COMPASS Presentation Slides

1. COMPASS Presentation Slides Slide Deck for Customizing Presentations on COMPASS for Partner Internal and External Audiences

2. Supported by Cooperative Agreement The project described in this slide set was supported by Cooperative Agreement Number 1C1CMS331048-01-00from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. Its contents are solely the responsibility of the authors and have not been approved by the Department of Health and Human Services, Centers for Medicare & Medicaid Services.

3. Overview This slide deck is not a presentation. It is designed to enable presenters to create customized presentations for a variety of audiences without re-creating existing slides or re-synthesizing literature or statistics. Throughout this slide deck you will find Overview slides. These slides are designed to delineate the various sections and types of information contained on slides in the individual section. Overview slides are designed to make this slide deck easier to review for presenters while creating their own customized presentations. The Overview slides should not be used in final presentations.

4. Overview Chronic Disease Slides Need to Address Chronic Diseases Chronic Diseases Increasing Chronic Physical Disease: Diabetes The Cost of Diabetes Chronic Physical Disease: Cardiovascular Disease The Cost of Cardiovascular Disease

5. Need to Address Chronic Diseases • Chronic diseases recognized as a leading health concern in U.S. • Chronic diseases cause 7 in 10 deaths each year in the U.S. • Nearly 1 in 2 adults in the U.S. live with at least one chronic illness • More than 75% of health care costs are due to chronic conditions

6. Chronic Diseases Increasing • Aging population and medical advances mean more people living with multiple chronic illnesses • The 27% of adult Americans with two or more chronic illnesses account for 65% of total health care spending • Diabetes and coronary artery disease (CAD) are two common chronic conditions seen in primary care • Depression, also commonly seen in primary care, can complicate treatment of diabetes and CAD

7. Chronic Physical Disease: Diabetes • 27% of U.S. residents 65 or older have diabetes • University of Chicago study predicts Americans with diabetes will increase 85% by 2034 – with direct health care costs reaching $336 billion a year, up 190% • Diabetes is: • Seventh leading cause of death in U.S. • Leading cause of kidney failure, non-traumatic lower limb amputations, new cases of blindness • Major cause of heart disease and stroke

8. The Cost of Diabetes Total cost of diagnosed diabetes in U.S. is >$175 billion a year in direct and indirect costs 27% of people with diabetes are undiagnosed—factoring in undiagnosed diabetes, prediabetes and gestational diabetes raises cost to $218 billion annually Average medical expenditures among people with diabetes are 2.3 times higher than patients without diabetes

9. Chronic Physical Disease: Cardiovascular Disease Leading cause of death in U.S. – accounts for more than one-third of all deaths Heart disease/strokes are main causes of disability in U.S. – affecting nearly 4 million people Currently 33.6% of U.S. adults live with one or more types of cardiovascular disease – expected to increase to 40.6% by 2030

10. The Cost of Cardiovascular Disease Medical costs are $273 billion – predicted to rise to $818 billion by 2020 (+199.6%) Productivity costs due to missed time at work and lost earnings due to premature death are $172 billion – estimated to rise to $276 billion by 2030 (+60.4%) Treatment for cardiovascular disease accounts for $1 of every $6 spent on health care in U.S.

11. Overview Depression Facts Slides • Chronic Mental Health Disease: Depression • The Cost of Depression • Higher Rates of Death • Workplace Costs of Depression • Depression & Employer Health Care Costs

12. Chronic Mental Health Disease: Depression • Depression affects patients, physicians, clinics and society • At any given time, 8% of the population has depressive disorder • Only 57% of those with major depression receive treatment • Major depression disorder is leading cause of disability in U.S. for ages 15-44.

13. The Cost of Depression • Personal and societal costs of depression go beyond feelings of sadness, isolation and inability to enjoy life. They include: • Higher rates of death • Serious complications for patients with other chronic diseases • Significantly higher health care costs for employers and consumers • Associated substance abuse problems

14. Higher Rates of Death Studies show that depression is associated with higher mortality rates in all age groups Most significant factor for suicide in older adults Suicide is 11th leading cause of death in U.S.

15. Workplace Costs of Depression Depression costs U.S. $84 billion/year in lost productivity/medical expenses Major depression results in more sick days and higher rates of short-term disability than other chronic diseases Employees with depression have high rates of absenteeism; are less productive Productivity of those providing care to person with depression can be negatively effected

16. Depression & Employer Health Care Costs Depression is one of the top drivers of health care costs for employers

17. Overview Risky Substance Use Slides Chronic Behavioral Disease: Risky Substance Abuse Alcohol Abuse a High-Impact Target The Cost of Alcohol Abuse Workplace Costs of Substance Abuse

18. Chronic Behavioral Disease: Risky Substance Use • Major health care issue and leading social problem • Affects society at every level: individual, family, community • Hazardous drinking one of four main contributors to chronic diseases; also adds to public health/social problems • In U.S., only about 10% of people with a drug or alcohol problem receive treatment

