Rejuvenating Chronic Care Management

Transcription

1 A-head B-HEAD C-HEAD Body-copy Caption Pull Quote Section intro This is an inline sidebar Subhead of the sidebar. A brief description Sidebar content goes here. Use this smaller text to show the difference between sidebar copy and body copy. Numbered lists and unordered lists can be used in sidebars as well. In malesuada consequat magna eu commodo. Nullam sit amet porttitor quam. Nulla lacinia non ipsum at fringilla. Ut odio arcu, pellentesque ut viverra non, euismod vel velit. Nullam non urna congue, egestas risus ac, tincidunt purus. Nunc sit amet ipsum hendrerit neque mattis gravida dignissim eu orci. Maecenas scelerisque, nulla et placerat accumsan, eratus. Sidebar title 1. Morbi a nisi eget enim ven Sidebar subhead 3. Nullam non urna con Sidebar copy Table header Table subhead 2. Mauris nec purus quis ex tristi 4. Duis lacinia tellus vitae arcu aucto Aliquam in ligula laoreet, fermentum mi non, condimentum nibh. Nullam finibus mauris nisi, sit amet uet turpis sodales vel. Fusce eget auctor justo, dictum ornare risus. Integer tempus ac lectus sed pellentesque. Table text Table title Rejuvenating Chronic Care Management >> Unordered list On.Demand: Combining Real-Time Solutions with Behavior Change Science JIMMY DONOVAN 2017 Envolve, Inc. All rights reserved. EnvolvePeopleCare.com MKT-WP-004 February 2017

2 Executive Summary: The healthcare industry and its reactive approach to managing chronic and acute conditions for its populations is ripe for change. Traditional disease management is at best a short-term solution for individuals with these conditions, including diabetes and heart disease, and at worst is time consuming, hard to understand, and failing to drive care plan compliance. An expert in driving sustainable behavior change, Envolve PeopleCare s On.Demand product suite is leading health plans and industry players to a more proactive approach to health and lifestyle management. With three offerings Basic, Plus and Complete On.Demand is a real-time mhealth solution that improves outcomes, reduces waste, drives down cost while empowering individuals by simplifying the management of complex conditions like diabetes. What is mhealth? The World Health Organization (WHO) defines mhealth as a component of ehealth, the cost-effective and secure use of information and communication technologies for health and health-related fields. mhealth is further classified as involved in the provision of health services and information via mobile technologies such as mobile phones, tablet computers and Personal Digital Assistants (PDAs). ( JIMMY DONOVAN Director of Innovation Publication and Presentation, Envolve PeopleCare Jimmy Donovan is the Director of Innovation Publication and Presentation within the Science and Product division for Envolve PeopleCare. He brings more than a decade of experience in communications, product development and healthcare to his current role. Jimmy is responsible for the identification, development and execution of opportunities in support of telling the Envolve PeopleCare story through clinical, scientific and innovation presentations and publications. Jimmy earned a Bachelor of Arts in Journalism from Penn State University. 2

3 Table of Contents I. THE IMPACT OF CHRONIC DISEASE ON U.S. HEALTHCARE...4 II. A REAL-TIME MHEALTH SOLUTION...6 III. INTRODUCING ON.DEMAND... 7 BASIC... 7 PLUS... 8 COMPLETE... 8 IV. DIABETES IS ONLY THE BEGINNING...9 V. CITATIONS

4 The Impact of Chronic Disease on U.S. Healthcare Chronic diseases those diseases enduring for more than three months are affecting Americans in greater numbers than ever before. From a poor diet to tobacco use and excessive alcohol consumption, these costly, prevalent and largely preventable health conditions are the result of an ever-growing list of societal factors. 1 For an individual living with a chronic disease such as diabetes, heart disease or hypertension the ability to truly understand his or her condition and find appropriate treatment is a significant challenge in itself. Those challenges are exponentially compounded when viewed from the lens of a population. Roughly half of the adults (118 million) in the United States have or had at least one chronic condition and half of those (60 million) had two or more. 2 Furthermore, there has been a recent increase in the number of people with multiple chronic diseases. 3 To say the impact and strain of chronic disease on the United States healthcare system is extraordinary may be the understatement of a generation. Total Healthcare Spending in % Chronic Conditions The personal tolls of our individual and collective chronic conditions are significant, and like the resulting financial considerations, have wide-ranging impacts. In recent years, health care utilization and spending has placed tremendous strain on state and federal budgets. Those with chronic conditions accounted for 86% of all health care spending in Taking the collective costs of chronic disease into account, the expenditures of the individual diseases remain staggering. Heart disease and stroke accounted for $315 4 billion in costs in Health expenditures of diagnosed diabetes totaled $245 billion in Heart disease and stroke accounted for $315 billion in costs. The most common chronic diseases are diabetes, asthma, arthritis, depression, and cardiovascular diseases such as heart failure, hypertension, stroke, and coronary artery disease. 16 4

