1 / 31

Chronic Disease

BD attach. 5. Chronic Disease . Management 2003 Annual . Report . -. Highlights. PEBB Board Meeting 1/18/05. BD attach. 5. 2003 Highlights - Outline. Purpose of Annual CDM Report Review Methodology Prevalence Updates

kesler
Download Presentation

Chronic Disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. BD attach. 5 Chronic Disease Management 2003 Annual Report - Highlights PEBB Board Meeting 1/18/05 Prepared by Aon Consulting

  2. BD attach. 5 2003 Highlights - Outline • Purpose of Annual CDM Report • Review Methodology • Prevalence Updates • Aon Reported Statistical Findings (Cost & Utilization for Level I & Level II Analysis) • Carrier Program Design • Participation • Carrier Reported Clinical Measures • Summary and Next Steps Prepared by Aon Consulting

  3. BD attach. 5 2003 Highlights - Outline • Purpose of Annual CDM Report • Review Methodology • Prevalence Updates • Aon Reported Statistical Findings (Cost & Utilization for Level I & Level II Analysis) • Carrier Program Design • Participation • Carrier Reported Clinical Measures • Summary and Next Steps Prepared by Aon Consulting

  4. BD attach. 5 Purpose To coordinate and measure the effectiveness of component chronic disease management programs developed and administered by PEBB’s medical insurance Carriers (Kaiser and Regence). Prepared by Aon Consulting

  5. BD attach. 5 2003 Highlights - Outline • Purpose of Annual CDM Report • Review Methodology • Prevalence Updates • Aon Reported Statistical Findings (Cost & Utilization for Level I & Level II Analysis) • Carrier Program Design • Participation • Carrier Reported Clinical Measures • Summary and Next Steps Prepared by Aon Consulting

  6. BD attach. 5 Methodology Aon Statistical Report • Examines 4 different chronic diseases: Asthma, Diabetes, Coronary Artery Disease (CAD), Congestive Heart Failure (CHF) • Measures changes in disease prevalence, participation, utilization, & cost for PEBB members based on incurred claims data • Prevalence based on agreed-upon definitions of each chronic disease (ICD, CPT, & NDC Codes) • Participation based on member list provided by carriers • Three types of utilization & cost analysis Level I – with & without disease Level II – participant vs. non-participants Clinical Measures – provided by carriers Prepared by Aon Consulting

  7. BD attach. 5 Methodology Carrier Reported Clinical Measures • Additional clinical measures reported separately by carriers from non-claims sources (e.g. chart notes). • Data reported uses the criteria mutually agreed upon by both carriers as outlined in the 2003 CDM Report • HEDIS* measures have been added as a benchmark where available • Regence relies on claims system for reporting on clinical measures from administrative data and does not have access to lab results * The carrier reported values should not be compared to HEDIS values as the carriers do not have the HEDIS continuous enrollment requirement. This difference in methodology was agreed to by both carriers at the beginning of the reporting process. Prepared by Aon Consulting

  8. BD attach. 5 Methodology Illustration of Different Criteria Used for the Three Types of Analysis Prepared by Aon Consulting

  9. BD attach. 5 2003 Highlights - Outline • Purpose of Annual CDM Report • Review Methodology • Prevalence Updates • Aon Reported Statistical Findings (Cost & Utilization for Level I & Level II Analysis) • Carrier Program Design • Participation • Carrier Reported Clinical Measures • Summary and Next Steps Prepared by Aon Consulting

  10. BD attach. 5 Prevalence • 11,835 (9.5%) PEBB members were identified with one or more of theses four chronic diseases as of 12/31/03, including: • 5.0% with Asthma • 3.6% with Diabetes • 1.75% with CAD • 0.50% with CHF • 1,179 (0.94%) have more than one chronic disease • Prevalence rates are generally consistent with industry benchmarks • Prevalence rates are similar for both carriers for CAD and CHF. Kaiser has a much higher prevalence of Asthma and Diabetes than Regence Prepared by Aon Consulting

