Transcript Place Title Here - Healthcare Innovation Summit

Trusting Windmills:
Consumers, Innovation and the New World of Health Care
Dr. Charlotte S. Yeh, MD
Chief Medical Officer, AARP Services, Inc.
May 14, 2014
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
LEARNING OBJECTIVES

Identify ways to embrace change and use it to succeed in this new healthcare
environment

Develop new and creative ways to involve consumers in the adoption of
disruptive innovations

Discuss inspirational ways of providing care to an older population that can
be adapted to any consumer group
A TIME OF CHANGE
“When the winds of change blow, some people build walls
and others build windmills.”
- Chinese Proverb
AARP: A LEGACY OF INNOVATION
AARP’s Founder,
Dr. Ethel Percy Andrus
THE NEED
 A program to help improve the
health care experience and
reduce health care costs of the
FFS Medigap population
 A program not dependent on
network, or provider payment
strategies
 A program that engages the FFS
population
BACKGROUND
 AARP and UnitedHealthcare have been working to
better understand the characteristics, needs and
general health of older adults.
 UHC is piloting health improvement initiatives with
the goal of enhancing care coordination and
delivery of services while maintaining costs and
high quality of care.
o Case Management, Disease Management,
Depression Management and Prescription
Drug Adherence programs.
o Programs* target people with chronic
illnesses living in high disease prevalence
areas in parts of five states NY, NC, OH, FL,
and CA.
o Began in early 2009 and continue today.
 Unique to the Medicare Supplement Health
Insurance Plan industry.
* AARP Medicare Supplement Plans, insured by UnitedHealthcare Insurance Company
CORE APPROACH
Rapid Test and Learn Model
1. Incubator Lab
•
•
•
Identify Core Impact Area(s)
Rapid iterative design, implementation and
pilot/test
Evaluation
2. Accelerator Lab
• Replicability
• Sustainability
• Scalability
3. Sharing Success
• Internal
• Peer-Reviewed Literature
• External
KEY PRINCIPLE
“If we are 100%
successful, we will
have failed”
INTEGRATED PILOT PROGRAMS
Chronic Illness/
High Risk Case Management (HRCM)
Disease Management
Helping individuals afflicted with select
chronic diseases reduce their risk of
disease progression, future catastrophic
events or deterioration
Helping people identified at high
predictive risk for catastrophic health
events or deterioration through on site
and telephonic case management
Integrated
Pilot Programs
Prescription Drug Adherence
Depression Management
Helping people in tandem with disease
management programs to comply with and
adhere to evidence based standards of
pharmaceutical care for their chronic
disease
Helping people, physicians, and other
caregivers identify depression, and to
access educational resources, referral
information, condition monitoring,
treatment adjustment, and relapse
prevention
RESULTS
 Satisfaction
From 2009-2011, 98% of members were either satisfied
or very satisfied with the pilot program.
 Engagement
Member months of engagement doubled from 20092010 and increased by 30% from 2010-2011
 Clinical Quality
The program had a positive impact on many quality
metrics
 Duration in the program was associated with
fewer readmissions
 Assessing Care of Vulnerable Elderly (ACOVE)
measures: 100% screened for falls (75% had no
additional falls), hearing loss, pain, and nutritional
status
 EBM metrics: Members were significantly more
likely (58%) to have recurring office visits and
recommended laboratory tests
TOTAL PROGRAM SAVINGS
The program ROI demonstrated savings over the first three years, and increased
year over year
ROI
Overall
2011
2010
2009
0
1
2
3
4
TOTAL PROGRAM SAVINGS
The total savings for the program was $8.3 million
Program Savings by Payer
INSIGHTS ON ENGAGEMENT
Engaged
 Saw themselves as “sick”
 Had less communication from their doctors
 Had less support at home
Not Engaged
 Saw themselves as “well”, and were less likely to
report symptoms of depression
 Could get answers from their doctors
 Felt comfortable managing their health for now
How is your health? 58%: “Better than others my age.”
“Living independently at home” vs. “managing my
health”
CONSUMER MODEL OF HEALTH CARE
“Living Well / Enjoy Life Every Day in Bite Size Pieces”
Healthy /
Independent
Episodic /
Intermittent
New LifeStyle
Change / Impact
Complex Needs
/ Support
“I can do this
myself”
“I am annoyed”
“uh oh… I am going
to have to change to
live the way I want”
“I need community
support”
FIRST ‘A-HA’: WE’VE MISSED THE
EMOTIONAL CONNECTION
SECOND ‘A-HA’: PROVIDE PATIENTS
WITH THE “HOW”
Real health care happens
at home
Care must be conceptualized
not merely as what you get
when you go to the doctor’s
office but also as the
decisions people make and
resources they have at home
– to stay healthy.
THIRD ‘A-HA’ – IT’S ABOUT THE
WHOLE PERSON
THIRD ‘A-HA’: JOURNEY TO CONSUMER
ENGAGEMENT
68 yr. old male – Caregiver for his wife
who is in Hospice due to multiple
myeloma. Married 43 years, has support
from children and step-children from
wife’s former marriage.
Bill
12/2
11/1
Recruitment Call.
Bill mentions wife is in
hospice care.
Bill notes he lost his wife the
prior week. Bill states he is
thankful she is no longer in pain.
Issues with stepchildren causing
anxiety.
Engagements
Continue
12/20
Stepson takes call
and requests nurse
to not call for one
month
Bill calls upset and crying.
Nurse does depression screen
and offers support on dealing
with his loss. Bill leaves call
thankful for someone to talk with.
4/4
9/23
2/18
Bill notes he lost his sister in law.
Bill shares his religious beliefs and
current bible study classes with his
son.
3/28
Bill is in ER for chest
pain, requests callback
Bill notes he spent
several days in
hospital due to chest
pain. Doctors believe
pain was due to stress.
Member expressed an
interest in receiving
home health care –
Nurse provided
assistance.
FINAL WORD
The future is here. Are you ready?
THANK YOU!!
Dr. Charlotte S. Yeh, MD
Chief Medical Officer
AARP Services, Inc.
(617) 650-6105
[email protected]