5 Industry payors and specialty healthcare organizations bear much of the financial burden presented by these conditions. While they bear that burden in a variety of ways, these managed care organizations often employ a traditional, reactive disease management approach to combat chronic disease. Claim reviews, generally-licensed case managers and standard medical necessity criteria pave the way for telephonic education and the promotion of condition self-management tend to comprise the foundation of these approaches. Envolve PeopleCare s extensive experience with such retroactive disease management programs has proven that traditional approaches can be clinically viable, even so for those identified as underserved. 6 Peer-reviewed journal entries from a number of case studies involving a variety of telephonic coaching methods and, generally, education, also support such a claim. 7, 8 What isn t supported by Envolve PeopleCare s experience and that same literature is the overall financial impact of these programs. Programs targeting chronic conditions have resulted in limited savings, but those savings are not always significant when compared to overall medical management costs. This lack of cost-effectiveness is preventing traditional disease management initiatives from making the population-sized impact intended from their development. The healthcare industry which has historically been challenged when it comes to finding and implementing innovative solutions 9 needs to turn the page to a future where chronic disease management programs are not just clinically appropriate, but also financially viable for the populations they serve. Envolve PeopleCare has partnered with Magnolia Health, a Medicaid Managed Care Organization in Mississippi, on the delivery of On.Demand to its membership with a diagnosis of diabetes. Since its implementation in August 2015, On.Demand Basic is generating savings on diabetes test strips and lancet costs for Magnolia Health, just one of the many cost saving features of the program. 5

6 A Real-Time mhealth Solution The convergence of technology, necessity and opportunity has the healthcare industry primed and ready for the next generation of chronic disease solutions. Innovation is shifting away from programs that address chronic and acute diagnoses and comorbidities with only outdated claims information, a reliance on self-reporting and dated best practices. With On.Demand leading a new wave of holistic disease and lifestyle management Envolve PeopleCare is positioned to guide its partners and members as the shift from yesterday s reactive approaches gives way to real-time solutions of tomorrow today. The convergence of technology, necessity and opportunity has the healthcare industry primed and ready for the next generation of chronic disease solutions. Innovation is shifting away from programs that address chronic and acute diagnoses and comorbidities with only outdated claims information, a reliance on self-reporting and dated best practices. With On.Demand leading a new wave of holistic disease and lifestyle management Envolve PeopleCare is positioned to guide its partners and members as the shift from yesterday s reactive approaches gives way to real-time solutions of tomorrow today. Paving the Way to On.Demand Telecare Monitoring (TCM) was a legacy disease management program from Envolve PeopleCare that helped pave the way to today s On.Demand product suite. As part of a 12-month study, TCM showed that program participants were 58% less likely to readmit into an inpatient setting for all causes. In addition, these participants were found to have: On.Demand is a mhealth solution that combines realtime monitoring of biometric data with cellular- and web-based technology, proactive and reactive health coaching, population health reporting and customizable interventions. With life stressors taking priority over health concerns, Envolve PeopleCare is leading the industry to find more ways to make daily life easier and a healthy lifestyle more accessible. On.Demand was developed to empower the individual by making a few components of managing an incredibly complex condition easier than they could have imagined. Members aren t thinking about their health all of the time. By freeing up an individual s internal resources, true, sustainable behavior change is more than possible. heart-related admissions 53% FEWER 58% 64% FEWER diabetes readmissions 62% FEWER diabetes admissions 55% REDUCTION of ER Visists reduction of all cause readmissions *Results are from a 12-month study implemented in home devices that captured blood pressure, blood sugars, blood oxygenation, and weight to those individuals identified as high risk. 17 6

