Excellus Board of Directors Meeting, 111299

1
Disease Management Norm Lindenmuth, MD Regional
Vice President/Chief Medical Officer Excellus
BlueCross BlueShield, Central New York Region
2
Definitions

• Disease Management
• Case Management
• Care Management
• Preventive Health

3
Care Management Target Populations

• Medically Complex
• Complex Disease-Specific (Diabetes,CAD,
• Asthma, Breast Cancer)

• Non-Complex Disease-Specific
• (Diabetes, Asthma, Depression, CHF)

• Immunization (Child,
• Adolescent, Adult)
• Cancer Screening (Breast,
• Cervical, Colon)

• All Members
• Employees
• Community

4
Disease Management

• A system of coordinated health care
  interventions and communications for populations
  with conditions in which patient self-care
  efforts are significant.
• Disease Management Association of America

5
The Process

• I. Prevalance Analysis
• II. Ability to Impact
• III. Standards (Evidence Based Guidelines)
• IV. Identify Population
• V. Define Measures

6
Excellus Disease ManagementPrograms in Production

• Asthma
• Coronary Artery Disease
• Depression
• Diabetes
• Hypertension

7
Additional conditions (a sub-set)frequently
coached across include

• Acute respiratory
• General arthritis
• TMJ syndrome
• Common skin problems
• Bunions
• Breast reduction
• Hernias
• Hemorrhoids
• Varicose veins
• Stroke
• Renal failure
• Cataracts

• Depression and stress
• Maternity
• Obesity/bariatric surgery
• Hypertension
• Carpal tunnel syndrome
• Gallbladder disorders
• Gastro-esophageal reflux (GERD)
• Otitis media (ear infections
• Migraine/other headache
• Osteoporosis
• Allergies

8
Interventions

• I. Member Based
• II. Provider Based

9
(No Transcript)
10
OpportunityHEDIS Data
11
Member Interventions

• Educate
• Mail - Newsletters
• Telephonic - One/One
• Seminars
• Reminders

12
Population IdentificationCAD

• Utilizing ICD-9 and CPT Codes
• Members must have one of the following claim
  situations
• 2 paid outpatient claims with different dates of
  service or same date with different sites of
  service
• 1 paid inpatient claim
• 1 paid emergency department claim plus one
  additional claim on a different date of service
  in support of the diagnosis
• 3 month supply of nitrates within 12 month period

13
Member Interventions

• Sample Member Educational Events
• The Diabetic Chef Series - gt2,000 attendees
• Diabetes in the New Millennium Series - gt 2,000
  attendees
• Healthy Eating for the Holidays - 300 attendees
• Chronic Illness and Emotional Health - 250
  attendees
• Key Program Initiatives
• Provision of free blood glucose meters - 15,000
  members
• Case managed members - 2,000
• Reminder Mailings - 20,000
• Healthy Horizons Newsletter (specific to
  Diabetes) - 40,000
• Avandia I Can Program - 4,000
• Counting Cholesterol Down - 14,000
• Diabetes In Control Program - 15,000

14
Provider Interventions

• Educate
• Newsletters
• Seminars
• Profile Patient/Provider
• Facilitate Just in Time Data

15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
MD ReminderPatient Female XX
19
Summary