  11. BD attach. 5 2003 Highlights - Outline • Purpose of Annual CDM Report • Review Methodology • Prevalence Updates • Aon Reported Statistical Findings (Cost & Utilization for Level I & Level II Analysis) • Carrier Program Design • Participation • Carrier Reported Clinical Measures • Summary and Next Steps Prepared by Aon Consulting

  12. BD attach. 5 Aon Statistical Findings Cost Findings • 28% of total 2003 PEBB claims were for members with at least one of the four chronic disease (includes claims for non-disease related illness/injury) • Average monthly claims for members (PMPM) with chronic disease was $570 – 4x higher than for those without chronic disease • PMPM ranged from $493 for asthma to $2,039 for CHF • Rate of increase in PMPM costs from 2002 to 2003 was 19% for members with chronic disease compared to a 5% increase for members without chronic disease Prepared by Aon Consulting

  13. BD attach. 5 Aon Statistical Findings Utilization Findings • Overall utilization continues to be higher for members with chronic disease verses members without chronic disease • Changes in utilization rates for members with chronic disease are mixed; additional analysis will be conducted to explain the reasons. Increases in utilization may be the result of members receiving appropriate preventive procedures which is positive. • Still too early to confirm trends due to anomalies during the reporting period • 2002 consolidation of carriers and plan designs • Small numbers for PEBB’s chronic disease populations • Many members have co-morbidities that confound analysis Prepared by Aon Consulting

  14. BD attach. 5 2003 Highlights - Outline • Purpose of Annual CDM Report • Review Methodology • Prevalence Updates • Aon Reported Statistical Findings (Cost & Utilization for Level I & Level II Analysis) • Carrier Program Design • Participation • Carrier Reported Clinical Measures • Summary and Next Steps Prepared by Aon Consulting

  15. BD attach. 5 Carrier Program Design Regence • DM programs rely on voluntary member participation – ‘opt-in’ program • Member must receive 2 interventions to be considered a participant • DM programs target the member and do not have direct contact with physicians • Regence data relies on claims system for reporting from administrative data Kaiser • Members are automatically registered in DM programs – ‘opt-out’ program • Members are automatically considered participating once entered in the Disease Registry • DM programs tightly integrated with physicians and case management • Kaiser data collected through EMR which includes lab results A detailed description of the disease management programs for each carrier by disease is found in the ‘Carrier Interventions’ section beginning on page 13 of the 2003 Report . Prepared by Aon Consulting

  16. BD attach. 5 2003 Highlights - Outline • Purpose of Annual CDM Report • Review Methodology • Prevalence Updates • Aon Reported Statistical Findings (Cost & Utilization for Level I & Level II Analysis) • Carrier Program Design • Participation • Carrier Reported Clinical Measures • Summary and Next Steps Prepared by Aon Consulting

  17. BD attach. 5 Participation • Kaiser participation is 100% for all diseases • Regence participation rates vary by disease: • Asthma: 56% • Diabetes: 74% • CAD: 27% • CHF: 34% • Regence participation increased significantly for CAD and CHF as a result of substantial changes in the administration of its disease management programs. Participation in 2002 was 5% for each disease prior to the changes. Note: Regence only contacts members considered ‘suitable’ for enrollment in disease management. For participation based on Regence suitability refer to page 20 of the 2003 Report. Prepared by Aon Consulting

  18. BD attach. 5 2003 Highlights - Outline • Purpose of Annual CDM Report • Review Methodology • Prevalence Updates • Aon Reported Statistical Findings (Cost & Utilization for Level I & Level II Analysis) • Carrier Program Design • Participation • Carrier Reported Clinical Measures • Summary and Next Steps Prepared by Aon Consulting

