Disease Management Update
Volume III, No. 45
March 1, 2007
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Table of Contents
- Patient-Centered Case Management Yields High Savings
- Disease Management Q&A: Engaging Participants for Program Duration
- HealthSounds Podcast: The Role of Behavior Modification in Disease Management and Health
- Outdoor Behavioral Healthcare Programs Effectively Treat Teen Substance Abuse
- Changing Lives with Lifestyle Management: Taking the Pulse of Population Health Programs
1. Patient-Centered Case Management Yields High Savings
A patient-centered case management program designed to improve healthcare quality and reduce medical expenses for those with complex or clinically advanced illnesses resulted in a decline in hospital admissions, reduced costs and satisfied patients, according to a report released in the American Journal of Managed Care.
The study of Blue Shield of California's HMO members examined the patient-centered management (PCM) program's impact on those with illnesses such as late stage cancers or degenerative neurologic conditions. Patients who received PCM had 38 percent fewer hospitalizations, a 22 percent increase in home care and suffered fewer treatment complications, such as nausea, anemia and dehydration, than patients who received usual case management.
Many cancer patients in the PCM group opted against further chemotherapy or radiation treatment (42 percent less chemotherapy than the patients in the group receiving usual care). The PCM group also had 62 percent more days in hospice care than the usual care group. Moreover, participant satisfaction scores were highly favorable.
The life span assessment remained the same for both participating groups, indicating that PCM can deliver cost-effective care with no adverse effect on survival. Overall, the study concluded that the PCM effectively reduced overall costs by 26 percent. The savings were realized in patients having fewer costly hospital days and emergency room visits, with care shifting to less costly home care and hospice settings when appropriate.
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2. Disease Management Q&A: Engaging Participants for Program Duration
Each week, a healthcare professional responds to a reader's
query on an industry issue. This week's expert is Roger Reed, executive vice president and chief health officer at Gordian Health Solutions.
Question: What percentage of participants who register for a 12-month program actually complete the program? What about people dropping out once they're enrolled? How do you re-engage people?
Response: What percentage of participants who register for a 12-month program actually complete the program? What about people dropping out once they're enrolled? How do you re-engage people?
Response: Our engagement model is currently an opt-in model, which means that we recruit and incentivize them to call us and enroll in our program. If they don't call us, we start our outbound telephonic outreach. When programs are offered on a voluntary basis, you’ll only make contact with 50 percent of the people that you try to enroll. And you will only enroll about half of that 50 percent.
If the program is incentivized — typically a $20 to $30 per-member per-month incentive or premium differential — the enrollment rate rises dramatically to between 65 and 85 percent. Those individuals who know that their paycheck is going to be touched every month will enroll if they're eligible. Virtually nobody drops out. We have an incentive program whereby we "touch their paycheck:" change their premium contribution based on their compliance with the coaching effort that month. We turn this contribution off and on.
If participants are incentivized, they don't drop out. Close to 90 percent remain enrolled for the entire year because they don't want their paycheck touched. If participation is voluntary, half of them will have dropped out by the six-month point, and another 25 percent between the six- and 12-month point, so only about 25 percent will continue.
For more details on motivating and training health coaches, health coach responsibilities, coaching diverse populations and coaching for specific diseases, please visit:
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3. HealthSounds Podcast: The Role of Behavior Modification in Disease Management and Health
In this week's Disease Management podcast, Michael Thompson, a principal with PricewaterhouseCoopers, describes how a lifestyle scorecard is being developed to incent members and employees to adopt health lifestyles. Dr. Richard Citrin, vice president of EAP Solutions at the University of Pittsburgh Medical Center, describes how a person's perception of their health drives their healthcare decisions. And Dr. Rick Botelho, a professor of family medicine and nursing at the University of Rochester, advises practitioners to put four key motivational principles into practice when helping patients change behaviors.
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4. Outdoor Behavioral Healthcare Programs Effectively Treat Teen Substance Abuse
Teens struggling with substance abuse report reduced frequency of use and a greater inclination to work on the emotional or social issues that trigger their behavior following treatment in a licensed, high-quality outdoor behavioral healthcare program, according to a study conducted by the Outdoor Behavioral Healthcare Research Cooperative at the University of Minnesota.
The study was designed to determine to what degree outdoor behavioral healthcare program students change over the course of treatment and to what degree they maintain these changes after leaving the program. Findings showed that the majority of participating teens with serious or significant substance use issues who previously were rated as "passive" about or "reluctant" to address problem behaviors became "actively interested" in working on or overcoming the issues triggering their substance use after attending an outdoor behavioral healthcare program. Other findings included significant reductions in symptoms of pre-existing depression, anxiety and stress after attending a program.
Prior to participation in the program, 44 percent of teens demonstrated no willingness to address the issues that triggered their substance abuse, 30 percent were reluctant to take action, and 28 percent were actively trying to address problems important to their well-being. After an average treatment length of about 45 days, 90 percent of the students had shifted to actively addressing problems that triggered their substance use.
For more of this study's findings, please visit:
5. Changing Lives with Lifestyle Management: Taking the Pulse of Population Health Programs
Healthcare organizations are using lifestyle management programs to help patients with chronic conditions modify unhealthy behaviors. In a recent online survey, employers, providers and health plans discussed lifestyle management program development within their organizations. This executive summary explores the differing approaches and techniques in population identification, treatment and outcome assessment.
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