Strengthening partnerships: A National Voluntary Health Agency’s initiatives in managed care Sarah L. Sampsel, MPH* Lisa M. Carlson, MPH, CHES* Michele L. Boutaugh, MPH, BSN* * Arthritis Foundation

The Burden of Chronic Conditions According to the November 13, 1996, issue of the Journal of the American Medical Association (JAMA), researchers estimated that by 1995, the number of people living with chronic conditions reached 100 million.

The Burden of Arthritis The clinical and economic burden of arthritis is greater than many other diseases, including asthma, diabetes and AIDS. US Department of Health and Human Services, National Center for Health Statistics; Arthritis Foundation website More People More Dollars

Economic Impact Arthritis and musculoskeletal conditions account for 13% of all health care spending 315 million physician visits per year 8,000,000 hospitalizations 1.5 billion days of restricted activity per year #1 most common reason for doctor visits #2 most common reason for hospitalization #4 most common reason for surgery Healthy People 2010; Yelin, Callahan. Arthritis Rheum; 38:

Incentives for working with managed care organizations National Arthritis Action Plan (NAAP): A Public Health Strategy –Modify health care systems –Develop arthritis performance indicators –Ensure adequate numbers of primary care and specialty providers –Educate the healthcare system about the true costs of arthritis –Build self-management education into routine arthritis care

Healthy People 2010 Arthritis and Other Rheumatic Conditions –Increase proportion of persons with arthritis who have had effective, evidence-based arthritis education as an integral part of the management of their condition –Increase employment rate among adults with arthritis in the working age population –Increase proportion of adults who have seen a health care provider for their chronic joint symptoms

Arthritis Foundation Goals Create incentive for health system change Foster collaborations among the Arthritis Foundation and managed care organizations Advocate for quality care measures for consumers

Strategies at the National Level Clinical improvement in arthritis care: a public health strategy Foster collaborations to provide appropriate education Collaborate to support a Medicare benefit for evidence-based self-management programs Arthritis indicators: performance measurement

Clinical Improvements in Arthritis Care –In collaboration with Improving Chronic Illness Care (Group Health Cooperative of Puget Sound) and CDC –The Chronic Care Model emphasizes productive interactions between informed, activated patients and prepared provider teams to improve patient outcome –Implementation of system changes in pilot system or alpha test site –Ability to identify a population of arthritis patients within a clinic or health plan population

Arthritis Care Change Concepts Immediate Action by PCP Appropriate diagnostic testing Routine assessments; linked to action –Pain, disability, well being, physical activity, endurance Self management

Arthritis Performance Indicators Goal: Development of a uniform set of arthritis indicators for performance measurement systems (e.g. HEDIS) Activities: Partnership with RAND and UAB to marshal evidence Consensus Meeting of experts to determine state of the evidence Development and implementation of performance indicators to improve care

The development and implementation of performance indicators for chronic condition care will result in: Turning Up the Volume Results in attention and interest in specific chronic conditions by the key organizations What gets measured, gets done…..

Local Success Stories ChapterManaged Care Activities VirginiaStep-up to manage arthritis care: arthritis education curriculum for managed care professionals CaliforniaDevelopment of JointHealth program for Medicare + Choice members FloridaEducation of case management/health services staff on burden and resources New YorkPartnering with health plans to provide and promote arthritis self-management programs OhioMulti-chapter partnership with MCO to provide ASHC to Medicare + Choice members

Benefits of working with a Voluntary Health Agency The voluntary health agency (vha) can provide assistance in understanding and identifying risks associated with the disease Programs and information can empower patients to manage their health and wellness The vha, as an expert, can assist with disease management and referral guidelines

Benefits, continued… Working with a voluntary health agency can: –Save the time, money and effort that would be required to develop initiatives –Cut overall health-care costs by targeting high-risk or high-utilization patients for education and/or intervention –Reduce the number of physician visits and use of medication –Serve as a model for management of other chronic diseases

Benefits, continued… Improve patient/member satisfaction: –Increased self-management behavior assists patients in feeling more control of disease –Increased ability to communicate symptoms, treatment success and other vital information –Improved health outcomes

Action Steps Expand efforts to educate stakeholders about the impact of the chronic condition Work with professional organizations to stimulate research about and to develop economic models of the natural history and costs of treatment Help health care systems identify their direct and indirect costs Identify key indicators of quality arthritis care Ensure wide adoption of standardized arthritis quality improvement measures Encourage the development of proactive advocacy initiatives regarding access and quality of care issues

Partnering with a voluntary health agency offers: Access to proven patient disease management programs Access to professional education resources for health care providers Increased ability to manage risk and control health care costs Improved patient and physician loyalty Key strategic market differentiation