  19. BD attach. 5 Carrier Reported Clinical Measures: Asthma Compliance with Appropriate Labs & Exams • Good care for asthmatics includes preventing flares of wheezing and shortness of breath which interfere with the patient’s functioning. • Two types of medication are used to treat patients with asthma; one to prevent acute flares, and one to treat acute flares when they occur • Clinical Goal: increase in the percentage of patients regularly using medications to prevent acute flares Kaiser Regence HEDIS 75th 2002 2003 Use of Appropriate Medications for Patients with Persistent Asthma Data for Regence is Not Available Note: HEDIS percentiles have been included for benchmarking only and should not be used as a comparator with the carrier reported values as the carriers do not have a continuous enrollment requirement. Prepared by Aon Consulting

  20. BD attach. 5 Carrier Reported Clinical Measures: Asthma Utilization Results • Preventive treatment should reduce acute flares which cause the patient to seek emergency care • Clinical Goal: a decrease in the number of ER visits by patients with asthma Regence Kaiser HEDIS 75th 2002 2003 There is no HEDIS Equivalent ER Visits per 1,000 Prepared by Aon Consulting

  21. BD attach. 5 Carrier Reported Clinical Measures: Diabetes Compliance with Appropriate Labs & Exams • Excellent care of diabetes includes good control of the blood sugar levels and of cardiac risk factors (coronary artery disease is the leading killer of diabetics) • Early detection of eye or kidney disease can lead to interventions to prevent or delay the onset of blindness or kidney failure • Clinical Goal: increase in percentage of members receiving appropriate screenings Kaiser Regence HEDIS 75th Mbrs (18-75 yrs old) who had HbA1c Test 2002 Mbrs who had Eye Exam 2003 Mbrs (18-75 yrs old) who had LDL-C Screening Mbrs Monitored for Diabetic Nephropathy Note: HEDIS percentiles have been included for benchmarking only and should not be used as a comparator with the carrier reported values as the carriers do not have a continuous enrollment requirement. Prepared by Aon Consulting

  22. BD attach. 5 Carrier Reported Clinical Measures: Diabetes Clinical Results • Proper care should result in controlled blood sugar level and controlled cardiac risk factors • Clinical Goal: • Decrease in the percent of members with poor HbA1c control • Increase in the percent of members with LDL-C controlled Kaiser Regence HEDIS 75th 2002 Of the Mbrs Tested for HbA1c, the % of those tested with Poor HbA1c Control 2003 Regence does not have Access to Lab Results Of the Mbrs Screened for LDL-C, the % of those screened with LDL-C Controlled Note: HEDIS percentiles have been included for benchmarking only and should not be used as a comparator with the carrier reported values as the carriers do not have a continuous enrollment requirement. Prepared by Aon Consulting

  23. BD attach. 5 Carrier Reported Clinical Measures: Diabetes Utilization Results • Proper care should result in a reduction in the number of hospital admissions and ER visits for members with diabetes • Clinical Goal: decrease in the number of hospitalizations per 1,000 and ER visits per 1,000 for diabetics Kaiser Regence HEDIS 75th Hospitalization for Diabetes or Comorbidity as Primary Diagnosis 2002 2003 Hospitalization for Diabetes or Comorbidity as Any Diagnosis There are no HEDIS Equivalents ER visits per 1,000 Prepared by Aon Consulting

  24. BD attach. 5 Carrier Reported Clinical Measures: CAD Compliance with Appropriate Labs & Exams • The goal of managing CAD is to prevent further events (angina/chest pain or repeat heart attacks) by controlling all risk factors (high blood pressure, cholesterol, inactivity, tobacco use) • Beta Blocker medications are the best drug treatment for preventing recurrent heart attacks • Aspirin has the ability to reduce clot formation in the narrowed coronary arteries • Clinical Goal: increase in percentage of members receiving beta blocker treatment, cholesterol screening, and aspirin use Kaiser Regence HEDIS 75th Mbrs Receiving Beta Blocker following a Heart Attack (AMI) Mbrs who had LDL-C Screening following an Acute Coronary Event (AMI, CABG, PTCA) 2002 Mbrs Using Aspirin following an Acute Coronary Event (AMI, CABG, PTCA) Regence does not have Access to Chart Notes There is no HEDIS Equivalent 2003 Note: HEDIS percentiles have been included for benchmarking only and should not be used as a comparator with the carrier reported values as the carriers do not have a continuous enrollment requirement. Prepared by Aon Consulting

