bad
behavior
General medical system unprepared and un-paid to identify or treat alcohol problems
early
Specialty substance use treatment system hampered by low insurance reimbursement, acute care model
Many people with alcohol problems do not want the primary treatment goal offered: abstinence
Current State of Treatment
20
Alcohol Disease Management
64% Alcohol is managed by an MBHO
57% BH is accredited by NCQA or JCHAO
< 1% Have no BH program
75% Alcohol screening plan-wide and available to all members
80% Alcohol treatment plan-wide and available to all members
Recent estimates suggest that almost 8% of the US population has an alcohol problem
92%
8%
Estimated Percentage of Plan Members with an Alcohol Problem
Recent estimates suggest that almost 9% of the US population has a major depressive disorder
91%
9%
Estimated Percentage of Plan Members with Depression
Alcohol 5%
Depression 47%
Diabetes 65%
Hypertension 70%
Identification Rates for Other Health Conditions
Alcohol Screening Instruments for Primary Care Providers
Percent Recommending Tool
7%
19%
13%
47%
11%
49%
18%
0% 10% 20% 30% 40% 50% 60%
None
TWEAK
MHQ
DSM IV/ICD9
AUDIT
CAGE
MAST/BMAST
Alcohol Screening Instruments for Behavioral Health Providers
Percent Recommending Tool
5%
25%
39%
56%
23%
63%
11%
0% 10% 20% 30% 40% 50% 60% 70%
None
TWEAK
MHQ
DSM IV/ICD9
AUDIT
CAGE
MAST/BMAST
DepressionHEDIS Collected 2003-2006
0%
20%
40%
60%
80%
100%
2003 2004 2005 2006
7 Days
30 Days
Acute Phase
Cont. Phase
Contacts
Behavioral Health Comparisons Disparities between behavioral health and non-
behavioral health are evident: Identification rates
Use of data elements to identify affected members
Rate of communication between plans Rate of activities that encourage follow-up with
identified or high-risk individuals
What more can be done?
Employee Assistance Programs Work with other businesses and health care
providers Use EAP and Health Plan data to build the case
for the effectiveness of employment-based alcohol treatment in business terms: Avoidable health care costs Avoidable productivity losses Avoidable absenteeism
What Businesses Can Do to Make Their Workplaces Safer, Healthier and More Productive Comprehensive Health Insurance Benefits
Average cost of upgrading is around $5 per beneficiary per month
Equitable co-pays, deductibles, limits. Co-pays less than $10/session.
It is being done!
Managing health plan benefits National Business Coalition on Health’s eValu8 RFI at www.nbch.org
Confidential screening and brief intervention
Encourage primary care screening and treatment
Monitoring utilization and outcomes
Looking forward: The 2007 eValue8 RFI
Investigate eValue8 scales-both within and between sections: Section scales Summary scales eValue8 total scale
What are the properties of these scales? Do they accurately measure what we want them to?
Which items do not contribute any unique variance to scales and can be eliminated from future versions of the RFI?