Diverse Strategies, Innovative Solutions

2009 annual report

DMAA: The Care Continuum Alliance 701 Pennsylvania Ave. N.W. • Suite 700 • Washington, D.C. 20004-2694 (202) 737-5980 • (202) 478-5113 fax • [email protected] • www.dmaa.org Officers

Chair Gordon K. Norman, MD, MBA Chief Innovation Officer, Health Improvement Alere

Chair-Elect Christopher Coloian Senior Vice President, Global Business Health Dialog

Treasurer About DMAA: Rose Maljanian, RN, MBA President and CEO The Care Continuum Alliance Strategic Health Equations, LLC

Secretary DMAA: The Care Continuum Alliance convenes all stakeholders provid- Jerome V. Vaccaro, MD ing services along the care continuum toward the goal of population President and Chief Operating Officer APS Healthcare health improvement. These care continuum services include strategies, such as health and wellness promotion, disease management, and care Chair: Government Affairs Jan E. Berger, MD coordination. DMAA: The Care Continuum Alliance promotes the role President and CEO of population health improvement in raising the quality of care, im- Health Intelligence Partners proving health outcomes and reducing preventable health care costs Chair: Quality & Research for individuals with chronic conditions and those at risk of developing Tehseen Salimi, MD, MHA VP, Customer Medical Synergies chronic conditions. DMAA activities in support of these efforts include Global Medical & Regulatory Affairs advocacy, original research and the promotion of best practices in care sanofi-aventis management. At-Large Susan B. Riley DMAA: The Care Continuum Alliance represents more than 200 cor- Tracey Moorhead porate and individual stakeholders—including wellness, disease and President & CEO, Ex Officio care management organizations, pharmaceutical manufacturers and benefits managers, health information technology innovators, biotechnology innovators, employers, physicians, nurses and other health care Directors professionals, and researchers and academicians. Visit DMAA online at www.dmaa.org. Chris Behling President Hooper Holmes Inc.

Katie Brookler Strategic Projects Colorado Department of Health Care Policy and Financing

Gail Borgatti Croall, MD Chief Medical Officer OptumHealth Inc.

D.W. Edington, PhD Director, Health Management Research Center University of Michigan

Jeffery Gruen, MD Director PRTM Management Consultants A Message from DMAA Leadership

Rajendra Pratap Gupta An increasingly diverse mix of organizations and individuals within DMAA and President the broader industry in 2009 heightened the role of population health management Disease Management Association of India in health care and in efforts to reform the nation’s health care system. The indus- Joseph Kvedar, MD try’s expertise in many of the common elements of leading reform models – data Founder and Director Center for Connected Health, use and analytics, health information technology, care coordination and coaching, Partners Healthcare outcomes measures – positioned population health as an essential component of a reformed system, regardless of the care models that prevail. Gregg Lehman, PhD President and CEO HealthFitness Inc. The past year also saw a strong consensus on the importance of prevention and

Jeffrey Levin-Scherz, MD, MBA, FACP wellness, both in the context of reform and, more broadly, in employers’ continued Principal strong support of workplace health promotion programs. DMAA demonstrated Towers Watson leadership here, through its partnerships with prevention and wellness advocates, Patricia P. Mueller, MD research focus on quality and outcomes and role as a strong industry representative SVP and Chief Medical Officer in Washington and elsewhere. DMAA bolstered its advocacy presence in 2009 and Coventry Health Care launched a grassroots campaign to add a consumer voice to the value proposition Jeremy J. Nobel, MD, MPH for population health management. Faculty Member Harvard School of Public Health Our research efforts in 2009 maintained a focus on outcomes evaluation and qual- Emad Rizk, MD ity improvement. DMAA produced a fourth volume of its Outcomes Guidelines President McKesson Health Solutions Report and made the document freely available online – an association first that demonstrates our commitment to consensus measures of value. DMAA launched Seth Serxner, PhD, MPH multiple quality initiatives, including a Web site portal, an online case studies reg- Principal and Senior Consultant Total Health Management specialty group istry and an annual Quality Impact awards program, which made its debut at The Mercer Forum 09, our 11th annual meeting. The Sept. 21 to 22 Forum, the March 29 to

Vicki Shepard MSW, ACSW, MPA 31 Integrated Care Summit and several Web-based seminars in 2009 fulfilled the Senior Vice President, Strategic and DMAA mission to “convene, education and communicate” to advance the practice Government Relations of population health improvement. Healthways

Dexter W. Shurney, MD, MBA, MPH In the end, though, the proof of the pudding is in the eating. In that spirit, DMAA Medical Director Employee Healthcare Plan, Vanderbilt includes in this report an enhanced research section: case studies culled from pre- University and Medical Center sentations at DMAA events and a review of noteworthy literature of the past year. Assistant Professor, Vanderbilt School This resource demonstrates, through real-world accounts, how population health of Medicine management improves lives and lowers costs. John Sory Senior Vice President, Health Care Solutions DMAA recognizes the commitment of its members to quality and value, and to ERT advancing evidence-based care for the well, at-risk and chronically ill. Learn more about their work and the benefits of DMAA membership at www.dmaa.org. Sue Willette Senior Vice President and Chief Growth Officer Staywell Health Management

Randall E. Williams, MD, FACC CEO Pharos Innovations LLC Tracey Moorhead Gordon K. Norman, MD, MBA

David B. Nash, MD, MBA President and CEO Chair, Board of Directors Dean Jefferson School of Population Health Honorary, Non-Voting

