Trusting Windmills: Consumers, Innovation and the New World of Health Care
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Transcript of Trusting Windmills: Consumers, Innovation and the New World of Health Care
Trusting Windmills:Consumers, Innovation and the New World of Health Care
Dr. Charlotte S. Yeh, MDChief Medical Officer, AARP Services, Inc.
May 14, 2014
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
LEARNING OBJECTIVES
Identify ways to embrace change and use it to succeed in this new healthcare environment
Develop new and creative ways to involve consumers in the adoption of disruptive innovations
Discuss inspirational ways of providing care to an older population that can be adapted to any consumer group
A TIME OF CHANGE
“When the winds of change blow, some people build walls and others build windmills.”
- Chinese Proverb
AARP: A LEGACY OF INNOVATION
AARP’s Founder,Dr. Ethel Percy Andrus
THE NEED
A program to help improve the health care experience and reduce health care costs of the FFS Medigap population
A program not dependent on network, or provider payment strategies
A program that engages the FFS population
BACKGROUND
AARP and UnitedHealthcare have been working to better understand the characteristics, needs and general health of older adults.
UHC is piloting health improvement initiatives with the goal of enhancing care coordination and delivery of services while maintaining costs and high quality of care.
o Case Management, Disease Management, Depression Management and Prescription Drug Adherence programs.
o Programs* target people with chronic illnesses living in high disease prevalence areas in parts of five states NY, NC, OH, FL, and CA.
o Began in early 2009 and continue today. Unique to the Medicare Supplement Health
Insurance Plan industry.
* AARP Medicare Supplement Plans, insured by UnitedHealthcare Insurance Company
CORE APPROACHRapid Test and Learn Model
1. Incubator Lab• Identify Core Impact Area(s)• Rapid iterative design, implementation and
pilot/test • Evaluation
2. Accelerator Lab• Replicability• Sustainability• Scalability
3. Sharing Success • Internal• Peer-Reviewed Literature• External
KEY PRINCIPLE
“If we are 100% successful, we will
have failed”
INTEGRATED PILOT PROGRAMS
Chronic Illness/ High Risk Case Management (HRCM)
Helping people identified at high predictive risk for catastrophic health
events or deterioration through on site and telephonic case management
Prescription Drug Adherence
Helping people in tandem with disease management programs to comply with and
adhere to evidence based standards of pharmaceutical care for their chronic
disease
Depression Management
Helping people, physicians, and other caregivers identify depression, and to access educational resources, referral
information, condition monitoring, treatment adjustment, and relapse
prevention
Helping individuals afflicted with select chronic diseases reduce their risk of
disease progression, future catastrophic events or deterioration
Disease Management
Integrated Pilot Programs
RESULTS Satisfaction
From 2009-2011, 98% of members were either satisfied or very satisfied with the pilot program.
Engagement
Member months of engagement doubled from 2009-2010 and increased by 30% from 2010-2011
Clinical Quality
The program had a positive impact on many quality metrics
Duration in the program was associated with fewer readmissions
Assessing Care of Vulnerable Elderly (ACOVE) measures: 100% screened for falls (75% had no additional falls), hearing loss, pain, and nutritional status
EBM metrics: Members were significantly more likely (58%) to have recurring office visits and recommended laboratory tests
TOTAL PROGRAM SAVINGS
2009
2010
2011
Overall
0 0.5 1 1.5 2 2.5 3 3.5
ROI
The program ROI demonstrated savings over the first three years, and increased year over year
TOTAL PROGRAM SAVINGS
Program Savings by Payer
The total savings for the program was $8.3 million
INSIGHTS ON ENGAGEMENT
Engaged Saw themselves as “sick” Had less communication from their doctors Had less support at home
Not Engaged Saw themselves as “well”, and were less likely to
report symptoms of depression Could get answers from their doctors Felt comfortable managing their health for now
How is your health? 58%: “Better than others my age.”
“Living independently at home” vs. “managing my health”
CONSUMER MODEL OF HEALTH CARE“Living Well / Enjoy Life Every Day in Bite Size Pieces”
Healthy / Independent
“I can do this myself”
Episodic / Intermittent
“I am annoyed”
New LifeStyle Change / Impact
“uh oh… I am going to have to change to live the way I want”
Complex Needs / Support
“I need community support”
FIRST ‘A-HA’: WE’VE MISSED THE EMOTIONAL CONNECTION
SECOND ‘A-HA’: PROVIDE PATIENTS WITH THE “HOW”
Real health care happens at home
Care must be conceptualized not merely as what you get when you go to the doctor’s
office but also as the decisions people make and
resources they have at home – to stay healthy.
THIRD ‘A-HA’ – IT’S ABOUT THE WHOLE PERSON
THIRD ‘A-HA’: JOURNEY TO CONSUMER ENGAGEMENT
Bill
68 yr. old male – Caregiver for his wife who is in Hospice due to multiple
myeloma. Married 43 years, has support from children and step-children from
wife’s former marriage.
Recruitment Call.Bill mentions wife is in
hospice care. Stepson takes call and requests nurse to not call for one
month
Bill notes he lost his wife the prior week. Bill states he is
thankful she is no longer in pain. Issues with stepchildren causing
anxiety.
Bill notes he lost his sister in law. Bill shares his religious beliefs and current bible study classes with his
son.
Bill calls upset and crying. Nurse does depression screen and offers support on dealing with his loss. Bill leaves call thankful for someone to talk
with.
Bill is in ER for chest pain, requests callback
Bill notes he spent several days in
hospital due to chest pain. Doctors believe pain was due to stress. Member expressed an
interest in receiving home health care –
Nurse provided assistance.
EngagementsContinue
9/23
11/1
12/2
12/20
2/18
3/28
4/4
FINAL WORD
The future is here. Are you ready?
THANK YOU!!Dr. Charlotte S. Yeh, MD
Chief Medical OfficerAARP Services, Inc.
(617) [email protected]