7 Introducing On.Demand On.Demand is designed to impact a variety of chronic diseases by providing health plans and other plan sponsors with a comprehensive solution to improve individual and population health outcomes, reduce waste and drive down costs. Approximately 9.3% of the population, or 29.1 million Americans are living with diabetes, 10 and more than 1-in-3 adults, or 86 million people, have prediabetes. 11 Among the most prevalent conditions in the United States and one that all too often leads to heart disease diabetes serves as a primary target for Envolve PeopleCare s mhealth program. Literature states that real-time transmission from telemonitoring devices of data can be an integral component to an appropriate change in care regimen 12 while also fostering a feeling of security and assuredness. 13 The On.Demand product suite of Basic, Plus and Complete which combines real-time monitoring of biometric data with cellular- and web-based technology, proactive and reactive health coaching for high-risk members, population health reporting and customizable interventions was developed with exactly these factors and much more in mind. These solutions are reducing barriers and risk by driving a reduction in preventable health care utilization, promoting member adherence to treatment guidelines and improving selfmanagement skills. These lead to even more clinically and financially beneficial outcomes, including appropriate service utilization, improved risk scores and financial flexibility needed to impact populations on a greater scale than was previously considered possible. On.Demand Basic CELLULAR TECHNOLOGY + CLOUD-BASED BIOMETRICS + SUPPLY CHAIN COORDINATION + SIMPLE POPULATION REPORTING Many living in lower socioeconomic statuses encounter significant barriers beyond those that impact their health. In addition, current practices require minimal if any requirements on consumers requesting their diabetes supplies from their health plans. This is where On.Demand Basic begins by delivering a supply kit straight to a participant s home. The package includes an introduction to the program, a cellular glucometer and a how-to-use instruction guide, and a supply of testing strips. The user tests his or her A1c with the provided strips, and the cloud stores blood glucose measurements in a secure place. This allows for real-time biometric tracking to support the development of individual and population intervention plans. As the science states, the more someone self-monitors his or her blood glucose, the more likely he or she will have a lower A1c score. 14 Once the strips have been recorded as used in the cloud, a fresh supply of testing strips are automatically mailed within eight days of the supply ending. 7

8 Decrease in Utilization Decrease in Average Glucose General Outcomes with On.Demand Increase in Compliant Glucose Testing Instant Cost Savings Health plans actively using the On.Demand Basic program are seeing savings of $8-to-$10 per participant per month when compared to those who opt out of the program. In addition to the immediate savings generated by a reduction to test strip waste, the program empowers the participant to engage and invest in his or her own health and plan of care. The hassles of refilling prescriptions and, specifically for those with diabetes, remembering to record test strips are gone. Access to monthly reports provides for a real-time look into the health of the program population, including biometric readings, member engagement and compliance information. On.Demand Complete EVERYTHING FROM ON.DEMAND PLUS + REAL-TIME COACHING AND OUTREACH On.Demand Complete provides for the most comprehensive solution available. With Complete, Licensed clinicians monitor the real-time biometric readings for signs of decompensation. Once identified, licensed clinicians engage and intervene to assess symptoms and current compliance with medications. Proactive and real-time coaching are also featured with Complete as clinicians connect with participants to discuss measurements and offer support in times of need. Beyond managing the chronic condition itself, On.Demand Complete allows participants to be assessed on their condition in the context of a more complex world. Real-time access to clinicians and coaches provides participants access to conversations beyond managing a chronic condition into other life topics including financial and social stressors. On.Demand Plus ON.DEMAND BASIC + 24/7 NURSE ADVICE + TARGETED EDUCATION On.Demand Plus takes the chronic disease management program to another level of intensity. In addition to everything offered with Basic, Plus provides access to a 24-hour, 7-days-per-week licensed nurse advice and targeted member education. On.Demand Plus participants receive educational materials based on their biometric measurement history. This tailored approach, delivering only relevant materials, empowers participants to make lifestyle changes effectively and quickly. Connecting to 24/7 nurse advice available to all participants regardless of disability provides a valuable tool for participants to discuss and identify root causes of a condition and plan future steps as they work to manage their condition. Glucometer - seen above. 8

9 Diabetes is Only the Beginning We have people who love the fact they don t have to pick up the supplies. They re automatically shipped to them, and they really like it. Christie Moody, Magnolia (MS) Health The positive impacts of On.Demand for those living with diabetes proves the program s concept. Many chronic diseases are ready to benefit from the design of the On.Demand product suite. A number of conditions are in need of real-time, biometric-based management programs based on their scale within the American population. These include heart disease, a diagnosis received by approximately 27.6 million adults, or 11.5% of the population. 15 Heart Failure management, featuring realtime monitoring of weight and blood pressure via a cellular scale and blood pressure cuff; and Coronary Artery Disease and Hypertension management, which will also use the cuff, comprise the next phase of On.Demand solutions. 9

