1. Prepared for The National Medicaid Congress, June 6, 2006
New Opportunities for Disease Management and Care Coordination Programs in Medicaid
Sandeep Wadhwa, MD, MBA Vice President, Care Management Services McKesson Health Solutions Chair, Government Affairs Committee Disease Management Association of America
Prepared for The National Medicaid Congress, June 6, 2006

2. Cross-country tour of DM trends
Provider-centric
Medical home
Nurse advice link
During the presentation we’ll take a virtual tour from the West Coast to the East Coast to learn about innovative programs.
Medicaid has become an active purchaser of DM services. Each program is different and specific to the state and population that it serves.
Medical functions are carved out in each state, assuring that the DM program is unique.
Introduce map to attendees…the map is of medically underserved populations throughout the United States.
Key:
Yellow: Underserved population
Beige: Underserved area
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Map Source: Map is of Medically Underserved Populations/Areas
Map source: GeoData.gov; HRSA_Geospatial_Data_Warehouse

3. Rural populations have unique needs
The two western states are primarily rural; the PA program is in rural counties only; IL includes urban and rural areas.
Each state created a unique program to tackle the needs of the Medicaid population.
Discuss the needs and challenges of implementing a DM program in a rural area.
Map source:
Oregon, Montana, Pennsylvania: Underserved Populations

4. RN helps Oregon member follow doctor’s plan
“…$6 million in avoided costs is…only part of the story." Barney Speight, State Medicaid Director, Oregon
Rest of the story
Severe bronchitis causes Flynn’s Christmas Eve asthma attack
Nurse helps her follow through on doctor’s action plan. “It kept me from panicking, which in itself is enough.”
Bonnie Flynn participates in the Oregon DM program. Tualatin (Ore.) Times photo.
DHS has had a contract with McKesson Health Solutions since October 2002 to work with more than 11,000 asthma, diabetes and congestive heart failure patients covered by the Health Plan. Patients have access to a 24-hour toll-free phone line where they may consult with a registered nurse, and nurses also visit patients in their homes as needed.
"The $6 million in avoided costs is not only a highly conservative figure but it's also only part of the story," said Barney Speight, state Medicaid director at DHS. "We also saw patients doing a better job of managing their disease, making fewer visits to hospital emergency rooms and smoking less.
"There's no question that these patients' quality of life improved because they had more control over their chronic disease."

5. Montana takes strong approach
Must call a nurse first
Triage is disease management conduit
Team Care
High users of ED get medical home
Must call RN before seeing PCP
“Clients will continue to get the professional care they need, as well as training to help them learn that it’s not necessary to visit the emergency room to treat a cold.” Mary Angela Collins, Medicaid Managed Care Bureau Chief, Montana
Big Sky country….showing the rural side of the state. Mountains are metaphor for strength.
Nurse First program. Program participants must call a nurse prior to seeing a healthcare provider. In addition to normal program recruitment tactics, DM participants can be located through triage calls.
On August 1, 2004, a new care management and education program that targets people with a history of misusing the Montana Medicaid system began. The Team Care Program required a pre-identified group of Medicaid clients to enroll in the program and choose one primary care provider (PCP) and one pharmacy. All Team Care enrollees must also call a nurse advice line before accessing health care (even from their PCP), except in emergent care situations. Team Care clients will continue to receive the professional care they need, and a team to help them decide how, when, and where to access care.
“Team Care is about helping these clients get the right care at the right time at the right place,” said Mary Angela Collins, Medicaid Managed Care Bureau Chief. “Clients will continue to get the professional care they need, as well as training to help them learn that it’s not necessary to visit the emergency room to treat a cold.”
Team Care is a pilot program and begins with an initial group of nearly 100 enrollees, which will expand to 300 by the end of the summer. Team Care clients are identified for enrollment by claims data analysis, DUR (Drug Utilization Review), or by medical health professional referrals. After one year, clients will either remain in the program or “graduate” back into standard Medicaid.

6. Providers central to Pennsylvania program
Pay-for-Participation
Primary care case management
169,000 children and 95,000 Medicaid beneficiaries
42 rural counties
Helps beneficiaries locate a medical home.
Asthma, Diabetes, COPD, Coronary Artery Disease and Heart Failure Programs.
Began enrolling participants on March 1, 2005.
Involvement of professional medical associations, community and advocacy organizations.
Map source:

7. Discussion and questions
Thank you.
Sandeep Wadhwa, MD, MBA
Vice President, Care Management Services, McKesson Health Solutions
Chair, Government Affairs Committee and Board Member, Disease Management Association of America