1. 1 Managing Chronic Illness in a Medicaid Population ~ The Indiana Chronic Disease Management Program December 2, 2004

2. 2 Chronic Disease Objectives –Provide consistently high quality care to Medicaid recipients that improves health status, enhances quality of life and teaches self management skills. –Reduce the overall cost of providing health care to Medicaid patients suffering from chronic diseases. –Provide support to primary care providers and integrate primary care with case management. –Utilize and strengthen the public health infrastructure. –Achieve long term results by changing the way primary care is delivered across the state, not just for Medicaid.

3. 3 MakeMake –Develop “in house”, typically as part of Primary Care Case Management (PCCM) program BuyBuy –Outsource to commercial vendor –Purchase chronic illness software system AssembleAssemble –Hybrid approach –State may purchase key components but state retains control of the program State Options: Make, Buy, Assemble

4. 4 One Stop Shopping (Commercial DM vendor)One Stop Shopping (Commercial DM vendor) “ Guaranteed” savings“ Guaranteed” savings Difficult to negotiate risk for Medicaid populationDifficult to negotiate risk for Medicaid population Jobs & revenue associated with running the program go out of stateJobs & revenue associated with running the program go out of state Focus tends to be on telephonic case managementFocus tends to be on telephonic case management Little or no local input/experienceLittle or no local input/experience Difficulties interacting with claims systems, makes reporting duplicativeDifficulties interacting with claims systems, makes reporting duplicative Advantages/Disadvantages: Buy

5. 5 Allows for local input and experienceAllows for local input and experience Focus is on provider/patient relationshipFocus is on provider/patient relationship Keeps revenues and jobs in stateKeeps revenues and jobs in state Creates a comprehensive, sustainable locally based infrastructure with effective case management in place to support primary care providers and Medicaid membersCreates a comprehensive, sustainable locally based infrastructure with effective case management in place to support primary care providers and Medicaid members Requires significant state resourcesRequires significant state resources State retains financial riskState retains financial risk TimeTime Advantages/Disadvantages: Make/Assemble

6. 6 Indiana Approach: Assemble Why?Why? –NGA Chronic Disease Policy Academy –Strong Department of Health Leadership –Interested & Dedicated Local Partners –Change the way care is delivered statewide Chronic Care ModelChronic Care Model –Ed Wagner & Team of National Experts (MacColl Institute, Institute for Healthcare Improvement) –Evidence based interventions with proven results –Promotes patient self management –Carries over to improve care for all patients in a practice

7. 7 Creates a comprehensive, sustainable community based infrastructureCreates a comprehensive, sustainable community based infrastructure Connects care management & primary careConnects care management & primary care The ICDMP infrastructure supports chronic care, quality improvement efforts statewide –The ICDMP infrastructure supports chronic care, quality improvement efforts statewide – for all patients, providers, payers and disease states Indiana Chronic Disease Management Program Key Principles

8. 8 Program Management.Program Management. Medicaid and Health are jointly responsible for the program including policy development, contracting and monitoring performance. Primary Care.Primary Care. The focal point of patient care is the primary care physician. Key elements of the Indiana CDM program are designed to provide information & resources to support the physician. Care Management.Care Management. Care management is comprised of: – –A Call Center that monitors patient status and follow-up based on the established protocols. – –A Nurse Care Manager network whose nurses provide more intense follow up and support to high risk patients. Patient Data Registry.Patient Data Registry. An electronic data registry is available to physicians and can be used for all patients. For Medicaid patients, it is populated with claims data and case management data. Measurement & Evaluation.Measurement & Evaluation. Measures of program performance are being established using both claims history data and individual health outcomes indicators for both an intervention & control group. Main Program Components

9. 9 Program Components: Client Flow Community Resources Self Management Training Nurse Case Management 15 - 20% of Patients Web-Based Patient Registry Chronic Care Model Collaborative Training Decision Support Call Center 80 - 85% of Patients Patient Provider Measurement & Evaluation: Randomized Controlled Trial & Overall Statewide Evaluation

10. 10 ICDMP Status Disease States:Disease States: –Current: Diabetes, Congestive Heart Failure, Asthma –Future: Stroke/Hypertension, HIV/AIDS Implementation: Phased In StatewideImplementation: Phased In Statewide Evidence Based Guidelines: Statewide DisseminationEvidence Based Guidelines: Statewide Dissemination Chronic Care Collaboratives: 3 Regional CollaborativesChronic Care Collaboratives: 3 Regional Collaboratives Measurement & EvaluationMeasurement & Evaluation –Monthly reporting – sample mandatory measures: –Design & implementation of randomized controlled trial

11. 11 Percent of patients achieving: August ’03 June ‘04 HbA1c < 828.7%59%HbA1c < 828.7%59% Self Management Goals 36.8%57.2%Self Management Goals 36.8%57.2% Blood Pressure <130/80 20.6%28%Blood Pressure <130/80 20.6%28% ICDMP Accomplishments To Date

12. 12 Challenges & Lessons Learned Provider buy-inProvider buy-in Incentives: providers, recipients, partners/vendorsIncentives: providers, recipients, partners/vendors Integration with Managed Care Organizations (MCOs)Integration with Managed Care Organizations (MCOs) DataData –Administrative vs. Clinical –Entry & Reporting Cost savings / Return on InvestmentCost savings / Return on Investment Medicare Modernization Act – Part DMedicare Modernization Act – Part D

13. 13 Critical Success Factors NGA Policy Academy & ResourcesNGA Policy Academy & Resources Technical Assistance from National ExpertsTechnical Assistance from National Experts (MacColl Institute, Institute for Healthcare Improvement, Center for Health Care Strategies, National Initiative for Children’s Healthcare Quality) Chronic Care Model FoundationChronic Care Model Foundation Integration of Health & MedicaidIntegration of Health & Medicaid Legislative SupportLegislative Support CMS SupportCMS Support Long Term View…..short term investmentLong Term View…..short term investment

14. 14 ICDMP Resources For More Information, such as Provider Toolkit & GuidelinesProvider Toolkit & Guidelines Patient Self Management & EducationPatient Self Management & Education Training MaterialsTraining Materials http://www.indianacdmprogram.com/ http://www.indianacdmprogram.com/http://www.indianacdmprogram.com/