Cancer%20Management:%20Fully%20Integrated%20population-based%20and%20Chronic%20Care%20Case-based%20Model

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Cancer Management Fully Integrated
population-based and Chronic Care Case-based Model

• Marnie W. Bute, R.N.
• Director, Health and Care Business Development
• May 8, 2007

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Contracted Medical Groups and Clinics
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Market Demand

• Trend management
• Integrated solution
• Outcome-based results
• Improved employee health
• Productivity
• Absenteeism
• Presenteeism
• Emerging vendor carve outs
• Cancer disease management
• Oncology Case Managers
• Cancer networks
• COEs
• Tiering
• Second opinions

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Population Health Management Approach to Cancer

20 of People Generate 80 of Costs
High Risk
Early Symptoms
Active Disease
Healthy/low Risk
At-Risk
Claims Cost Distribution
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Integrated by Design

• Integrated, national, member-centric model built
  on three integral components

• Trained member advocates positioned to meet the
  member where theyre at, when theyre needed
• Member decision Support all advocates are
  trained to help a member make decisions that are
  best for them
• Member tools resources communications
  protocols utilized in all member touch points to
  ensure optimal member experience

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HealthPartners Approach

• Comprehensive cancer components
• Prevention/Wellness
• Early diagnosis/Screening
• Evidence-based treatment
• Palliative care
• End-of-life care
• Measurement and reporting

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Cancer Prevention

• Member Advocates
• Phone-based health improvement courses
• Weight Management
• Member Decision Support
• Should I quit smoking?
• What kind of a diet reduces my risk of cancer?
• Member Tools Resources
• Health Assessment
• Tobacco use assessment and cessation
• Cost Calculator
• How much do I spend on cigarettes each year?
• Fitness Programs
• Worksite Wellness Programs
• Provider Support
• Patient-provider relationship support

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Health Assessment Integration

• Personal, printable reports for individual
  participants.
• Engagement into programs may be linked to
  incentives
• Focus on participation in follow-up programs
• Seamless hand-offs and outreach to other health
  care services to optimize impact (disease
  management, case management, behavioral health,
  dental, pharmacy)

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Fruit and Vegetable Intake
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Program Outcomes Partners in Quitting Tobacco
Cessation

• N534 (data from course completers)
• 20 of enrollees quit prior to lesson 1
• Between baseline and post-course, 93 of survey
  completers quit smoking (n112)
• At 6-months follow-up, 63 of survey completers
  quit smoking (n63)

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Cost and Quality Information

• Cost calculators
• Medical and drug costs
• Plan annual expenses
• Look up costs for conditions and services
• How much do I spent on cigarettes each year?

Plan annual expenses
Look up drug costs
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Cancer Early Diagnosis

• Member advocates
• Where is the most cost effective mammogram?
• Member decision support
• Should I have a colonoscopy or a
  flex-sigmoidscopy?
• Member tools resources
• Proactive cancer screening reminders
• Cost calculator
• Teachable moments
• Provider treatment selection support
• Information therapy
• Provider support
• Patient-provider relationship support

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Teachable Moments Message Detail
General message area, talking points, and
instructions to deliver message
Controls to enter disposition of message and email
Members unique qualification for this campaign
plus objective of campaign
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Teachable Moment Message Status and Outcome
Message shown as delivered, along with Member
response and email sent
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MN Colon Cancer Screening
2002 2003 2004 2005
HP Clinical Indicators 60 68 73 75
HP Comm HEDIS 62 59 63
BCBS Comm HEDIS 60 51
Medica Comm HEDIS 54 53
HEDIS Comm Natl Ave 49 52
Clinical Indicators includes all products
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Commercial HEDIS Results

• 2005 (2004 DOS)
• Colorectal Cancer rate 58.9
• Breast Cancer rate 80.8
• Cervical Cancer Rate 85.4

• 2006 (2005 DOS)
• Colorectal Cancer Rate 62.6
• Breast Cancer Rate 75.7
• Cervical Cancer Rate Rotated Out (RO)

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Cost and Quality Information

• Find Best Choice providers who offer the best
  overall cost and high quality for different
  services

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Cancer Treatment

• Member advocates
• Evidence based
• Medical behavioral case management
• In patient outpatient coordination of care
• Depression assessment
• Medical director advocacy
• Pharma by phone
• Member decision support
• Should I enroll in this clinical trail?
• Member tools resources
• Centers of Excellence
• Complementary alternative medicine
• Provider support
• Patient-Provider relationship support
• Collaborative practice models including physician
  and support-service providers

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Decision Support

• Case Manager
• Assess status, needs, and issues
• Identify decisional conflict
• Provide education
• Help clarify personal values preferences
• Facilitate communication with physician(s)

• Carol
• I was planning to have breast reconstruction
  surgery now that my breast cancer treatment is
  finished I have so much going on, Im just not
  sure.

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Results Decision Support
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Results Decision Support
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Cancer Palliative Care/End of Life

• Member advocates
• Medical behavioral case management end of
  life case management
• Outpatient coordination of care
• Depression assessment
• Pharma by phone
• Medical director advocacy
• Member decision support
• One-on-one decision support in the members home
• Member tools resources
• Advance directives
• Complementary alternative medicine
• Hospice
• Provider support
• Patient-Provider relationship support

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All Palliative Care patients pre-PC ALOS 6.14
days
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All Palliative Care patients post-PC ALOS 4.98
days
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Variable Cost Difference Pre/Post Palliative Care
Referral -All Palliative Care Patients
Avg. cost of 1-5 days prior to PC consult
Avg. cost of 1-5 days following PC consult
Based on January 2005-December 2006 Cases
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Moving Forward

• Survivorship
• Medication therapy management
• Clinical trials
• Payment reform
• Enhance specialty networks
• Productivity

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Measurement and Reporting

• Member support and provider support
• Cost and utilization
• Engagement
• Activity and intervention
• Clinical outcomes
• Satisfaction
• Member
• Provider
• Self-reported outcomes
• Self-perceived health status
• Productivity

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Member Experience

• Personalized, tailored
• Comprehensive self-management materials and
  support
• Seamless and transparent integration

Meet me where Ill be when I need you
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Best Practice in Care
Standard Staff Knowledge of How To
Consult multicultural and language resources Use internal and external resources appropriately to answer cultural competence questions
Gather essential information Ask about language preference and ethnicity Chart information in patient records
Use trained interpreters Arrange for an interpreter Work with an interpreter Use telephone interpreting services
Provide translated vital documents Access translated documents or translations of needed documents Use vital translated documents with an interpreter
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Results Achieving Equity
Ethnicity Engagement Rate Goal 95 Engagement Rate Goal 95
Ethnicity Baseline YE 2006
African American 92 97
Asian 88 96
Caucasian 95 98
Latino 100 98
Native or Alaskan American 89 100
Other Race 90 94
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Satisfaction

• Member satisfaction overall
• Ranges from 85-96 percent
• Annual survey
• Proof of member-centric approach

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Value for the Purchaser

• Ease of management
• Comprehensive integrated program
• Evidence-based
• High employee satisfaction
• Trend reduction
• Productivity

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Key Takeaways

• Cancer management must be a population based
  approach
• Integrated as a health plan solution
• The broad continuum of prevention to end-of-life
  needs targeted and meaningful interactions
• Interactions are dependant upon integrated
  platforms with member advocates, decision
  support, robust member tools and resources that
  are self directed and interactive
• Carve out vendor programs can only impact a small
  slice of the large and complex cancer continuum

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• Thank You!
• Questions?
• Please feel free to contact me at
• Marnie.W.Bute_at_HealthPartners.com