1 Advocacy

A Respected Voice for Population Health A Strong Response to Regulatory Threats Politics and policy framed the past year like no other topic of In October, DMAA took the lead in an industry response to concern for population health management and the broader interim final regulations for the Genetic Information Non- care community. The year started with a new administration discrimination Act (GINA). The GINA rule, published joint- and Congress eager to revitalize the economy and reform the ly by the departments of Health and Human Services, Labor nation’s health care system. Both initiatives harbored op- and the Treasury, threatened to severely restrict workplace portunities and challenges for chronic disease prevention and wellness and disease management programs with prohibitions care. on the collection of family medical history – defined as genetic information – and the provision of participation incentives. As the year progressed, DMAA assumed an industry leader- DMAA rallied opposition to the new rule with support from ship role through vigorous efforts to advocate legislative rec- prominent allied organizations, provided well-documented ognition of population health management and to challenge arguments to regulators about the new rule’s potential harm- burdensome regulatory measures that threatened workplace ful effects and generated media coverage of the issue through health promotion programs. DMAA also made its members’ strategic communications. voice heard in policy-making for health information technology standards, Medicare special needs plans, state prevention In other advocacy accomplishments in 2009, DMAA: and health promotion programs, employer-sponsored well- ( Launched a multistate grassroots campaign to collect ness programs – and, of course, health care reform. personal accounts from patients, case managers, physicians and family caregivers about the value of population DMAA Advocacy and the Reform Debate health programs. The resulting “Voices of Wellness & DMAA advocacy on reform, in fact, started in late 2008, Care Coordination” story bank, on the DMAA Web site, with publication of its “Principles for Health Care Reform.” supported advocacy around health care reform and other DMAA remained faithful to this roadmap as reform moved important issues. through 2009 from broad concepts to detailed legislative ( Participated in a White House Regional Health Care language. The Obama administration’s “down payment” Reform Summit in Des Moines, Iowa. on reform – the American Recovery and Reinvestment Act (ARRA), or economic stimulus package – aligned, generally, ( Established a Board-level Health Information Technology to DMAA advocacy for prevention and wellness and, directly, (HIT) Committee to promote the important role of HIT in its exception for population health under new provisions to in chronic condition care. tighten HIPAA data use standards. ( Successfully communicated to federal officials the association’s positions on regulations arising from the ARRA, As debate shifted to an almost exclusive focus on reform, including the definition of “meaningful use” of HIT and DMAA took an active role individually and in concert with notification requirements for breaches of protected health other chronic disease care advocates, including the Partner- information. ship to Fight Chronic Disease (PFCD). Through Capitol ( Conducted complimentary member Webinars on ARRA Hill briefings and the establishment and chairing of a PFCD changes to HIPAA and on the implications for wellness working group on Congressional Budget Office assessment and disease management of the GINA interim final rule. of chronic care savings, DMAA helped drive a strong presence for prevention and wellness in leading reform packages. ( Co-hosted with the Partnership to Fight Chronic Disease DMAA also regularly made its positions known through briefings for congressional staff on the importance of meetings with and letters to House and Senate leaders, reaf- chronic disease prevention and management in health firming its position as the industry’s recognized advocate. care reform.

2 Our Strategic Vision: Advocate population health improvement as a tool to improve the quality and value of health care. education/communication

Convene, Educate, Communicate Webcasts DMAA offered several remote learning opportunities in In 2009, DMAA honored its commitment to advancing best 2009, all at no or reduced cost to members, including practices in population health management and communicat- Webcasts on “Improving Employee Health and Productiv- ing value to purchasers, payers, policy makers and other audi- ity Through Communities of Medical Value,” “HIPAA and ences. DMAA conducted comprehensive, onsite education the Economic Stimulus Law: What You Need to Know” and exhibit events in March and September and educational and “The GINA Regulation: Implications for Wellness and Webcasts throughout the year on practice and policy topics. Disease Management Programs.” DMAA also leveraged new and traditional communications vehicles, including social networking and podcasting, to Communicating the Value of Population Health expand awareness of population health management’s role in DMAA serves as a primary source of timely industry intel- chronic disease prevention and care. ligence for members, policy makers, health care purchasers and other audiences through a variety of print and electronic The Forum 09 vehicles. The bimonthly, peer-reviewed DMAA journal, The historic debate in Congress over health care reform Population Health Management, comprehensively covers the – and population health management’s role in a reformed clinical and business aspects of population health manage- system – set the tone for this 11th annual meeting of DMAA, ment and is available online at no cost to members. The Sept. 21 and 22, in San Diego. Educational sessions, includ- weekly DMAA electronic newsletter, DMAA eNews, provides ing a new “Pacesetters Policy” series, explored relevant and valuable reports on health policy issues, research, corporate timely issues, including comparative effectiveness, state news and other essential topics. initiatives and the implications of a new health IT law for population-based care. Speakers reinforced the theme: former Online, DMAA continues to expand its award-winning Web Medicare and Medicaid administrator Mark B. McClellan, site, www.dmaa.org, with new features and content, including MD, PhD; Agency for Healthcare Research and Quality many exclusive to members. DMAA also extended its reach Director Carolyn M. Clancy, MD; researcher and informed electronically to social media in 2009, establishing a profes- consent advocate Michael J. Barry, MD; and medical home sional networking group on Linkedin and a Twitter account and HIT expert David K. Nace, MD. for updates on conference planning and other activities.

Integrated Care Summit To bolster its international efforts, DMAA launched in December 2009 an International Population Health Manage- DMAA, the National Association of Manufacturers and ment Wiki to build an evolving and expanding online Center for Health Value Innovation (CHVI) presented the clearinghouse of population health management practices employer-focused Integrated Care Summit March 29 to 31, worldwide. DMAA encourages contributions of new and in Austin, Texas. The Summit brought together employers updated information to the wiki, at dmaa.pbworks.com. at the forefront of workplace health promotion and leading population health management providers in an intimate setting that fostered exceptional learning opportunities. Keynote speakers included CHVI President and CEO Cyndy Nayer, MA, Partnership to Fight Chronic Disease Executive Director Kenneth Thorpe, PhD, and Christine C. Ferguson, JD, director, Strategies to Overcome and Prevent (STOP) Obesity Alliance.

4 Our Strategic Vision: Convene, educate and communicate to aid in the continued evolution of population health improvement. partnerships

Building Alliances for Quality Care ( Collaborated with the Case Management Society of America on a case management model act and an initia- DMAA recognizes the value of coalition building and strate- tive to identify synergies between case management and gic alliances with stakeholders across the continuum of care population health. – physicians, employers, case managers and others. DMAA ( Participated in “National Workplace Wellness Week,” strengthened established partnerships in 2009 and formed April 5 to 11, 2009, as a member of the U.S. Workplace new alliances with organizations aligned with its vision for Wellness Alliance. high-quality, population-based care. ( Sponsored, through The Campaign to End Obesity, a Capitol Hill federal-state workshop on obesity prevention In 2009, DMAA: initiatives. ( Enhanced its role as a partner organization and advi- ( Held a second annual Capitol Caucus in April 2009 with sory board member of the Partnership to Fight Chronic the American Association of Preferred Provider Organi- Disease. DMAA contributed a chapter to the PFCD 2009 zations. almanac, co-hosted Capitol Hill briefings on prevention and chronic disease issues in health care reform and ( Participated as an Executive Committee member of the established and chaired a new PFCD work group on the Patient-Centered Primary Care Collaborative. Congressional Budget Office scoring process. ( Developed and led a broad-based coalition and response ( Co-hosted a series of Washington, D.C., briefings on pre- to federal regulations for the Genetic Information ventive care with the Center for Studying Health System Nondiscrimination Act. Change and the American College of Preventive Medi- ( Hosted in October 2009 the Third Annual Predictive cine, including a June 8 presentation, “The Dollars and Modeling Symposium with the Society of Actuaries. Sense of Prevention: A Primer for Health Policy Makers.” ( Engaged and supported creation of a new organization representing the Clinical Groupware Collaborative.

