Managed Healthcare Executive - February 2009 - (Page 24) { HEALTH MANAGEMENT } the information was collected in later efforts, Aetna created a rigorous process to safeguard the data and make sure it’s applied appropriately, Toscano says. In the demographic-capturing e ort, 5.8 million members to date have selfidenti ed by race, which represents 25% to 28% of total membership. “There certainly was a lot of worry and consternation about getting this information,” Dr. Rawlins says. “Jack Rowe, CEO at the time, pointed out accurately that the only way to nd out who the population is, is to ask.” He says health insurers have a growing responsibility to address healthcare disparities in speci c populations. At APS Healthcare in Brook eld, Wisc., a Healthy Together hypertension-speci c DM model has been in place since 2003. “We take a holistic approach by not just focusing on the individual’s hypertension,” says Helene Forte, vice president of medical operations for APS Healthcare. “You can’t separate out the di erent medical conditions, nor the mind/body connection.” For example, someone who is dealing with particularly stressful life circumstances would not likely bene t as much from treatment. In a sense, APS Healthcare wants to know each patient’s medical history plus a bit more. “What keeps them up at night?” Forte says. “You want to engage them in wanting to make change.” Consider the patient with insomnia who also has hypertension. She recommends providing strategies that can address the sleep issues so the member is in a better state of mind to focus on blood pressure. Forte says it’s also important not to focus on too many issues at one time. Overwhelming a member is unlikely to produce improved outcomes. The number of people with hypertension is continually climbing, according to 24 FEBRUARY 2009 Forte, who said prevalence rose 10% over the last decade. She cites the Framingham Study, which states that 50% of people over age 55 will acquire hypertension. “Early identi cation is absolute key,” Forte says. OPT-OUT ENROLLMENT At Sanford Health Plan in Sioux Falls, S.D., the plan has a hypertension-only, opt-out disease management program, involving approximately 3,400 hypertensive members—or 1.5% of membership. It boasts a 95% participant rate. EXECUTIVE VIEW About $54 billion to $63 billion is tied to hypertension. Hypertension is prevalent among African Americans. Design a hypertension program with cultural considerations. Each month, Sanford reviews claims and diagnostic codes to identify hypertensive members. Those members receive a welcome booklet de ning hypertension and providing diet and exercise ideas, a health risk assessment, as well as an optout form. “Once we receive the health risk assessment, we stratify according to standard risk factors. Those who are high-risk get a phone call from the nurse…We can waive copays or o er special programs to get them on board,” says Michael Crandell, MD, of Sanford Healthcare. The approach to hypertension control has shifted, Dr. Crandell says. “Today we’re really seeing that people are going back to modifying behavior, as opposed to [physicians] throwing pills at patients,” Dr. Crandell says. “The philosophy is that if you can prevent or modify disease early, not only will you improve quality of life, but you lower costs for em- ployers and members in terms of premiums and, importantly, costs of other comorbidities. If I get someone who is obese to lose weight, that might also control back pain and hypertension just through behavior modi cations.” One trend in managing hypertension is on-site case management, an option available through Sanford. Case managers meet face to face and o er personalized solutions for weight loss, blood pressure control, and other behavior modi cations. Such approaches are expected to drive down costs in the long-run. From July 2007 to May 2008, Sanford spent $750,000 on hypertension: $99,000 for hospital costs; $500,000 for physician costs; another $150,000 for miscellaneous costs. Sanford is counting on a return on program investment over the next few years. “The most important message is that this is a disease that is managed one member at a time. Look at each member as an individual and do the best you can for that member. It’s a labor-intensive philosophy, but it’s proven e ective,” Dr. Crandell says. Greg Steinberg, MD, chief medical ofcer of ActiveHealth, says ActiveHealth Management recently expanded its program to now address childhood hypertension and obesity, which he calls a “potential iceberg.” Through these new programs, nurses o er support to motivate the entire family to incorporate healthy and permanent lifestyle habits. “I can’t overemphasize the necessity of a robust disease management program for our nation that targets not only adults with high blood pressure but children’s BP as well,” Dr. Steinberg says. “And the program must target not just BP but any other disease in a comprehensive, holistic way. It should be able to highlight gaps in care for the patient at any given time.” MHE FOR MORE INSIGHT See more Health Management on managedhealthcareexecutive.com http://www.managedhealthcareexecutive.com
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