Tuesday, February 24, 2009

The Latest Population Health Management Journal Is Out!

Oh joy! Isn’t it great when you open your mailbox and find a goody like the latest issue of Population Health Management? Sure, you want to thumb through every page, ponder every word, examine every graph and review every citation but…. you don’t have time. But unlike your colleagues, you also regularly read the Disease Management Care Blog. That is your secret weapon. Scan the summaries below and then decide which needs to be read right away and which ones can wait. As an added bonus, the DMCB helps you impress your co-workers with your erudition by rustling up some key quotes. Use them to impress the boss at those upcoming conference calls and business planning meetings.

Dominick Esposite, Erin Taylor and Marsha Gold: Using qualitative and quantitative methods to evaluate small-scale disease management pilot programs.

Heard of the Medicaid Value Program? Neither did the DMCB, but this involved having 10 organizations use a variety of care interventions for Medicaid beneficiaries with multiple chronic conditions. Using a combination of qualitative and quantitative research, the authors found the implementation, competing priorities, provider buy-in and local leadership commitment to be the key ingredients associated with success. This is must reading if you’re going to use some of that Federal stimulus money to quickly rustle up a new Medicaid-based program.

Key quote you could use at an upcoming meeting “According to Esposito’s article in PHMJ, a smaller than expected number of eligible beneficiaries and lower than expected patient engagement rates are not uncommon.”

Iver Juster, Stephen Rosenberg, Deeptimayee Senapati and Mayur Shah: “Dial-an-ROI?” Changing basic variable impact cost trends in single population pre-post (“DMAA Type”) savings analysis.

In a prior post, the DCMB delighted in a review of chronic vs. non-chronic trends to derive what the cost of health care would have been absent a disease management program. If you think that’s simple, read this paper from a DM Jedi Master and his colleagues and find out just how complicated it can be and why, in the end, you’re going to need an actuary to ascertain whether you’re really reducing claims expense.

Key quote you could use at an upcoming meeting “According to Sensai Juster’s article in PHMJ, the length of the look-back period, the length of claims runout and the number of months of enrollment are important determinants of trend!”

Jason Cooper, Lakevia Hall, Angel Penland, Andrew Krueger and Jeanette May: Measuring medication adherence.

Read this and you’ll not only know the operational definition of medication adherence (the days supplied divided by the days prescribed) but how to handle claims runout and disenrollment when it comes to assessing whether a population is taking their meds. You’ll also get benchmark adherence rates in a commercial population (depending on the condition, mostly between 75% and 84% - bile acid sequestrants unsurprisingly are lower). Kudos to Accordant for making the data available.

Key quote you could use at an upcoming meeting “According to May’s article in the PHMJ, our medication adherence rates are already running at [insert ‘more’ or ‘less’] than what’s been reported in the literature!”

Kejian Niu, Liming Chen, Ying Liu and Herman Jenich: The relationship between chronic and non-chronic trends.

Sorry, but there’s no escaping this chronic and non-chronic trend stuff. In this paper, the authors stress-tested the DMAA methodology in a stable population without a disease management program and compared the chronic and non-chronic trends over time. It turns out the two were similar if there is satisfactory statistical adjustments and persons are annually requalified.

Key quote you could use at an upcoming meeting: “Good thing our actuarial consultants are using the DMAA methodology to assess the impact of our disease management program. According to Niu’s article in PHMJ, that approach has considerable merit!”

Thomas Kotsos, Keven Muldowney, Griselda Chapa, Eric Margin and Antonio Linares: Challenges and solutions in the evaluation of a low back pain disease management program.

This is even more evidence that the DMAA approach is taking root, since this article also relied on that methodology to assess a condition of great interest to employers. There appeared to be savings, but the subpopulation with simple mechanical low back pain apparently experienced an increase in claims expense. Everyone else experienced decreased utilization. One lesson may be to leave the simple back pain patients out of the program.

Key quote you could use at an upcoming meeting: “We’re already doing the top 5 chronic diseases, so let’s tackle a new one – like low back pain. Kostos in PHMJ showed that a telephonic nurse support intervention can make a difference!”

Al Lewis: How to measure the outcomes of chronic disease management.

Exhausted by all this high falutin actuarial stuff? The remarkably insightful father of disease management comes at the topic from another point of view by giving you 5 Important Questions that should always be asked when you are attempting to assess whether your disease management program is working.

Key quote you could use at an upcoming meeting: “You’re right of course, but how do we estimate the amount of co-morbidity reduction that has also taken place? According to Al Lewis (and everybody knows his name), that is a key question that must be addressed!”

And then there’s an editorial by … the DMCB. Called ‘Disease Management Grows Up,’ it points out that the sophistication of the literature above reflects an evaluation-science sea change underway in the disease management industry. In fact, the growing sophistication of measurement in population-based programs could well turn out to be the benchmark for other healthcare reform initiatives, including the patient centered medical home.

Key quote here: ‘Gosh, if the company I work for isn’t a member of DMAA, we should join. Not only would we get the PHMJ, we could get involved in future iterations of how to measure outcomes in population care management programs!’

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