( Provided resources and information to a National Busi- ness Coalition on Health project to update eValu8 tool modules on wellness and disease management programs.

6 Our Strategic Vision: Promote and expand stakeholders to include all members of the coordinated health care team. Our Strategic Vision: Research, identify and promote best practices for population health improvement strategies. research

Research as a Roadmap to Quality ( Dedicated programming at its annual meeting to quality improvement, including a keynote by Agency for Health- Understanding the best approaches to wellness, prevention care Research and Quality Director Carolyn Clancy, MD, and chronic condition care requires a sound base of evidence and a Quality Impact awards presentation. in study design and outcomes measurement. In 2009, as in each of the previous three years, DMAA advanced the science ( Created a Quality in Population Health Improvement of program evaluation with its Outcomes Guidelines project, Web site to recognize the industry’s contributions to im- the centerpiece of an active research agenda. proving quality and to provide a single source of DMAA research publications, online tools and other resources for DMAA research leverages the rich experience of industry- improving care. leading member organizations and individuals through a ( Launched a Quality Improvement Case Studies Registry framework of committees and work groups on critical issues under the quality site to collect accounts of program suc- in population health management. Under the umbrella of cesses in a searchable, online database. the DMAA Quality and Research Committee, related panels explore current practices and emerging issues in outcomes evaluation, quality improvement, market trends, transitions Moving Forward of care, predictive modeling and other key topics. DMAA As 2009 came to a close, DMAA turned to important new members enjoy exclusive access to committee participation projects, including publication of a second market analysis, a and represent many of the brightest minds in population next phase of the Outcomes Guidelines Report and work to health improvement. update a DMAA dictionary of population health management terminology. Building Consensus on Outcomes Evaluation At its 2009 annual meeting, The Forum 09, in San Diego, DMAA released a fourth volume of its landmark Outcomes Guidelines Report. This work incorporates the recommen- dations of three previous volumes and adds significant new material, including a definition, framework, basic capabilities and core measures for population health management; additional recommended measures for medication adherence and wellness programs; and special considerations for evaluating mature programs. For the first time, DMAA made the report freely available on its Web site, www.dmaa.org, demonstrating its commitment to best practices and standardization in program evaluation.

Ensuring a Focus on Quality Measuring and improving quality are integral to the population health improvement model. Population health supports a fully connected health care system that provides the health care team with tools for proactive, coordinated, high-quality care. With that perspective, DMAA launched significant initiatives last year to promote quality improvement across the continuum of care. In 2009, DMAA:

9 The Value of DMAA Membership

DMAA: The Care Continuum Alliance is the premier inter- Our Members national membership organization representing the full con- DMAA added 26 new organizational members in 2009, tinuum of care, including wellness, disease and case manage- including those representing physicians and other health ment. Our more than 200 corporate and individual members professionals, home health care providers and health informa- include established and emerging leaders in all aspects of tion technology innovators. DMAA membership reflects the population health management, including: breadth of population-based care and the industry’s growing ( Wellness, disease and care management organizations diversity:

( Physicians, nurses and other health care professionals International ( Employers Population Population Health Health ( Health plans Management 8% Management Support Organizations ( Pharmacy benefits managers Organizations 9% ( Pharmaceutical manufacturers

( Health information technology and biotechnology 14% 45% innovators Partner

( Researchers and academicians 24% ( Hospitals

( Laboratories Individual

DMAA meets the needs of this diverse membership with leadership in advocacy, research, education and business ( Population Health Management Organizations - development. Our work on behalf of members heightens the Organizations that provide wellness, disease or care visibility of population health management and care coordi- management or population health services or education nation among policy makers, health care providers, purchas- to patients, either directly or via telehealth applications. ers and payers, consumers and other key constituencies. Also health plans and integrated delivery systems, including insurers; HMOs/PPOs; Medicare Advantage plans, In 2009, DMAA demonstrated the value of physician-hospital organizations; Medicaid plans; and membership with: management service organizations.

( A new Population Health Resources Directory, a search- ( Population Health Management Support Organiza- able, online database of DMAA member services and tions - Includes organizations providing support services products available as a tool for prospective clients and to population health management providers, including other visitors to the DMAA Web site. software solution providers, health information technolo- ( Expanded online access to the DMAA peer-reviewed gy innovators, remote patient monitoring device manufac- journal, Population Health Management. turers, electronic medical record systems, personal health record suppliers, predictive modeling and other stratifica- ( Creation of a unique “DMAA member” logo for the ex- tion services. clusive use of members to demonstrate industry leadership and commitment to quality and value. ( Individual Members - government employees, academicians, independent specialty consultants, independent ( Webinars – free or at substantially reduced rates for nurse consultants, case managers, pharmacists and psy- members – on emerging legislative and regulatory issues chologists, full-time students. in population health management. ( Partner Organizations - Includes employers; insurance ( Significant discounts on DMAA educational meetings and companies (life, disability and re-insurance); academic publications. medical centers; trade associations, accrediting organiza- ( New opportunities to participate on committees and work tions; physician groups; executive search firms; consul- groups that shape industry research and advocacy. tants; and investment brokers and bankers.