19. Alcohol Abuse a High-Impact Target Rankings of 25 Preventive Services Recommended by USPSTF PB & ROI scoring: 1 = lowest; 5 = highest • Ranked higher than: • Screening for high blood pressure or cholesterol • Screening for breast, cervical, or colon cancer • Adult flu, pneumonia, or tetanus immunization Addressing alcohol abuse can have a huge impact and return on investment in improving public health

20. The Cost of Alcohol Abuse • Excessive alcohol consumption responsible for 79,000 deaths and cost of $224 billion in U.S. annually • 75% of costs stem from binge drinking • Costs resulted from: • Losses in workforce productivity 72% of total • Health care expenses 11% • Law enforcement/criminal justice expenses 9% • Motor vehicle crash costs 6%

21. Workplace Costs of Substance Abuse • Employees coping with substance abuse… • Cost employers 2X as much in health care expenses • Are 3.5 times more likely to be involved in a workplace accident • 47% of industrial injuries are linked to alcohol use • Alcohol abuse/dependence is associated with 557 days of lost annual productivity per 1,000 workers • Employees who use drugs are 5X more likely to file a workers’ compensation claim

22. Overview Co-Morbid Physical and Mental Chronic Diseases Slides Mental/Physical Co-Morbidities Worsen the Problem Depression & Other Chronic Illnesses Depression & Diabetes Depression & Cardiovascular Disease Depression & Substance Abuse

23. Mental/Physical Co-MorbiditiesWorsen the Problem Studies show mental chronic diseases can worsen physical chronic diseases Conversely, people with a chronic physical disease are at much greater risk for depression than overall population When depression is present with a physical chronic disease, health care treatment costs are 65% higher

24. Depression & Other Chronic Illnesses • Depression co-occurs in up to 20% of patients with diabetes or coronary artery disease • These patients have poorer self-care, greater functional impairment, and increased risk of complications and mortality • Depression can interfere with patient’s ability to follow medication and dietary regimens • Depression increases medical costs in patients with diabetes or coronary artery disease by 65%

25. Depression & Diabetes Depression increases risk for diabetes, and vice versa 15% of people with diabetes also suffer from depression In U.S., people with diabetes are twice as likely as average person to have depression Studies show people with diabetes and depression have severer diabetes symptoms than people with only diabetes

26. Depression & Cardiovascular Disease Up to 15% of patients with cardiovascular disease experience major depression For people with heart disease, those with depression have increased risk of having a heart attack or blood clots—than people with heart disease patients but no depression Depression is such a risk factor in cardiac disease that American Heart Association has recommended all cardiac patients be screened for depression.

27. Depression & Substance Abuse More than 21% of adults with depression engage in substance abuse vs. 8% of those without depression Depression and substance abuse can be triggered by stress of chronic illness Rates of undetected depression among drug and alcohol users estimated as high as 30% Adults who use illicit drugs were twice as likely to report suffering from serious mental illness, such as depression, as adults who do not use drugs

28. Overview Depression Treatment in Primary Care Slides Depression & Primary Care Challenges in Primary Setting Why It’s Important to Manage Depression in Primary Care

29. Depression & Primary Care • People—especially the elderly—more likely to contact their primary care physician when they experience symptoms of depression • The Challenge • While about 75% of patients with depression see a primary care provider, PCPs only detect about 50% of patients with depression • About 50% of patients with depression receive treatment • Only 20-40% of treated patients see substantial improvement in year following diagnosis

30. Challenges in Primary Setting • Multiple barriers frustrate efforts of primary care providers to provide effective depression treatment • Inconsistent use of diagnostic criteria • 80% of depressed patients have physical health conditions – many providers focus on them • Depression treatment is time consuming; clinical procedures and staffing are not set up or compensated for added care • Primary care physicians often uneasy discussing mental health issues • Sometimes difficult to refer to mental and behavioral healthcare resources

31. Why It’s Important to Manage Depression in Primary Care Also, behavioral health resource shortages require innovative ways to leverage resources

32. Overview Introduction to COMPASS Slides New Approach Needed Introducing COMPASS What is COMPASS? Funded Through CMS Purpose of COMPASS Seeks to Achieve the Triple Aim Overall Goals of COMPASS

33. New Approach Needed Substantial evidence indicates collaborative care management models (CCMMs) for patients with chronic medical and mental health conditions can greatly improve their quality of care, outcomes and satisfaction, plus be cost-effective and even cost saving in long run Such models have not been widely used in primary care settings, in part because they require a change from the traditional model, and existing payment designs do not compensate their costs

34. Introducing COMPASS Care Of Mental, Physical And Substance-use Syndromes

35. What is COMPASS? Collaborative Care Management Model to improve care and outcomes of Medicare and Medicaid patients with depression and diabetes and/or cardiovascular diseases Some clinics may also address risky substance use Combines evidence-based elements and best practices learned in implementing such CCMMs as IMPACT and DIAMOND for depression; TEAMcare for diabetes, cardiovascular care and depression; and SBIRT for risky substance use

