Population Health Management

CHA Health (CHA) is a provider-owned managed care plan serving a predominantly rural membership in Kentucky. Quality Oncology, Inc. is a national disease management company specializing in cancer care. This paper reports the results over the first 2 years of a cancer disease management program installed at CHA. The authors also review the evidence-based health services research that has guided the development and implementation of the program. The authors conclude that cancer is a disease state where specialized management can improve efficiency, treatment effectiveness, patient coordination, and outcomes reporting.

Decision-makers in health plans, large medical groups, and self-insured employers face many challenges in selecting and implementing disease management programs. One strategy is the "buy" approach, utilizing one or more of the many vendors to provide disease management services for the purchasing organization. As a relatively new field, the disease management vendor landscape is continually changing, uncovering the many uncertainties about demonstrating outcomes, corporate stability, or successful business models. Given the large investment an organization may make in each disease management program (many cost$1 million or more in annual fees for a moderately sized population), careful consideration must be given in selecting a disease management partner. This paper describes, in detail, the specific steps necessary and the issues to consider in achieving a successful contract with a vendor for full-service disease management.

The prevalence of patients with cancer histories and types of cancers prevailing among a cohort of adults with end-stage hip osteoarthritis was established in order to determine if this group might require some form of enriched pre- and postoperative rehabilitation in view of their adverse medical history. Body weights and selected physical capacity indicators were specifically compared among hip surgical patients with and without cancer histories to specify characteristics that could direct potentially desirable and improved intervention efforts. The medical records of 1,000 hip osteoarthritis surgical candidates were scrutinized, and numbers with and without malignancy histories were recorded. Malignancy typologies and selected body mass and physical capacity indices were recorded. Specific subgroup comparisons among these variables were then made for 40 cancer survivors and an age- and gender-matched subgroup of 40 otherwise healthy osteoarthritis patients, and for selected breast, prostate, and colon cancer survivors. (1) Fourteen percent of the present patient group had a cancer history. (2) The most common malignancy noted was breast cancer, followed by prostate and then colon cancer. (3) Among subjects matched for age and gender, 85% with a cancer history were overweight or obese, compared with 60% of those with no comorbid disease history. (4) Patients with cancer histories were more impaired immediately before, and after, surgery than patients with no cancer history. (5) Patients with breast and colon cancer histories had significantly slower recovery rates after hip surgery than those with a prostate cancer history (p < 0.05). Thus, breast, prostate, and colon cancer survivors constitute a modest proportion of patients undergoing surgery for painful disabling hip osteoarthritis. As a subgroup, cancer survivors, especially breast cancer survivors, are overweight, and more impaired before and after surgery than adults of the same age without a cancer history undergoing hip surgery.

The societal and economic impact of asthma is a well-documented phenomenon in this country. Despite improved knowledge and techniques of care, there have been signs of worsening morbidity/mortality and a seeming disconnect between physician and patients as regards communication of care strategies. In an attempt to fashion innovative educational strategies to enhance primary care physician (PCP) and caregiver efficiencies in improving patient outcomes (clinical and financial), the "Preceptor" model of one-to-one PCP/asthma specialist has been developed. Review of utilization and prescribing data demonstrates a clear pattern of statistically significant cost improvement in the aggregate care setting, as well as improved appropriateness of use of proper asthma medications. Use of the "Preceptor" model of PCP learning is an effective and unique way to enhance both caregiver knowledge and improved care efficiency in asthma management.

This article describes how the resources in the Health Plan Employer and Data Information Set (HEDIS®; a registered trademark of the National Committee for Quality Assurance) Performance NAVIGATOR for Controlling High Blood Pressure (HEDIS NAVIGATOR) developed by Merck & Co., Inc. assist managed care organizations in understanding and encouraging the active involvement of their members in adhering to a treatment plan developed in partnership by physicians and patients. (HEDIS is a set of standardized performance measures that enable purchasers and consumers to make informed decisions regarding the quality of managed care organizations.) The discussion uses the Health Belief and Transtheoretical Models as a framework to better understand patient behavior change. Targeted strategies to facilitate adherence are also addressed. Examples of structured programs using nationally recommended guidelines and HEDIS NAVIGATOR resources are included to illustrate coordinated efforts to assist patients with high blood pressure adhere to their treatment plan and help managed care organizations improve patient outcomes and HEDIS scores.