Trusting Windmills: Consumers, Innovation and the New World of Health Care

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 peoplebuild 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 Medigappopulation • A program not dependent on network, or provider payment strategies • A program that engages the FFS population

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. • Case Management, Disease Management, Depression Management and Prescription Drug Adherence programs. • Programs* target people with chronic illnesses living in high disease prevalence areas in parts of five states NY, NC, OH, FL, and CA. • Began in early 2009 and continue today. • Unique to the Medicare Supplement Health Insurance Plan industry. BACKGROUND * AARP Medicare Supplement Plans, insured by UnitedHealthcare Insurance Company

CORE APPROACHRapid Test and Learn Model • Incubator Lab • Identify Core Impact Area(s) • Rapid iterative design, implementation and pilot/test • Evaluation • Accelerator Lab • Replicability • Sustainability • Scalability • Sharing Success • Internal • Peer-Reviewed Literature • External • KEY PRINCIPLE • “If we are 100% successful, we will have failed”

Chronic Illness/ High Risk Case Management (HRCM) Disease Management INTEGRATED PILOT PROGRAMS Helping people identified at high predictive risk for catastrophic health events or deterioration through on site and telephonic case management Helping individuals afflicted with select chronic diseases reduce their risk of disease progression, future catastrophic events or deterioration 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

Satisfaction From 2009-2011, 98% of members were either satisfied or very satisfied with the pilot program. • Engagement Member months of engagement doubled from 2009-2010 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 RESULTS

The program ROI demonstrated savings over the first three years, and increased year over year TOTAL PROGRAM SAVINGS

The total savings for the program was $8.3 million TOTAL PROGRAM SAVINGS Program Savings by Payer

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” INSIGHTS ON ENGAGEMENT

CONSUMER MODEL OF HEALTH CARE“Living Well / Enjoy Life Every Day in Bite Size Pieces” New LifeStyle Change / Impact “uh oh… I am going to have to change to live the way I want” Complex Needs / Support “I need community support” Healthy / Independent “I can do this myself” Episodic / Intermittent “I am annoyed”

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

Bill • 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. THIRD ‘A-HA’: JOURNEY TO CONSUMER ENGAGEMENT 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 12/2 11/1 12/20 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. Recruitment Call. Bill mentions wife is in hospice care. 4/4 Stepson takes call and requests nurse to not call for one month 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. 9/23 2/18 3/28 Bill notes he lost his sister in law. Bill shares his religious beliefs and current bible study classes with his son. Bill is in ER for chest pain, requests callback

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 cyeh@aarp.org

Trusting Windmills: Consumers, Innovation and the New World of Health Care