We Do Things Differently. Judith Frampton, RN, MBA Vice President, Medical Management December 3, 2008

Transcription

1 We Do Things Differently Judith Frampton, RN, MBA Vice President, Medical Management December 3, 2008

2 Joint ranking by U.S. News & World Report and National Committee for Quality Assurance Top-rated for Quality of Care and Member Satisfaction Source: Quality Compass 2004, 2005 and 2006 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass is a registered trademark of NCQA. NCQA is a private, non-profit organization dedicated to improving health care quality. America s Best Health Plans is a trademark of U.S.News & World Report Harvard Pilgrim Health Care

3 Why we do better even though it s s the same network? It s not the same members... The educated member, armed with the right questions, drives physician behavior Harvard Pilgrim Health Care

4 Diabetes Heart Failure Anticoagulation Management Harvard Pilgrim Health Care

5 Why we do better even though it s s the same network? It s not the same members... The educated member, armed with the right questions, drives physician behavior It s not the same tools... Patient-specific, actionable information for doctors gets results Harvard Pilgrim Health Care

6 Heart Failure Registry Name DOB Phone Harvard Pilgrim ID Number Place an X if patient does not have HF Charles Berwind (617) HPF X Drug Type Drug Name Date of Last Prescription # of Prescriptions ACE inhibitor ACCUPRIL 20 MG 8/30/ Anticoagulation Management Potential Drug Interaction - Warfarin/NSAIDs Dear Dr Primary Care Physician Harvard Pilgrim Health Care and its Pharmacy Benefits Place an X Manager, MedImpact, are working together to for Nurse communicate C omments patient-specific opportunities to improve the Educator Services quality of prescription medication use. The MedPreferred Program offers a convenient method for identifying opportunities for improvements and facilitating prescribing changes. Our records show patient HPF /11/1920, has recently filled a prescription for KenethA Min 11/06/1934 (617) HPF X anticoagulant therapy and now has a prescription written by Drug Type Drug Name Date of Last Prescription # of Prescriptions Diuretic FUROSEMIDE 40MG 7/12/ Dr. for a nonselective NSAID. ZAR OXOLYN 5MG 5/28/ Non-selective NSAIDs may increase the risk of Howard Krutt 3/28/1945 (617) HPF gastrointestinal and other bleeding complications because of antiplateleteffects and GI mucosal injury. Drug Type Drug Name Date of Last Prescription # of Prescriptions ACE Inhibitor LISINOPRIL 5 MG 5/15/ We recommend you consider discontinuing Digitalis DIGOXIN 125MG 1/11/ NSAID therapy and changing to an alternate Beta-blocker COR EG 6.25MG 4/9/ therapeutic regimen. For individual patients requiring therapy, options may include: Diabetes Registry Name DOB Phone Urine Microalbumin Creatinine Dilated Eye Exam (No referral needed for annual eye exam) LDL-C HbA1c Mark "X" if Not Diabetic John Doe 7/5/ xxx-xxxx 12/1/ /1/2006 Joseph Smith 12/28/ xxx-xxxx 5/13/2007 4/15/ /13/2006 Mary Brown 8/14/ xxx-xxxx 10/7/ /7/2006 Fred Cook 9/2/ xxx-xxxx 11/8/2006 Rose Wilson 2/4/ xxx-xxxx Jan Gold 4/7/ xxx-xxxx 4/17/2007 4/17/2007 James Gold 8/14/ xxx-xxxx 3/13/2007 5/24/2007 Peter Jones 11/5/ xxx-xxxx 12/4/2006 5/26/2007 5/26/2007 Susan Thomas 6/12/ xxx-xxxx 1/22/2007 Edward Kind 12/10/ xxx-xxxx 5/15/2007 5/15/2007 Robert Lawson 7/18/ xxx-xxxx 11/17/ /17/2006 Susan Glade 1/5/ xxx-xxxx Rebecca Stone 10/10/ xxx-xxxx 2/17/2007 2/17/2007 2/17/2007 Mark "X" for Case Mgmt. Services Harvard Pilgrim Health Care

7 Why we do better even though it s s the same network? It s not the same members... The educated member, armed with the right questions, drives physician behavior It s not the same tools... Patient-specific, actionable information for doctors gets results It s not the same priorities... Keep the clinical message short, sharp, and focused Harvard Pilgrim Health Care

8 It s not the same priorities... Aspirin use for diabetes Weight management for heart failure Long-term inhaler use for pediatric asthma Harvard Pilgrim Health Care

9 Why we do better even though it s s the same network? It s not the same members... The educated member, armed with the right questions, drives physician behavior It s not the same tools... Patient-specific, actionable information for doctors gets results It s not the same priorities... Keep the clinical message short, sharp, and focused Harvard Pilgrim Health Care

10 HPHC Inc Diabetes HEDIS Results Percent LDL Profile Eye Exam Poor HbA1c Control (lower is better) * Numbers in boxes = measures which were more difficult due to new criteria Harvard Pilgrim Health Care

11 HPHC Inc Asthma HEDIS Results Percent Meds Ages 5-9 Meds Ages Meds Ages Harvard Pilgrim Health Care

12 Medical Management Programs It s not one size fits all! End Stage Renal Disease High-Risk Cardiac Congestive Heart Failure Rare Diseases Your Care Champion High-Risk Pregnancy Predictive Modeling Health Advance High-Risk Oncology High-Risk Diabetes High-Risk Asthma High-Risk Anticoagulation Diabetes Asthma Breast Cancer Screening Cervical Cancer Screening Colorectal Cancer Screening Osteoporosis Coronary Artery Disease STD Screening Immunization ADHD December 1,

13 Return on Investment 1 2 YEARS 3-5 YEARS PLUS 10 YEARS PLUS End Stage Renal Disease High-Risk Cardiac Congestive Heart Failure Rare Diseases Your Care Champion High-Risk Pregnancy Predictive Modeling Health Advance High-Risk Oncology High-Risk Diabetes High-Risk Asthma High-Risk Anticoagulation Diabetes Asthma Breast Cancer Screening Cervical Cancer Screening Colorectal Cancer Screening Osteoporosis Coronary Artery Disease STD Screening Immunization ADHD December 1,

14 High Touch High Tech Cost Effective! Harvard Pilgrim Health Care

15 Interactive Speech Recognition Technology Advantages over traditional approaches: Very personalized and highly interactive Ability to collect information regarding member behavior Voice activation means no need to use the key pad Called ID boxes display Harvard Pilgrim Data provided is as reliable as during a clinical interview Bandwidth and scalability 2,000 or 50,000 calls at a time Osteoporosis Screening Reminder Call Comments Harvard Pilgrim Health Care

16 ...the most underutilized channel for outreach Harvard Pilgrim Health Care

17 Custom-designed programs for employers Free expert consultations Recommendations based on: Utilization Demographics Client Culture Productivity and Absenteeism Multiple Channels: On-site Mail Web Phone Video Teleconferencing Harvard Pilgrim Health Care

18 It s About The Way We Do Things!

19 Best disease management outcomes in the United States Health Industries Research Companies Health and Disease Management Service, Harvard Pilgrim Health Care

20