  25. BD attach. 5 Carrier Reported Clinical Measures: CAD Clinical Results • LDL cholesterol is the form of cholesterol circulating in the blood that can attach to the blood vessel wall and cause further damage/narrowing • Good care will result in management of all cardiac risk factors including cholesterol levels • Clinical Goal: an increase in the percent of members with LDL-C controlled Kaiser Regence HEDIS 75th 2002 2003 Kaiser Data not Available in 2002 Of the Mbrs Screened for LDL-C, the % of those screened with LDL-C Controlled Regence does not have Access to Lab Results Note: HEDIS percentiles have been included for benchmarking only and should not be used as a comparator with the carrier reported values as the carriers do not have a continuous enrollment requirement. Prepared by Aon Consulting

  26. BD attach. 5 Carrier Reported Clinical Measures: CAD Utilization Results • Preventive treatment should reduce the number of hospital admissions for members with CAD • Clinical Goal: a decrease in the number of hospital admits per 1,000 for members with CAD Regence HEDIS 75th Kaiser 2002 2003 Hospital Admits for Members Having a Coronary Event (AMI, CABG, PTCA) There is no HEDIS Equivalent Prepared by Aon Consulting

  27. BD attach. 5 Carrier Reported Clinical Measures: CHF Utilization Results • There are two goals of treatment for CHF • Minimize patient care • After hospitalization, discharge in a stable condition so that patient is able to self-manage • Appropriate diagnosis and care during hospitalization and appropriate management as an outpatient will reduce both the number of hospital admissions as well as the number of re-admissions • Clinical Goal: decrease in both the number of hospital days and the number of re-admissions Kaiser Regence HEDIS 75th Hospital Days for CHF (per 1,000) There are no HEDIS Equivalents 2002 2003 Re-admissions within 90 days (per 1,000) Prepared by Aon Consulting

  28. BD attach. 5 Carrier Reported Measures Clinical Measures - Findings • Performance on appropriate screenings and exams generally improved in 2003 • Utilization results are mixed; additional analysis will be conducted to explain the causes. For example, the increase in CAD hospitalizations may be due to increased use of PCTA’s which is positive. • Both carriers scored below HEDIS 75th percentile on some measures, however, comparisons with HEDIS are difficult to interpret given the small size of PEBB’s chronic disease populations and differences in methodology *HEDIS benchmark measures not directly comparable due to HEDIS continuous enrollment requirement Prepared by Aon Consulting

  29. BD attach. 5 2003 Highlights - Outline • Purpose of Annual CDM Report • Review Methodology • Prevalence Updates • Aon Reported Statistical Findings (Cost & Utilization for Level I & Level II Analysis) • Carrier Program Design • Participation • Carrier Reported Clinical Measures • Summary and Next Steps Prepared by Aon Consulting

  30. BD attach. 5 Summary • There is clear evidence members with chronic disease experience higher cost and utilization than the population without chronic disease • Performance on clinical measures generally improved in 2003 • Still too early to evaluate the effectiveness of PEBB’s Chronic Disease Management Program on controlling costs - consistent with current industry knowledge as outlined in the recent Congressional Budget Office findings • In the early stages of evaluation, performance on clinical measures is a better short-term indicator of the overall effectiveness • Additional experience is needed to isolate the long-term effect of chronic disease management due to: • Anomalies in 2002 reporting year (consolidation of carriers/plan design) • Random variations possibly due to the small population being measured Prepared by Aon Consulting

  31. BD attach. 5 Recommendations for Future Program Direction • Continue to track prevalence, utilization, cost, and clinical measures over time • Encourage carriers to demonstrate continuous improvement in program design, participation, and outcomes • Align current programs with 2007 Vision • Develop intervention strategies for other conditions prevalent in the PEBB population e.g., obesity and smoking cessation • Develop metrics and opportunities for collaboration to address depression Prepared by Aon Consulting

More Related