Transcript Slide 1

What are Commercial Health Plans Doing
To Improve Behavioral Health Care Quality?
Doug Nemecek, MD, MBA
Senior Medical Director
September 28, 2010
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Best Practices in Health Plan
Behavioral Health Programs
 Evidence-Based Approach
 Integrated Data - Medical, Pharmacy, Behavioral
 Open Access
 Education and Support for Patients and Families
 Collaborate with Health Care Professionals
 24/7/365 Telephonic Support
 Improve Health
 Increase Productivity
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Screening
 Depression Screening
• Lifestyle Management
programs, Health Coaching,
Disease Management
programs, Case Management
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Low Back Pain
COPD
Renal Disease
Migraines
Diabetes
Fibromyalgia
Pregnancy
HIV
Cancer
And More
 Alcohol Screening
• Lifestyle Management
programs, Health Coaching,
Disease Management
programs, Case Management
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Low Back Pain
COPD
Pancreatitis
Osteoarthritis
Pregnancy
Pneumonia
Hepatitis C
Heart Failure
Cancer
And More
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Clinical Screening Toolkit
Health Benefit carriers, employer groups, and epidemiologists increasingly recommend the use of validated screening
instruments to identify individuals with undiagnosed disorders, to monitor ongoing symptom severity, and to assess
outcomes in clinical practice. Where necessary, CIGNA Behavioral Health has obtained permission from copyright
holders for use and distribution, and supports clinical excellence by making the following validated instruments available
for these purposes:
Instrument:
Patient Health Questionnaire - 9 (PHQ-9)
Patient Health Questionnaire - 15 (PHQ-15)
Patient Health Questionnaire - Brief (PHQ-Brief)
Alcohol Use Disorders Identification Test
(AUDIT)
Alcohol Use Disorders Identification Test - "C"
(AUDIT-C)
Description:
Links:
Self-report instrument: 9 depression symptoms
scored on scale and one additional question on
functional impairment to screen and monitor
depression symptom severity.
Tool
Self-report instrument: 15 somatic symptoms
scored on a scale to screen and monitor for
somatic symptom severity. Derived from the
PRIME-MD diagnostic instrument for common
mental disorders.
Tool
Self-report instrument: 8 questions scored on
scale and one additional question on functional
impairment. Identifies depression and panic
disorder while providing measurement of recent
psycho-stress and functionality, including some
gender-specific sources of stress.
Tool
Self-report instrument: 10-items identify and
monitor adult alcohol consumption that is
harmful or hazardous to their health.
Tool
Brief version of AUDIT is AUDIT-C, which uses
the first three questions from the AUDIT.
Tool
Instructions For Use
Instructions For Use
Instructions For Use
Instructions For Use
Instructions For Use
STABLE resource toolkit
For the screening, assessment, monitoring, and
education for persons with depression and
bipolar disorder.
Tools and Instructions for Use
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Proactive Identification
For individuals that take the Patient Health
Assessment
Self-Reported risks targeted for outreach:
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Stress
Drug Use
Alcohol
Life Satisfaction
Job Satisfaction
Absence
Telephonic outreach will also occur for Stress or
Alcohol if individual is ranked ‘high’ in intervention
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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The Depression Program - Member Support
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Identification
• Review of claims and referrals
• Focus on those treated by PCP or OB/GYN
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Opt-out approach
• Individual “in” unless opts out
• Mail-only option – but can call coach at any time
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Member Stratification
• Level 1: Low Risk
• Letter with phone number for individual coaching
• Level 2: High Risk
• Call to introduce program and schedule first “coaching call”
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Standard assessments to create personalized plan
• PHQ-9, PHQ-15,
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Alcohol screening and referrals
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Personal coach assigned, plan developed
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Intensive Case Management
 Focus on patients with complex clinical conditions and at the
highest risk for hospital admission and re-admission
• readmission within 180 days
• opiate use/abuse
• chronic pain
• psychotic disorder, first admission
 Dedicated care manager
 Assistance with appointment reminders
 Coordination with medical and behavioral providers
 Education and empowerment
 Identification of community and other resources
 Regular telephone contacts with patients, family members
and treating providers
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Health Plan Behavioral Health Website
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Employer-specific logon
• Product customization, co-branding
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Provider directory and web referrals
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20-question well-being evaluation
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Health management resources
• Coaching, audio seminars, articles, self-assessments
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Healthy Rewards® discount program
• Eye care, hearing care, online drugstores, fitness clubs
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My Reminders
• online tool allows you to set up recurring reminders that will be e-mailed to you
• Appointment reminder tool
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Depression Online Tool
• Secure, convenient support at no cost
• Information about depression and how to overcome it
• Articles on topics like building your support team
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Self-Assessment
• designed to help gauge the current state of your behavioral health, give a snapshot of your
emotional, social outlook, your stress level and general well-being
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Online Provider Directory
CIGNA
privileges
providers
across 14
clinical
specialties
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Multicultural Network Improvements
Opportunity
2007 Winner: NCQA Innovation in Multicultural Health Care
Award
 Increase cultural and language
support for diverse members
Fewer than 1 in 11 Hispanic Americans with a mental
disorder contact a mental health specialist
Action
Ethnic Health Providers Added to
Behavioral Network
Collected voluntary information
from practitioners such as gender,
1,200
ethnicity and language spoken
Result
 Almost 50% increase from those responding
most favorably when asked how well their
practitioner met their cultural, linguistic, or
specialty needs
 50% increase in behavioral network
practitioners with diversity of race/ethnicity,
languages spoken, religion and sexual
orientation
Number Practitioners
1,000
800
600
400
200
0
2001
2002
Hispanic
Impact
2003
2004
2005
2006
Asian/Pac Isl
African Amer
Native Amer
Other
 Achieved significant increases in satisfaction
and access for minority patients
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Treating Behavioral Conditions – Practitioner Support
Behavioral conditions often present in Primary Care settings. The following links and
resources are intended to support Primary Care Physicians in assessing, treating, and/or
referring commonly seen behavioral problems. CIGNA encourages collaboration between
behavioral and medical settings and the coordination of behavioral health and medical
care.