( International Organizations

10 DMAA Member roster

Accordant A CVS Caremark Company Health Dialog Inc. North Highland Company ActiveHealth Management Inc. Health Integrated Inc. Novartis Pharmaceuticals Corp. Aetna Inc. Health Partners Nurtur Alere HealthPartners Partners HealthCare System Inc. AllOne Health Management Solutions HealthFitness Pfizer Health Solutions Inc. almeda GmbH HealthLines Services BC Pharos Innovations American Medical Group Association HealthMedia Inc. Phytel Inc. American Specialty Health HealthSciences Institute Practinet BV Ameritox, Ltd. Healthways Inc. PricewaterhouseCoopers LLP AnyCare GmbH Highmark Blue Cross Blue Shield PRTM Management Consultants, LLC APS Healthcare Inc. Holman Group Providence Health & Services AxisMed Gestao Preventiva Da Saude SA Home Access Health Corporation QualityMetric BioMedCom Consultants, Inc. Honeywell HomMed LLC RAND Blue Cross Blue Shield Association Hooper Holmes Inc. RMD Networks Blue Cross Blue Shield of Arizona Huntsville Hospital Robert Bosch Healthcare Blue Cross Blue Shield of Louisiana IMetrikus Inc. ROMIT Disease Management Blue Cross Blue Shield of Massachusetts Independence Blue Cross sanofi-aventis Blue Cross Blue Shield of Michigan INSPIRIS Inc. Scandinavian Health Partner Blue Cross Blue Shield of Minnesota Intel Corp. Digital Health Silverlink Communications Blue Cross Blue Shield of Rhode Island InterComponentWare Inc. Solucia Consulting BlueCross BlueShield of Kansas City Iowa Chronic Care Consortium Sompo Japan Research Institute BlueCross BlueShield of South Carolina Johns Hopkins HealthCare State of Colorado Medicaid BlueCross BlueShield of Tennessee The Joint Commission StayWell Health Management Bluegrass Family Health Kaiser Permanente Health Plan Inc. SummaCare Blue Shield of California KidneyTel Swiss Center for Telemedizin MEDGATE CalorieKing Liberty Dental Plan Corporation Inc. Sykes Assistance Services Corporation Capital Blue Cross LifeMasters Supported SelfCare Inc. Symcare Personalized Health Solutions Care Management Technologies Lockton Companies LLC SynCare LLC CareGuide Louisiana Health Care Review Inc. Tethys Bioscience, Inc. CareSource Management Group Magellan Health Services Inc. Towers Watson The Catholic Health Assoc. of the United Mayo Clinic Tufts Health Plan States McKesson Health Solutions UMR Care Management Central Virginia Health Network MEDai, Inc. UnitedHealth Group Children’s Mercy Family Health Partners MedAssurant Inc. Unity Health Insurance Christus Health Medco Health Solutions Inc. Universal American Financial Corp. CIGNA HealthCare and CareAllies Medybiz Private Limited URAC Coventry Health Care Inc. Meiji Yasuda System Technology Com- U.S. Preventive Medicine Daman National Health Insurance pany Ltd. ValueOptions Company Mercer LLC Vanderbilt Medical Center Deloitte Svcs. LLP Life Sciences & Health Merck & Co. Inc. Care Verisk Health Inc. Milliman Inc. Direct Connect Solutions VitalHealth Software Motion Picture & Television Fund Disease Management Association of India WellDoc Inc. National Association of Manufacturers Focused Health Solutions Inc. WellMed National Committee for Quality Assurance ForeSee Health Wellpoint Inc. National Pharmaceutical Council Geisinger Health Plan XLHealth Corp. Nationwide Better Health GlaxoSmithKline Yukon-Kuskokwim Health Corporation NaviNet Inc. Hazelden Foundation Neighborhood Health Plan of Rhode Health Care Service Corp. Island

11 Advancing the Population Health Improvement Model

DMAA: The Care Continuum Alliance promotes a proac- ( Patient-centric health management goals and education tive, accountable, patient-centric population health improve- which may include primary prevention, behavior modi- ment model featuring a physician-guided health care deliv- fication programs, and support for concordance between ery system designed to develop and engage informed and the patient and the primary care provider; activated patients over time to address both illness and long ( Self-management interventions aimed at influencing the term health. DMAA members believe that managing health targeted population to make behavioral changes; requires the active, integrated involvement of all health care professionals coordinated with the patient and their caregiv- ( Routine reporting and feedback loops which may include ers and families. We offer these principles to describe the communications with patient, physicians, health plan and elements of this fully-connected health system, leveraging ancillary providers; teams of care providers, focused on proactive, coordinated, ( Evaluation of clinical, humanistic, and economic out- quality health care. comes on an ongoing basis with the goal of improving overall population health. The population health improvement model highlights three components: the central care delivery and leadership roles of The population health improvement model: the primary care physician; the critical importance of patient activation, involvement and personal responsibility; and the ( Encourages patients to have a provider relationship where patient focus and capacity expansion of care coordination they receive ongoing primary care in addition to specialty provided through wellness, disease and chronic care manage- care; ment programs. The convergence of these roles, resources ( Complements the physician/practitioner and patient and capabilities in the population health improvement model relationship and plan of care across all stages, including ensures higher levels of quality and satisfaction with care wellness, prevention, chronic, acute and end-of-life care; delivery. Further, coordination and integration are important ( Assists unpaid caregivers, such as family and friends, by tools to address health care workforce shortages, individual providing relevant information and care coordination; access to coverage and care, and affordability of care. ( Offers physicians additional resources to address gaps in The accountability for delivering and coordinating appro- patient health care literacy, knowledge of the health care priate cost-effective care and the credit for achieving tar- system, and timeliness of treatment; geted improvement and goals for population health must be ( Assists physicians in collecting, coordinating and analyz- explicitly recognized and proportionately rewarded. To this ing patient specific information and data from multiple end, the population health improvement model envisions members of the health care team including the patients optimization of both physician office practices and other themselves; services that improve population health, where demonstrated to add value. To best achieve this, payers, purchasers, patients and their advocates and other members of the health care team must promote and ensure appropriate reimbursement schedules for cognitive services, care coordination, referral activities and adherence to desired processes, such as the use of evidence-based clinical guidelines.

Key components of the population health improvement model include:

( Population identification strategies and processes;

( Comprehensive needs assessments that assess physical, psychological, economic, and environmental needs;

( Proactive health promotion programs that increase awareness of the health risks associated with certain personal behaviors and lifestyles;

12 Our Vision: All stakeholders in the health ( Assists physicians in analyzing data across entire patient populations; care continuum are aligned toward

( Addresses cultural sensitivities and preferences of indi- optimizing the health of viduals from disparate backgrounds; populations. ( Promotes complementary care settings and techniques such as group visits, remote patient monitoring, telemedi- cine, telehealth, and behavior modification and motivation techniques for appropriate patient populations. Our Mission

Accountable measurement of progress toward optimized We believe the highest achievable health status is population health should include: attained through the promotion and alignment of

( Various clinical indicators, including process and out- population health improvement by: comes measures; ( Promoting a proactive, patient-centric focus across ( Assessment of patient satisfaction with health care; the care continuum;

( Functional status and quality of life; ( Convening health care professionals across the care continuum to share and integrate practice models; ( Economic and health care utilization indicators; and ( Emphasizing the importance of both healthful be- ( Impact on known population health disparities. haviors and evidence-based care in preventing and managing chronic conditions; DMAA: The Care Continuum Alliance supports this population health improvement model to provide the elements of a ( Promoting high quality standards for and defini- fully-connected health care system to provide all members tions of key components of wellness, disease and, of the health care team essential tools to ensure proactive, where appropriate, case management, and care coordinated, quality health care. coordination programs as well as support services and materials;

( Identifying, researching, sharing and encouraging innovative approaches and best practices care delivery and reimbursement models;

( Establishing consensus-based outcomes measures and demonstrating health, satisfaction, and financial improvements achieved through wellness, disease and case management, and care coordination programs;

( Supporting delivery system models that ensure appropriate care for chronic conditions and coordination among all health care providers including strategies such as the Chronic Care Model, the physician-led medical home concept, and the disease management model;

( Encouraging the widespread adoption and interop- erability of health information technologies;

( Advocating the principles and benefits of population health improvement to public health officials, including state and federal government entities;

( Underscoring the level of commitment to population health improvement and timeframes necessary to realize the full benefits. 13 Population health management: profiles in care quality & Value

The more than 200 members of DMAA: The Care Continuum Alliance represent leaders in all aspects of population health management. Their experience and expertise, documented in the peer-reviewed literature and on display annually at The Forum, Integrated Care Summit and other DMAA educational events, advances understanding of established approaches to chronic condition prevention and care and promising new strategies to improve health care quality and value.