36. Funded Through CMS • COMPASS is a three-year initiative funded by Centers for Medicare and Medicaid Services (CMS) Healthcare Innovation Challenge • Objectives of CMS Innovation Challenge: • Lower cost of care for people enrolled in government programs like Medicare and Medicaid • Engage broad set of partners to test new delivery models • Identify new models of workforce development to create jobs • Leverage existing models to improve patient care quickly

37. Purpose of COMPASS • Develop best and sustainable model for improving mental and physical conditions in primary care • Develop role descriptions and training for two new types of workers required for model: care managers and local expert consultants • Identify implementation and operational costs, model features, and financial models needed to sustain/spread model over different geographic areas, populations and types of provider systems

38. Seeks to Achieve the Triple Aim • COMPASS seeks to achieve Triple Aim for the targeted population: • Improve health of the population • Improve patient experience, including quality of care • Improve affordability of care

39. Overall Goals for COMPASS Achieve depression improvement of a drop in PHQ-9 by 5 points or a PHQ-9 of <10 for 40% of patients Improve diabetes and hypertension control rates by 20% Decrease un-needed hospitalizations and ED visits Improve patient and clinician satisfaction with the care process by 20% Reduce healthcare costs of Medicare and Medicaid measured patients by $25 million

40. Overview COMPASS Consortium Slides COMPASS Consortium Partners Geographic Reach of COMPASS COMPASS Partner Deliverables

41. COMPASS Consortium Partners • Institute for Clinical Systems Improvement (ICSI) – Leads and coordinates the initiative • Eight partners offering COMPASS at selected sites • ICSI member clinics offering DIAMOND program • Mayo Health System • Kaiser Permanente Southern California • Kaiser Permanente Colorado • Community Health Plan of Washington • Michigan Center for Clinical Systems Improvement • Mount Auburn Cambridge Independent Practice Association • Pittsburgh Regional Health Institute • Two supporting partners • HealthPartners Institute for Research and Evaluation • AIMS Center, Washington State

42. Geographic Reach of COMPASS Opportunity to test collaborative care management model across a variety of health care systemsand patient populations

43. COMPASS Partner Deliverables Eight medical groups across seven states must each enroll at least 1,000 Medicare and Medicaid patients by Sept. 30, 2013 Targeted patients must have depression and diabetes and/or cardiovascular disease, with an option to deliver screening and intervention for risky substance use in primary care clinics to meet Triple Aim goals

44. Overview (1 of 3) More Collaborative Care Management Models Upon Which COMPASS Is Based Slides Collaborative Care Management Model A Proven Approach COMPASS Components COMPASS Components (Cont) IMPACT IMPACT Improved Depression Care Patient Benefits of Implementing IMPACT

45. Overview (2 of 3) More Collaborative Care Management Models Upon Which COMPASS Is Based Slides (Continued) IMPACT Saves Money (Slide 1) IMPACT Saves Money (Cont.) (Slide 2) DIAMOND ICSI’s DIAMOND Model DIAMOND Improves Depression DIAMOND Supports the Triple Aim TEAMcare TEAMcare Results

46. Overview (3 of 3) Collaborative Care Management Models Upon Which COMPASS Is Based Slides (Continued) SBIRT SBIRT Model (Slide 1) SBIRT Model (Slide 2) Partners in Integrated Care WIPHL’s SBIRT Experience WIPHL SBIRT Outcomes SBIRT Lowers Costs

47. Collaborative Care Management Model • COMPASS built squarely on proven collaborative care management models stemming from Chronic Care Model developed by Dr. Ed Wagner • Chronic Care Model: • Widely accepted as basis of redesign of primary care and other changes in health care delivery • Has become dominant model for medical home • Viewed as one of most promising vehicles for achieving Triple Aim

48. A Proven Approach COMPASS is based on several evidence-based CCMMs and their best implementation practices IMPACT: Management of depression in a primary care setting – pioneered many of components used in later models DIAMOND: Management of depression in primary care built on IMPACT model—implemented in 80+ clinics TEAMcare: Management of patients with depression and diabetes or coronary artery disease SBIRT: Identification of risky substance use and appropriate interventions or referral to treatment

49. COMPASS Components • Thorough initial evaluation, including: • screening for relevant co-morbidities • measuring condition severity • assessing patient readiness for self-management support to control key disease parameters • Computerized registry for care monitoring • Treatment intensification when there is lack of improvement • Prevention of avoidable hospital and ED admissions and readmissions

50. COMPASS Components (Cont.) • Care manager to: • Monitor condition status • Provide self-management support • Refer to community resources • Coordinate care • Provide proactive follow-up, • Communicate recommendations by consulting physicians about treatment changes to the primary care physician