10 Citations 1. Bauer, U.E., Briss, P.A., Goodman, R.A., & Bowman, B.A. (2014). Prevention of chronic disease in the 21st century: Elimination of the leading preventable causes of premature death and disability in the USA. Lancet, 384, doi: /s (14) Meraya, A.M., Raval, A.D., & Sambamoorthi, U. (2015). Chronic condition combinations and health care expenditures and out-of-pocket spending burden among adults, medical expenditure panel survey, 2009 and Preventing Chronic Disease, 12, E12. doi: / pck Dennis, S.M., Harris, M., Lloyd, J., Davies, G.P., Faruqi, N., & Zwar, N. (2013). Do people with existing chronic conditions benefit from telephone coaching? A rapid review. Australian Health Review, 37, doi: /ah Centers for Disease Control and Prevention. (2016). Chronic Diseases: The Leading Cause of Death and Disability in the United States. Retrieved from 5. Centers for Disease Control and Prevention. (2015). Chronic Disease Prevention and Health Promotion. Retrieved from gov/chronicdisease/index.htm 6. Hutchison A.J., & Breckon, J.D. (2011). A review of telephone coaching services for people with long-term conditions. Journal of Telemedicine and Telecare, 17, doi: /jtt Dennis, S.M., Harris, M., Lloyd, J., Davies, G.P., Faruqi, N., & Zwar, N. (2013). Do people with existing chronic conditions benefit from telephone coaching? A rapid review. Australian Health Review, 37, doi: /ah Wayne, N., Perez, D.F., Kaplan, D.M., & Ritvo, P. (2015). Health coaching reduces HbA1c in type 2 diabetic patients from a lowersocioeconomic status community: A randomized controlled trial. Journal of Medical Internet Research, 17, e224. doi: /jmir Herzlinger, R.E. (2006). Why Innovation in Health Care is So Hard. Harvard Business Review. Retrieved from why-innovation-in-health-care-is-so-hard. 10. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, Atlanta, GA: U.S. Department of Health and Human Services; Centers for Disease Control and Prevention. (2014). Prediabetes: Could it be you? Infographic. Retrieved from gov/ diabetes/pubs/statsreport14/prediabetes-infographic.pdf. 12. Aguilar, K.M., Campbell, R.S., Fiester, A., Simpson, R.L., & Hertel, C. (2014). Bringing care home: How telemonitoring can expand population health management beyond the hospital. Nursing Administration Quarterly, 38, Cruz, J., Brooks, D., & Marques, A. (2014). Home telemonitoring in COPD: A systematic review of methodologies and patients adherence. International Journal of Medical Informatics, 83, Klonoff, D. C. (2007). Benefits and Limitations of Self-Monitoring of Blood Glucose. Journal of Diabetes Science and Technology (Online), 1(1), Blackwell, DL & Lucas, JW. Centers for Disease Control and Prevention. (2015). Summary Health Statistics: National Health Survey, Tables of Summary Health Statistics for U.S. Adults: 2014 National Health Interview Survey. Available from: nhis/shs/tables.htm. 16. Centers for Disease Control and Prevention. (2015). Chronic Disease Prevention and Health Promotion. Retrieved from gov/chronicdisease/index.htm 17. Frommelt, A. & Schoonover, A. (2013). Emerging Technologies and Principles to Avoid Unnecessary Admission and Readmissions in a Medicaid Population. As Presented to the 2013 AHIMA Convention and Exhibit. Atlanta, GA. 10

11 About Envolve PeopleCare Envolve PeopleCare focuses on individual health management through education and empowerment. Through behavioral health, nurse triage, mhealth, and health, wellness and disease guidance programs, we help transform lives. Envolve is a family of health solutions, working together to make healthcare simpler, more effective and more accessible for everyone. As an agent for change in healthcare, we re committed to transforming the health of the community, one person at a time. Envolve represents one, integrated company with three main focus areas: Pharmacy Solutions, PeopleCare, and Benefit Options. Drug Benefit Management Acaria Specialty Drug Solutions Online Drug Management Tools Analytics and Clinical Consulting Home Delivery Services Digital Health Behavioral Health Health and Life Coaching Nurse Advice Line Care Gap Closure Services Foster Care Management Employee Assistance Program Vision Benefits Dental Benefits 11

12 Envolve, Inc. All rights reserved. MKT-WP-004 MKT-WP-001 February