In the pages that follow, we chronicle the accomplishments of DMAA members and other innovative organizations dedicated to improving population health and to evaluating outcomes with measures born of best practices and industry consensus. Explore population health management’s valuable contributions to care through these brief case studies and selected abstracts from the DMAA peer-reviewed journal, Population Health Man- agement, and other respected publications. Learn how wellness, disease management and other population-based interventions in diverse settings, from the workplace to the physician’s office, improve health, mitigate risk and lower costs. CASE STUDIES: Improving the Health of Populations

Lancaster County Business Group on Health Results BRiDGE Project MeritCare Health System improved outcomes for patients, as evidenced by decreased hospitalizations and decreased emer- The Lancaster County Business Group on Health, gency department visits, saving more than $500 per patient GlaxoSmithKline and American Pharmacists Association per year; and improved hypertension, LDL cholesterol and partnered on the BRiDGE Project, a cost-effective, patient- hemoglobin A1c control. centric model that brought significant savings, reduced absenteeism and improved health when employees received tools to take control of their disease and rewards for doing so. A Physician-Directed Population Management Strategy Key factors are the role of the pharmacist, who provides one- on-one coaching, and referrals to local community resources OptumHealth Inc. tested the concept of physician-directed through the attending physician, thereby improving medica- population management in three primary care physician tion adherence and improved diet and exercise. practices, involving 546 patients exhibiting claims markers for coronary artery disease (CAD), diabetes and hyperten- Results sion. Critical components of the pilot included physician One year results of The BRiDGE Project show an average management of evidence-based medicine opportunities, ac- net total cost savings of $5,812 per patient. On average, A1c tive physician referrals into disease management and wellness levels dropped 8.1 percent to 7.3 percent. LDL levels of less programs and a pay-for-outcomes risk factor management than 100 (an American Diabetes Association goal) increased incentive. from 38 percent to 67 percent. Results Physicians planned to take action, took action or actively Hands-On Care for the Frail Elderly closed 63 percent of 1,421 evidence-based opportunities forwarded. Physicians referred 80 of 187 eligible members Easy Care, a community-based care management program, to health and wellness programs, and 43 members actively collaborates with HealthSpring, a Medicare Advantage enrolled in the programs. A net of 96 distinct risk factor im- coordinated care plan, in caring for the sickest and most frail provements were achieved during the study period, compared Medicare patients living in the community. Lessons learned with nine risk factor improvements in the six months prior to include the importance of implementation management; the study period. early and regular communication to network physicians and members and between teams; coordination with all vendors; and establishing data sets early. Point of Service Population Health Management Results Geisinger Health Plan and Geisinger Community Prac- Over almost three years, hospital admissions have decreased tice have implemented ProvenHealth Navigator (PHN) to by more than 30 percent, and the medical loss ratio (MLR) redesign primary care practices, providing population health for this group has fallen by 56 percent. Cost reductions of management services at the point of service. A central feature more than 30 percent have continued over time. of the model is disease and case management for patients with chronic, comorbid conditions, such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), dia- Targeted Chronic Disease Care in the Advanced betes, CAD and chronic kidney disease, with case managers Medical Home embedded into the primary care office. MeritCare Health System’s award-winning diabetes man- Results agement program conducted in conjunction with BlueCross Quality indicators related to diabetes, hypertension, CAD BlueShield of North Dakota uses the advanced medical home and preventive care screenings have improved. PHN also model of care delivery. This novel approach enhances the is associated with a 17 percent lower admission rate, a 14.5 coordination of care provided to primary care patients and percent lower readmission rate, a 15 percent lower inpatient intensifies the care of patients with chronic medical condi- expense per member per month (PMPM), and an 11 percent tions to reduce complications. lower pre-drug medical expense PMPM. In addition, reductions in acute admissions per 1,000 for CHF (-16 percent), COPD (-17 percent) and diabetes (-14 percent) were noted.

15 CASE STUDIES: Promoting Health and Wellness

Reducing Tobacco Use and Exposure to Second-Hand and stress management; tobacco cessation programs; Smoke onsite nutrition and stress classes; and various promotional campaigns to increase fitness participation and awareness One component of Blue Cross’ comprehensive approach to of disease prevention strategies. reducing tobacco use and exposure to second-hand smoke is stop-smoking support. The program’s success can be attrib- Results uted to access to pharmacy claims data for tobacco treatment The program yielded a return on investment of $1.65 for medications, ease of physician referrals to smoking cessation every dollar spent on the program. Four-year expenditures programs and rewards for provider groups that offer quitting were $808,403, and savings were $1,225,524. Health care assistance. The Minnesota Adult Tobacco Survey (MATS) expenses per person per year were $176 lower for participants, measured the prevalence of smoking from a random sample and inpatient expenses were lower by $182. of Blue Cross members in Minnesota. Using enrollment, disenrollment, current and former smoking prevalence and smoking-related disease prevalence data, Blue Cross calcu- Best Practice vs. Standard Practice Program Design lated annual health care cost and productivity savings over five years, from 2003 to 2007. The goal of this case study is to better understand the prevalence of best practice program elements among StayWell Results Health Management customers and to explore the differences The MATS demonstrated tobacco use among members de- in engagement rates and health risk change based on use of clined significantly, from 14.7 percent in 1999 to 10.9 percent “best practice” versus “standard practice” program designs. in 2007 (p<.01), a decline of 26 percent since 1999. Among all Best practices based on nine components were identified in Minnesotans, smoking rates declined from 22.07 percent in published literature and by industry experts. Information on 1999 to 17.0 percent in 2007. For all plan types, cumulative the use of best practices was collected from standard reports, total savings over five years were $126.8 million from reduced internal documentation and structured interviews with ac- health care costs, and $17.1 million from reduced productivity count management staff. Companies were rated on the extent losses. Savings per additional nonsmoker over five years were of their implementation of best practices and assigned a total $5,335 in health care costs savings, and $721 in productivity score. Standard definitions were used to calculate engagement savings. rates and health impact measures.

Results Lowering Costs Through Comprehensive Companies using recognized best practices in the industry Health Promotion demonstrate superior program engagement rates and health risk reduction when compared with standard practice compa- Highmark offered a comprehensive health promotion pro- nies. More research is needed to determine influence of other gram to all its employees beginning in summer 2002. The factors on these measures (e.g., organizational culture, pro- Highmark Wellness Program offers health risk assessments gram maturity). Forty-eight percent of those who completed (HRAs); online programs in nutrition, weight management a telephone-based weight control program lost weight.

