Managed Healthcare Executive - January 2009 - (Page 20)

{ S P E CI AL RE PO R T} DM will evolve, but how? To succeed in the current environment, DM programs will become much more sophisticated and transparent. Ariel Linden speci es four key elements that are essential for long-term success: 1. Identify appropriate patients. Currently, potential DM participants are identi ed by claims with a focus on prior year hospitalizations. Linden recommends using additional data from health risk assessments conducted on a regular basis, and in the future, from electronic medical records. “If you only look at last year’s claims you miss about 80% of the people you should be targeting,” he says. “You don’t want to nd the people who were in the hospital last year; you want to nd the people who are at highest risk for hospitalization this year and next year.” years practicing poor health behaviors. Evidence suggests that nurses who aren’t trained or procient in these techniques can actually reverse any advances the patient has made, Linden says. “Nurses spend most of their medical careers telling people what to do; they aren’t trained to listen. The foundation of motivational interviewing and other models is active listening, identifying change-talk, and redirecting patients to act on that change.” 4. Stay in touch. Many DM programs use quarterly contact cycles. Instead, Linden says, they should stay in contact more frequently with high-risk participants through daily remote monitoring. “If someone is at risk for hospitalization, you want to stay in close touch so you can observe and respond to sudden changes in symptoms,” he says. “You won’t capture that data through phone calls every three months.” 2. Enroll and engage. Currently, DM participants are contacted by telephone, which is labor-intensive and doesn’t effectively address barriers to enrollment. DM programs must incorporate motivational interviewing techniques. “People don’t like being called at home by individuals they don’t know so an enrollment specialist has an uphill battle from the outset. If that enrollment specialist isn’t properly trained in behavioral change theory, they will fail to win people over and get them to enroll.” Intervene. Any intervention should be rooted in behavior change theory. Chronically ill individuals often have spent 5. Generate incentives for participation and physician support. Right now, physicians aren’t closely involved in disease management programs, while participant compliance is inconsistent. “We need a systematic approach that includes incentives for physician buy-in, and incentives for patient participation,” Linden says. 3. industry since DM became common,” he says.“With people switching health plans, and with improvements in usual care that can only peripherally be attributed to DM, you don’t necessarily see a dramatic reduction following implementation of a formal program.” New NCQA measures will evaluate DM programs During the summer of 2008, NCQA posted 12 proposed disease management measures on its Web site for public comment. For its accreditation and certi cation programs, these new measures will signi cantly expand the market’s ability to judge the value of DM and compare DM organizations’ impact on patients. The proposed measures will examine whether patients are receiving appropriate treatment and help in managing their lifestyles for conditions such as heart fail20 JANUARY 2009 5 ure, ischemic vascular disease, COPD, asthma and diabetes. For example, one measure will look at whether blood pressure levels are controlled in patients with ischemic vascular disease. During the public comment period, NCQA also conducted eld tests of the measures. “We are currently analyzing data from the eld tests and based on those results, we do anticipate there will be some modi cations to the measures put forth for public comment,” says Je Van Ness, NCQA communications director. In addition, NCQA is looking at ways to expand the suite of measures available for DM programs. The organization is re-evaluating existing measures that seem relevant to DM, and is considering ways they could be adapted for use in evaluating DM programs. “We are closely collaborating with DMAA: The Care Continuum Alliance on developing de nitions for a wider array of measure speci cations,” Van Ness says. In fact, DMAA recently released the third volume of its Outcomes Measurement Guidelines, which helps establish an industry consensus on nancial and outcomes measures of DM programs. It o ers guiding principles and recommendations. Among the updates are new identication methodology recommendations, new measures for medication adherence, expanded guidelines for measuring wellness programs, de nitions for operational processes, and guiding principles for evaluating programs for more than one condition. DMAA President Tracey Moorhead stresses that the guidelines are approaches that users can adapt among their own populations. MHE Mike Quan/Getty Images

Table of Contents Feed for the Digital Edition of Managed Healthcare Executive - January 2009

Managed Healthcare Executive - January 2009 Contents Editorial Advisors For Your Benefit News Analysis Politics & Policy Letter of the Law Managed Care Outlook New Day 5 New Realities of Disease Management Pharmacy Best Practices Health Management Technology State Report: Hawaii MHE Resource Ad/Edit Index

Managed Healthcare Executive - January 2009

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