Depression:
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Printable Depression Practice Guidelines
Participant Tool Kit
Practitioner Tool Kit
Bipolar Disorder:
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Printable Bipolar Disorder Practice Guidelines
Participant Tool Kit
Practitioner Tool Kit
ADHD:
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Printable ADHD Practice Guidelines
Participant Tool Kit
Practitioner Tool Kit
Alcohol and Other Drug Abuse:
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Guide to Helping People Who Drink Too Much
Participant Tool Kit
Practitioner Tool Kit
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Performance Results
6  Spotlight at CIGNA Behavioral Health Project Highlights:
 Reducing Readmissions
• Those in Intensive Care Management have shown a significant reduction in
readmissions, increase in medication adherence, and a healthcare cost reduction of
$3,000 per member.
 Call Center Redesign
• Decrease Customer Service and Personal Advocate call transfers 40% (from 4,0006,000/month to 3,000; $4/call)
 Improving Alcohol/Drug Treatment Engagement
• Improve HEDIS Initiation and Engagement measures, adding to CIGNA value
equation
• Initial improvement in treatment initiation from 35.9% to 47.0%.
 Enhancing the Privacy Culture
• Improve employee awareness and compliance as indicated by audit scores; posttraining audit is indicating a 25% improvement.
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Intensive Case Management 6-Sigma Study
Increase in medication compliance
Reduction in inpatient admissions
and readmissions
Emergency room visits decreased
Overall medical and behavioral
health outpatient costs
remained controlled
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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ICM - Improvement Overview
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Increased the inpatient referrals from 15% to 30% with a statistically
significant improvement (P Value= 0.000)
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The reach rate in 2009 compared to 2008 did not achieve statistical
significance, but the volume improved considerably- 1400 were reached in
2008, while 2393 individuals were reached in 2009.
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Completion of the Program improved from 17% to 25% (P Value= 0.000)
 Engagement Rate: In 2008, the results were 36% and after our interventions
in 2009 the results were 54%, a statistically significant improvement (pvalue=0.000).
 The 30-day readmission rate for engaged individuals was 6.0%, as
compared to the non-engaged population of 8.2 % (P-Value = 0.008).
 Costs savings, from 2008 to 2009 for the engagement readmission rate was
estimated at $1,068,694.
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Clinical Integration: Behavioral & Pharmacy
Complex
Psychiatric
Case Management
Clinical algorithms screen for prescriptions in multiple therapeutic
classes of psychotropic medications & multiple medications in a
class. A six-month study revealed:
 $0.15PMPM savings
 18% reduction in medical and pharmacy costs
OxyContin ®
Management
Program
Pharmacy claims help identify patterns of drug use that are of
concern. First year results:
 $2.5 million savings
 3,900 members identified & outreached
 Year-over-year dosage reductions
Antidepressant
Improvement
Outcome Program
Helps providers identify members needing closer depression
medication monitoring. 3 year improvements:
 One-time fill rate decrease from 16.10% to 15.3%
 Medication compliance improved from 48.22% to 54.3%
Narcotics
Therapy
Management
Provider-based initiative identifying members with six or more
narcotic analgesics prescriptions.
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Outcome Measures – Bipolar Disorder Improvements
 The annual outcome goal:
• Medication Persistence Rate
• 2007 Baseline:48%,
• Current measure: 2009 58%
 Monthly goals:
• Medication Adherence rate: 80% to 84%
• Letters to Prescribers: 59.5% to 45%
• Outreach to Individuals: 12% to 38%
 Admission Rates:
• There is a 15.15 % drop in bipolar admissions between the baseline
year of 2007 and the intervention year of 2009
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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Improving Behavioral Health Care Quality
Questions?
Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2008 CIGNA.
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