16 CASE STUDIES: Managing Chronic Conditions

Value-Based Drug Benefit Design at Marriott have predicted more events. For avoiding additional inpatient stays, the estimated savings provided a return on investment Observational and prospective studies show that by selectively (ROI) of $1.52 per $1 spent. For reducing the number of AMI reducing the cost disincentive, value-based insurance drug episodes, the estimated savings provided an ROI of $2.25 per benefit design improves appropriate chronic medication use. $1 spent. Marriott International and ActiveHealth Management worked together to discover why employees are not compliant and how to incentivize people to take the most essential drugs. Enhancing Statin Therapy Efficiency for At-Risk Patients Results Marriott reduced copayments for members in five specific The goals of this study, by Blue Cross Blue Shield Associa- drug classes and for those not on a treatment but with a high- tion and BlueCross BlueShield of Texas, a division of Health risk profile, resulting in improved adherence and medical Care Service Corporation, were to increase utilization of savings that offset costs from subsidies and increased drug statins among at-risk patients and to increase generic statin use. Members appropriately starting a new drug showed a utilization. The health plan identified members within a large 24.95 percent increase for all drug classes. Adherence (defined employer group who were at risk of a major adverse cardiac as a medication possession ratio greater than or equal to 75 event (MACE) and recommended that providers initiate a percent) increased for all five drug classes by 27.42 percent. statin regimen for those without a statin claim. In addition, Savings from averted clinical adverse events was calculated at all members of the plan were required to try a generic before $1.17 per member per month (PMPM) and cost from subsi- a brand statin. dies and increased drug use, at $0.96 PMPM for a net savings of $0.21 PMPM. Results The program resulted in an increase in overall statin usage and an increase in use of generic statins. For every 17 mem- Encouraging Beta Blocker Use to Reduce bers at risk of MACE, one member initiated statin therapy Subsequent AMI during the three-month follow up. The intervention group’s generic market share increased to 51 percent, while the The goal of this study, by Blue Cross Blue Shield Associa- control group’s generic market share increased to 32 percent. tion and BlueCross BlueShield of Tennessee, was to reduce Plan PMPM payments for the drug class decreased $0.58 subsequent acute myocardial infarctions (AMIs) in patients in the intervention group, and the control group decreased admitted for an AMI by encouraging the use of beta blockers. $0.53. The intervention consisted of providing educational materials to physicians and patients, counseling on the importance of continuing the beta blocker medications and coordinating Integrated Diabetes Disease Management in physician services. the Medical Home Results To support the Medical Home Model, Blue Cross Blue Participants displayed better compliance with beta blocker Shield of Massachusetts partnered with an alliance of physi- medication and experienced fewer subsequent AMIs than cian groups, Atrius Health, to increase patient activation and non-participants, even though their average risk score would integrate diabetes disease management. Strategies included an evaluation of active member participation, as well as an examination of areas of overlap between individual disease management activities to identify opportunities to leverage unique core competencies and reduce redundancies through integration.

Results The results of the Collaborative Chronic Illness Care pilot have been an increase in member engagement from 23 percent to 47 percent and more efficient care delivery, resulting in improved clinical outcomes, exceptional care and a flexible project structure with high portability potential.

17 CASE STUDIES: Proven Approaches to Program Evaluation and Design

Cummins – Application of Six Sigma Impact of Adherence to Optimal Lifestyle Metrics Cummins Inc. has successfully applied Six Sigma principles Adherence to four specific, lifestyle-related health behaviors to the execution of onsite clinics, wellness programs and (physical activity, non-tobacco use, moderate alcohol use and disease, case and utilization management programs. Six consumption of five fruits and vegetables per day) has been Sigma allows the company to align with the business strate- associated with increased longevity (as much as 14 years) and gies of reducing costs, increasing customer satisfaction and improved functional health status. This investigation, by producing superior financial results. Six Sigma principles and HealthPartners’ JourneyWell division and AB3Health LLC, methodology can be applied to the design, implementation, studies the impact of adherence to varying levels of this opti- delivery and measurement of comprehensive health manage- mal lifestyle metric (OLM) and incidence of chronic condi- ment programs. This innovative approach provides structure, tions among employed adults. Improved understanding of the discipline and accountability, resulting in significant savings impact of lifestyle-related health behaviors may hold signifi- over a relatively short period. cant potential for population health improvement strategies.

Results Results Cummins has effectively executed a complex, incentive- Adherence to three or four components of the OLM, com- driven health management program with impressive results, pared with none or one component, showed a reduction including a 13 percent decrease in risk for excessive utiliza- in risk for diabetes (66 percent), heart disease (45 percent), tion and a 7 percent decrease in medication compliance risk cholesterol (17 percent), hypertension (15 percent), back pain after only 12 months. From a behavior change perspective, (43 percent) and cancer (24 percent). As adherence to OLM Cummins wanted to ensure that employees had access to the components improves, two-year incidence rates fall by 15 right medications and that the medications were used at the percent for hypertension and 66 percent for diabetes. right medication possession ratio (MPR). As a result of the SHPS Inc. programs, the baseline MPR measure started at 0.55 in 2007, and dropped to 0.51 for the current population Prospective vs. Annual Requalification ID (baseline population still employed). Population health management evaluation is impacted by measurement approaches tied to identification methods: “requalification” vs. “prospective.” It is hypothesized that the Overcoming Barriers to Enrollment and Engagement prospective evaluation approach to measurement produces To improve a program’s opt-in rate, HMC developed dis- inaccurate savings calculations due to the effect of regression ease management engagement process models to understand to the mean. the attributes that lead to successful operational outcomes. HMC analyzed three binomial logistic regression models, Results with dependent variables that included member permission Prevalence and its trend are higher for the prospective cohort to participate, or enrollment; member assessment follow- than the requalified cohort. Average monthly cost decline is ing enrollment, or engagement; and member engagement higher for the prospective group compared with the requali- on the first call following enrollment. Independent variables fied group. Therefore, average monthly savings are higher included ZIP code-level demographic factors, internal data, for the prospective group vis-à-vis the requalified group. The operational factors, and health plan factors. average risks profile also is lower for the prospective group compared with the requalified group. Given higher savings Results and prevalence for the prospective group, the total savings is HMC found that it was most successful at enrolling members higher and, therefore, return on investment (ROI) is higher who have socioeconomic, educational or geographical barri- in that group. The difference in ROI narrows in subsequent ers to regular, proactive care. By identifying such attributes years, but still, a substantial absolute difference in ROI with a high level of statistical certainty, HMC can focus on persists between prospective and requalified group. reducing barriers to enrollment by customizing marketing strategies for certain subgroups to drive stronger operational outcomes.

