Stretching Scarce Resources: State Strategies to Design Effective, Affordable Benefit Packages Autumn Dawn Galbreath, M.D. Director University of Texas Disease Management Center

Introduction to Disease Management (DM) Systematic, population-based approach –Identifies people at risk –Intervenes –Measures outcomes

Important Characteristics Best practices throughout the entire continuum of care Clinical guidelines Reduced cost Improvement of measurable outcomes in the quality of care

“Management Soup” Case Management High-Cost Case Management Disease Management Population Management Managed Care

Does It Work? The “literature is now replete with titles in DM, quality improvement, and clinical practice improvement, but…there is not much evidence that {these}…improve efficiency in the care process for the disease.” 9 9 – Curtiss F. Lessons learned from projects in disease management in ambulatory care. Am J Health-Syst Pharm 1997;54:

Summary of the Literature 24 trials previously published, only 8 of which are randomized and controlled CHF: 8 trials Diabetes: 3 trials Asthma: 1 trial Coronary artery disease: 1 trial General primary care/postdischarge care: 5 trials

Remaining Questions Is DM truly cost-effective in a heterogeneous patient population with a forthcoming and straightforward analysis of the economic data? Does DM improve clinical outcomes? Does DM improve subjective outcomes such as quality of life and patient satisfaction? Does DM improve provider satisfaction with the care they are able to provide? Is DM better administered in a face-to-face clinic setting or telephonically?

South Texas CHF Demonstration Project Target enrollment: 1200 patients Target population: Veterans, Military, Medicare, Medicaid, and indigent patients Time of Enrollment: 18 months

Disease Selection High volume High cost Variation in management Propensity for acute decompensation

Barriers to DM Acute care model of the current health care system Lack of integrated information systems Lack of provider support Limited resources Danger of fragmentation of care

Lessons Learned Provider Buy-In Start-Up Costs and Savings Realization “Don’t promise what you can’t deliver”

For additional information, contact: Autumn Dawn Galbreath, MD Director University of Texas Disease Management Center 4243 Piedras Drive East #240 San Antonio, Texas (210) (office) (210) (pager)

Disease Management in Uninsured Populations Florida Medicaid Disease Management Initiative Virginia Health Outcomes Partnership Easy Breathing (Hartford, CN) National Jewish Asthma Disease Management Pilots