Health Plans considering options for incorporating disease management programs must determine the best strategy for their organization. This workshop provides the information you need when building in or carving out, the best option and the tools to evaluate disease management vendors. Specifically participants learn how to: Determine if your organization should build an In-House Disease Management Program to Improve Outcomes and Reduce Health care Costs; Make t h e Business Case for Disease Management; Build your own disease management program; Financial and clinical strategies that drive improved quality; Select t h e Best Disease Management Partner for your Organization; What t h e contract s h ould like? 

State Medicaid programs are increasingly turning to disease management as a strategy to capture the benefits of coordinating care. Florida, Mississippi, North Carolina, Virginia, and Washington are among the few states with significant experience. Many are requesting more robust offerings from their Medicaid Managed Care Organizations. In this workshop, participants will learn to: Track and manage the care for transient populations; Implement successful outreach programs for the rural poor; Implement cultural competency and successful communication strategies; Partner with community health care facilities to improve effectiveness and reach more members

Without the signals that result from face-to-face interaction, DM nurses working in a call center environment must rely on the unique application of behavior change strategies and techniques to positively influence patient behavior. To successfully apply these techniques, DM organizations must provide nurses with practical, hands-on training that emphasizes listening skills and encourages regular feedback from internal coaches. More than a one-time training session, these tactics require a fundamental change in organizational culture toward a more collaborative atmosphere that utilizes technology and measurement tools to promote behavior change and drive sustainable outcomes. This session will provide: An overview of a recent 14-week pilot project conducted by HMC and a leading national behavior change expert, Karen Ingersoll, PhD; Outline steps for achieving this culture change within a DM organization; Analyze the impact of this culture on patient outcomes through the results of the study. Participants will learn: How to successfully integrate various behavior skills and techniques within a call center environment; How to measure the incremental impact of behavioral change strategies and techniques on clinical outcomes; How to implement feedback tools and programs that support staff training and development on a daily basis  
    

Health plans, hospitals, and government agencies are aggressively implementing pay for performance programs across the nation.  In this session expert panelists discuss: National trends - Pay for performance program currently in place; Success and failure of different models; Programs with measurable results – Are there any? If not, why?;  Effective integration with disease management initiatives
      

This session will review the fundamentals of pay for performance, including the history, the current state of the programs in place and the relevance to disease management. Then it will examine the legal, regulatory and policy issues that arise in connection with implementing pay-for-performance programs for chronic care management. How you create an incentive based performance structure; Maximizing the potential of disease registries; Risk stratifying patients; Applications in the public and private sector; Using quality based incentives for paying your providers for outcomes in disease management; Why are such programs being designed?; What are the design options and pitfalls for commercial and government contracting?; How should disease management contractors seek to be protected from a legal perspective?; This session will explore recent developments and trends, as well as provide practical advice on those participating in these programs

The industry has responded to recent reports questioning the economic value of Disease Management by shifting focus from measurable financial savings to the less tangible rewards of Disease Management including improved quality of life, quality of care, provider integration, increased self-management, and uniform implementation of best practices. While it is clear that all of these results are integral to improving overall health and controlling increasing healthcare cost, Health Plan financial management still want to know what the financial value of dm is. In this point counter point discussion you hear the differences and similarities in one plan’s financial and clinical perspectives.
      

The United States spent $75 billion in 2003 to treat obesity and related conditions, according to the Centers for Disease Control, which estimates that one-third of Americans are obese and another third are overweight. Obesity also contributes to other high-cost chronic diseases, including diabetes, cardiovascular disease and cancer. As the prevalence of obesity and related conditions and their associated medical costs continues to grow, employers and other purchasers are looking for ways to help enrollees more effectively manage their weight. In this session panelists discuss: Developing a weight management health education program using internal resources; Utilizing prevention programs and telephonic case management · Lessons learned in building this program, including how to identify potential candidates and find needed data; Measuring success, including projected return on investment
          

In order to ensure that depressed patients get effective treatment, disease management programs typically seek to ensure that evidence-based practices are utilized. This may be a necessary step, but it is hardly sufficient for ensuring good clinical outcomes. The most relevant "evidence" that the DM program should be monitoring is the actual clinical outcomes being produced while treatment is in progress. Outcomes management is often the weakest part of any treatment program. Outcomes programs are often well-intended silos that exist alongside a clinical delivery system, largely ignored by treating clinicians. Data may be collected, but they have no impact on care as it is being delivered. How clinical outcomes in real world practice compare to outcomes in well-controlled research settings · The high degree of variability in outcomes by clinician; How outcomes management includes important risk management functions; How real time feedback to clinicians can prevent clinical errors       

Examine the unique challenges of an aged, blind and disabled population. Explore the collaboration efforts between a MCO and disease management partner. Review the reconciliation process and results of a successful COPD program. 

ConnectiCare has achieved successful clinical and financial outcomes through the development of an integrated disease management program. The Insulin Sooner program was launched to educate physicians who were treating patients with elevated HbA1c levels not begin controlled using multiple oral hypoglycemic. Physicians identified were invited to an educational program and discussion group. The second session featured the tracking and reporting of patient improvement measured after the first session intervention. In this session participant learn how to: Collaborate with commercial partner and secure program support · Strategies for using pharmacy claims data to identify patients at risk; Work with physicians to improve care management; Design a patient panel report for physicians and construct a prescriber intervention program; Measure and report on outcomes to ensure the continued success of the program
      

Depression is one of the most common health care cost drivers today. Medica through a unique partnership with its behavioral health network, United Behavioral Health, has developed and launched an innovative program to improve health and contain costs through depression disease management. The program focuses on treatment compliance, care coordination and education. This session will describe program development, lessons learned, and successful strategies. During the session the presenters discuss the three components of this disease management program: Telephonic support with a licensed behavioral health specialist; Face-to-face visits for members who are not able to be reached by telephone; Physician consultation phone line
      

Self-management of one’s chronic disease is a major tenet of disease management programs and a growing focus for health plans, employers, clinicians, and vendors. Companies large and small are coming out with new instruments for self-care, mobile care, and home care, all aimed at improving outcomes, giving patients greater sway over their conditions, or both. This presentation provides an overview and analysis of the emerging marketplace in self-management tools. Mike Barrett, author of the Forrester Research report Healthcare Unbound and now head of his own consulting firm, will address four key questions: What are the key trends and market segments in patient self-management technology? How will technology developments affect disease management programs? Where are we in the evolution of specific products, such as remote patient monitors? How will technological innovation influence the issue of Who pays?
      

Increasingly, disease management populations are located in multiple diverse locations across the country. DM programs must engage members are providers creatively in areas where health plan market share is limited and provider network relationships are less prevalent. This presentation presents results from several novel engagement strategies in a multi-million member DM/DS program with regional concentration and national scope. In this session Dr. Nash and Mr. Costello discuss strategies to: Overcome challenges in working with national disease management populations; Use member and provider input in the design of communication tools; Assess the effectiveness of novel outreach strategies in disease management