Abstracts

How Employers Use Incentives to Keep Employees Worksite Health Promotion: The Value of the Tune Healthy: Perks, Programs and Peers Up Your Heart Program

Medical Benefits Population Health Management Capps K, Harkey J. Chung, M., Melnyk, P., Blue, D., Renaud, D., Breton, M. Vol. 26, No. 23, 15 December 2009 Vol. 12, No. 6, 2009 Objective: To review the 2009 survey of small, medium and Objective: To evaluate Tune Up Your Heart, a Daimler- large employers’ health and wellness programs in the United Chrysler Canada Inc. (DCCI) program aimed at improving States workforce cardiovascular disease (CVD) risk. Conclusion: More than two out of three companies in all Conclusion: Program participants demonstrated significant sizes offer formal health and wellness or disease management improvements in CVD risk, weight, body mass index, blood programs and incentives to encourage employee participa- pressure and adherence to recommended exercise and diet tion. Smoking cessation programs are the most popular, fol- regimens. lowed by weight management and physical activity programs.

An Ounce Of Prevention More Than A Pound Of Cure Obesity Management Interventions: A Review of the Financial Executive Evidence Ladd S. Population Health Management Vol. 25, No. 8, October 2009 Yaskin, J., Toner, R.W., Goldfarb, N. Objective: To discuss corporate wellness programs. Vol. 12, No. 6, 2009 Conclusion: Nearly 60 percent of companies queried offer Objective: To provide an overview of the full range of wellness programs. In addition, 80 percent make available to methods and models for weight loss, including some available employees health risk assessments and 56 percent use health without medical supervision. coaches. Effective programs involve a holistic commitment to Conclusion: Combination approaches – surgical or pharma- wellness that embraces management, employees and service cologic, combined with a behavioral intervention – were most providers. likely to be effective.

Impact of Decision Support in Electronic Medical Using an Ounce of Prevention: Does It Reduce Health Records on Lipid Management in Primary Care Care Expenditures and Reap Pounds of Profits? A Study Population Health Management of the Financial Impact of Wellness and Health Risk Gill, J.M., Chen, Y.X., Glutting, J.J., Diamond, J.J., Screening Programs Lieberman, M.I. Journal of Health Care Finance Vol. 12, No. 5, 2009 Phillips, JF. Objective: To examine the impact of lipid management Vol. 36, No. 2, Winter 2009 tools integrated into an electronic medical record (EMR) in Objective: To understand the impact of wellness and health primary care practices. risk screening programs on an employed population. Conclusion: This study showed few differences in quality of Conclusion: The research suggests that active participation lipid management after implementing an EMR-based disease in wellness and health risk screening programs may be a fac- management intervention in primary care settings. How- tor in the health care costs for the individuals studied, which ever, a team approach to care in which ancillary staff identify was lower than the overall per-capita health care costs in the patients in need of testing or more aggressive management United States. could increase the tools’ effectiveness.

21 Incorporating Tailored Interactive Patient Solutions The Application of Disease Management to Clinical Using Interactive Voice Response Technology to Trial Designs Improve Statin Adherence: Results of a Randomized Population Health Management Clinical Trial in a Managed Care Setting Puterman J, Alter DA. Population Health Management Vol. 12, No. 4, August 2009 Stacy J, Schwartz S, Ershoff D, Shreve M. Objective: To evaluate the extent to which clinical trials Vol. 12, No. 5, October 2009 incorporate disease management as a minimum standard of Objective: To study the impact of a behavior change pro- care for both the intervention and control groups. gram to increase statin adherence using interactive voice Conclusion: The application of disease management pro- response (IVR) technology. grams has increased over time as a viable intervention in Conclusion: Results of this study suggest that a behavioral clinical trial design, but there is opportunity for increased support program using IVR technology can be a cost-effec- use. tive modality to address the important public health problem of patient non-adherence to statin medication. The Effects of a Computer-Tailored Message on Second- ary Prevention in Type 2 Diabetes: A Randomized Trial Initial Implementation of a Depression Care Manager Population Health Management Model: An Observational Study of Outpatient Utilization Adams SY, Crawford AG, Rimal RN, Lee JS, Janneck LM, in Primary Care Clinics Sciamanna CN. Population Health Management Vol. 12, No. 4, August 2009 Angstman, K.B., DeJesus, R.S., Williams, M.D. Objective: To test the effect of computer-generated, tailored Vol. 12, No. 5, 2009 feedback on the quality of chronic disease management for Objective: Follow-up care, medication adherence and comor- type 2 diabetes when provided to a patient prior to a sched- bid condition management can challenge optimal depression uled physician visit. care in the primary care setting. This study evaluated the Conclusion: Although there were no significant differences impact of using a depression care manager model to address in the percentage of participants who received intensified care these issues. or routine tests between the control and intervention groups, Conclusion: This study found that initial use of a depres- the results indicate that more directed messaging may be sion care manager model significantly increased utilization needed to help patients effectively manage their diabetes. of health care resources for any reason and, specifically, for Patients might benefit from directed feedback, providing depression. them with specific questions to ask their physician that can lead to improved care, rather than receiving general and educational informational messages. Health Risk Appraisals: How Much Do They Influence Employees’ Health Behavior? Integrating Pay for Performance with Educational Health Affairs Strategies to Improve Diabetes Care Huskamp HA, Rosenthal MB. Vol. 28, No. 5, September/October 2009 Population Health Management Foels, T, Hewner, S. Objective: Examine the characteristics associated with Vol. 12, No. 3, 2009 voluntary completion of a health risk assessment (HRA) for enrollees of an employer-sponsored health insurance plan. Objective: To improve consistency of adherence to evidence- based diabetes guidelines, to engage physicians in critical re- Results: The study found that there were some differences view of their practice patterns around care of diabetic patients in HRA completers and non-completers. In addition, when and to change office systems to improve care. comparing the two groups, results show that an HRA can improve quality of care. Conclusion: The program achieved significant improvement in comprehensive diabetes care at the physician practice site level. Success is attributed to engagement of physicians, ac- tionable reports, office-based education, written action plans and alignment with internal disease management. 22 The Effects of a Disease Management Program on Conclusion: A strong link exists between health and pro- Self-Reported Health Behaviors and Health Outcomes: ductivity. Integrating productivity data with health data can Evidence From the “Florida: A Health State (FAHS)” help employers develop effective workplace health and human Medicaid Program capital investment strategies. More research is needed to understand the impacts of comorbidity and to evaluate the Health Education & Behavior cost-effectiveness of health and productivity interventions Morisky D, Kominski G, Abdelmonem A, Kotlerman J. from an employer perspective. Vol. 36, No. 3, June 2009 Objective: To measure the effects of a disease management program on physiological and behavioral health indicators for The Relationship Between Modifiable Health Risk Medicaid patients in Florida. Factors and Medical Expenditures, Absenteeism, Short Term Disability, and Presenteeism Among Employees Conclusion: Patients in the disease management program at Novartis benefited through better control of hypertension, asthma symptoms and cholesterol and blood glucose levels. Journal of Occupational and Environmental Medicine Goetzel RZ, Carls GS, Wang S, Kelly E, Mauceri E, Columbus D, Cavuoti A. Urban-Rural Differences in the Effect of a Medicare Vol. 51, No. 4, April 2009 Health Promotion and Disease Self-Management Objective: To examine the relationships among employee Program on Physical Function and Health Care Expen- health risks and medical care and productivity outcomes, and ditures to quantify the differences in these outcomes when compar- The Gerontologist ing high-risk with lower-risk employees. Meng H, Wamsley B, Liebel D, Dixon D, Eggert G, Conclusion: Three group factors were created from the Nostrand J. study data that statistically grouped risks into three catego- Vol. 49, No. 3, 2009 ries: high biometric laboratory values, smoking and alcohol Objective: To evaluate the impact of a multi-component use, and emotional health risk. The study results showed a health promotion and disease self-management intervention significant association among the health risks associated with on physical function and health care expenditures among the categories and increased presenteeism. Medicare beneficiaries and to determine if these outcomes vary by urban or rural residence. Cholesterol Measurement as a Workplace Health Conclusion: The intervention offered a promising strategy Promotion Intervention for reducing decline in physical function and potentially lowering total health care expenditures for high-risk Medicare Occupational Health beneficiaries, especially for those in rural areas. Future stud- Fritsch M, Montpellier J, Kussman C. ies need to investigate whether the findings can be replicated Vol. 61, No. 3, March 2009 in other types of rural areas through a refined intervention Objective: To determine the impact of education and coach- and better targeting of the study population. ing on lifestyle choices and lipid values among employees with hyperlipidemia. Health and Productivity as a Business Strategy: Conclusion: Total cholesterol and low-density lipoprotein a Multiemployer Study values improved during the intervention. Positive lifestyle changes were made involving exercise and diet. Appropriate Journal of Occupational and Environmental Medicine physician visits and continuous health care increased. Lipid- Loeppke R, Taitel M, Haufle V, Parry T, Kessler RC, based interventions at the worksite can elicit positive changes Jinnett K. in lifestyle, appropriate health care use and improved lipid Vol. 51, No. 4, April 2009 values. Objective: To explore methodological refinements in measuring health-related lost productivity and to assess the business implications of a full-cost approach to managing health.

