Population Health

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Closing the Gap: Best Practices in Population Health Management September 9, 2011
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CCA Quality & Research Co‐chairs
Jason Cooper, MS Vice President, Clinical Analytics CIGNA David Veroff, MPP Senior Vice President, Evaluation Services Health Dialog 2

Outcomes Guidelines

Past • Definitions • Measures • Evaluation  Considerations

Present • Defining best  practices • Examples of  best practices

Future • Leading  practice  efforts • Standards

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Vol. 5 and Beyond
PHM Wellness Chronic Care  Management

Definition Evaluation Considerations Measures Standards Defining Best Practices Leading Practice Efforts C C C C C C C C

– Completed C – Current Work
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2011 Q&R Areas of Focus
• Population Health Management
– – – – HERO‐CCA Collaboration PHM Integration Strategies PHM Evaluation Checklist PHM Evaluation Measurement Grid for ACOs/PCMHs

• Wellness
– Engagement – Data Aggregation

• Chronic Care Management
– Medication Adherence – Transitions of Care
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Moving towards Guidelines:  HERO‐CCA Collaboration
Goal: Identify and recommend measures and standards for the  measurement of PHM programs for the employer community  (though other settings/segments will also benefit).

• Scope: Measures and standards applicable to all  programs delivered to an employer’s population • Working Group Domains – – – – – – Health impact Participation Satisfaction Financial outcomes Value on investment Organizational support

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HERO‐CCA Draft Domain Specifics
Participation • Health assessment • Screening • Coaching (lifestyle &  chronic) • Population‐based Satisfaction • Client satisfaction • Participant satisfaction Health Impact • Health risk change  (population & coaching  levels) • Clinical indicators – chronic,  utilization (population &  coaching levels)

Financial Outcomes • Health care cost (i.e.,  medical, pharmacy) • Absence • Disability • Workers comp • Productivity

Value on Investment • Program costs • Incentive costs • ROI (health care and total)

Organizational Support • Corporate culture • Wellness champion

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HERO‐CCA Deliverable Framework
HERO ‐ CCA Domain Workgroup Approach Milestone Timeframe Phase I: Workgroup Kick‐off Phase I: Define Workgroup  Scope Phase I: Present Update at  2011 HERO Forum Phase I: Define Domain Phase I: Current State  Assessment and Gaps Phase II: Recommend  Measures Phase III: Develop Process  and Measure Standards 8

7/29/2011 9/1/2011 9/13/2011 10/1/2011 4/1/2012 8/1/2012 12/1/2012

Leading Practice Efforts:  PHM Integration and Evaluation Strategies 2011 Goal: Research, identify, and demonstrate integration  strategies to embed PHM programs within new service  delivery models (e.g., ACOs, PCMHs) and recommend  strategies for evaluation of new service delivery models that  use PHM programs 

• Deliverables:
– Detailed case studies that highlight program integration; – Addendum to ACO toolkit with measures and evaluation  checklist.

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PHM Checklist
(Care Provider – Data Collection)
Initials Date ET 6/20/11 1) Has member had an annual health risk assessment? 2) Has the member had appropriate lab work? 3) Have members current concerns and health risks been prioritized? 4) Evaluated the member's readiness to address a lifestyle risk(s)? 5) Are preventive exams current? 6) Has medication adherence been discussed when appropriate? 7) Has an individual action plan (with goals) been discussed with the  person? 8) Has the action plan been shared with other providers (in/out of  network)? 9) Document the interactions with member? 10) Document goal achievement? Repeat each Year 10

PHM Checklist
(Administrator – Pop. Evaluation)
Initials Date ET 1) Have current population health risks and chronic conditions  been  6/20/11 identified? 2) Have year over year risk change on matched cases been identified? 3) Have interactions and goal completion been summarized? 4) Has preventive exam compliance been calculated?...
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