23 Do Employee Health Management Programs Work? Impact of 2 Employer-Sponsored Population Health Management Programs on Medical Care Cost and American Journal of Health Promotion Utilization Serxner S, Gold D, Meraz A, Gray A. Vol. 23, No. 4, March/April 2009 American Journal of Managed Care Mattke S, Serxner SA, Zakowski SL, Jain AK, Gold DB. Objective: To explore the various aspects of a population Vol. 15, No. 2, February 2009 health management program, including measurement of such a program, best practice program characteristics and a review Objective: To estimate the overall impact of a population of the literature for recent real world program outcomes. health management program and its components on cost and utilization. Conclusion: Research suggests that programs using the outlined best practice characteristics have positive return on Conclusion: Results suggest that the programs did not investment with substantial impact on health care costs over reduce medical cost in their first year, despite a beneficial -ef two to three years. fect on hospital admissions. Although this study had important limitations, the results suggest that a belief that these programs will save money may be too optimistic and better “Dial-an-ROI?” Changing Basic Variables Impacts Cost evaluation is needed. Trends in Single-Population Pre-Post (“DMAA Type”) Savings Analysis Using Qualitative and Quantitative Methods to Evaluate Population Health Management Small-Scale Disease Management Pilot Programs Juster IA, Rosenberg SN, Senapati D, Shah MR. Vol. 12, No. 1, February 2009 Population Health Management Esposito, D., Taylor, E.F., Gold, M. Objective: To understand if chronic (absent disease manage- Vol. 12, No. 1, 2009 ment) and non-chronic trends are similar. Objective: To evaluate small interventions in the Medicaid Conclusion: Chronic and non-chronic trends are similar Value Program (MVP), which targeted various subpopula- based on the criteria recommended in the DMAA Outcomes tions of recipients with multiple chronic conditions. Guidelines Report. Conclusion: The combined evaluation of qualitative and quantitative data helps assess the potential promise of each How To Measure the Outcomes of Chronic Disease intervention and identify themes and challenges common to Management all. The collective experiences of the MVP interventions sug- Population Health Management gest that well-conceived efforts to integrate care across a con- Lewis, A. tinuum of services – primary care, mental health, substance Vol. 12, No. 1, 2009 abuse, long-term care – holds promise if properly targeted, standardized ahead of time and supported by key clinical staff Objective: To demonstrate a methodology for disease man- and organizational leadership. agement outcomes measurement that is valid, transparent, easy to apply and freely available in the public domain. Conclusion: In the health plan community as a whole, Obesity and the Workplace: Current Programs and disease management in the broadest sense is effective, as Attitudes Among Employers and Employees measured by the relative stability in the rate of adverse medi- Health Affairs cal events closely associated with common chronic disease at Gabel JR, Whitmore H, Pickreign J, Ferguson CC, a time when prevalence of most common chronic conditions Jain A, K C S, Scherer H. is increasing. Vol. 28, No. 1, January/February 2009 Objective: Survey employers and employees regarding the presence and effectiveness of weight loss programs in the workplace. Results: Both employer and employee survey respondents view workplace weight management and obesity programs as effective and believe these programs succeed in lowering the rate of obesity in the workplace. 24 Officers

Chair Gordon K. Norman, MD, MBA Chief Innovation Officer, Health Improvement Alere

Chair-Elect Christopher Coloian Senior Vice President, Global Business Health Dialog

Treasurer About DMAA: Rose Maljanian, RN, MBA President and CEO The Care Continuum Alliance Strategic Health Equations, LLC

Katie Brookler Strategic Projects Colorado Department of Health Care Policy and Financing

Gail Borgatti Croall, MD Chief Medical Officer OptumHealth Inc.

D.W. Edington, PhD Director, Health Management Research Center University of Michigan

Jeffery Gruen, MD Director PRTM Management Consultants 2009 annual report

Diverse Strategies, Innovative Solutions

DMAA: The Care Continuum Alliance 701 Pennsylvania Ave. N.W. • Suite 700 • Washington, D.C. 20004-2694 (202) 737-5980 • (202) 478-5113 fax • [email protected] • www.dmaa.org