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UAD/CVD Update

United Against Diabetes and Cardiovascular Disease. UAD/CVD Update. Knut Ringen, DrPH, MHA, MPH Stoneturn Consultants. Supported by. The situation. 2007—Start-up 2008-2010—Treading water during financial crisis 2009-2013—ACA distraction and opportunity 2013—Getting re-started.

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UAD/CVD Update

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  1. United Against Diabetes and Cardiovascular Disease UAD/CVD Update Knut Ringen, DrPH, MHA, MPH Stoneturn Consultants Supported by www.uad-cvd.org

  2. The situation • 2007—Start-up • 2008-2010—Treading water during financial crisis • 2009-2013—ACA distraction and opportunity • 2013—Getting re-started www.uad-cvd.org

  3. UAD/CVD Mission Only organization dedicated to: • Reducing prevalence of chronic diseases in working families • Developing and testing strategies for prevention, early detection and aggressive management of diabetes/CVD in multiemployer health plans • Helping multiemployer plans adopt evidence-based programs www.uad-cvd.org

  4. How we Started in 2007 www.uad-cvd.org

  5. www.uad-cvd.org

  6. Our Message # 1 • Diabetes is epidemic • 2006: 15% of target population over age 40 has diabetes • 2/3rds know it • Already 10-15% of health and welfare costs www.unitedagainstdiabetes.org

  7. Our Message # 2 • Diabetes can be managed • To do so, health and welfare funds must become proactive • Each fund can do it alone, or we can do it together • We think a common approach is best www.unitedagainstdiabetes.org

  8. Why Diabetes and CVD? www.uad-cvd.org

  9. MAKING THE LINKDiabetes and CVD • 68% of patients with diabetes don’t think CVD is a serious complication • 60% don’t even think they are at risk Even though • 2 out of 3 patients with diabetes die prematurely from CVD Making the Link is an ADA/AHA joint initiative www.uad-cvd.org

  10. MAKING THE LINKDiabetes and CVD Costs, 2007-08 Making the Link is an ADA/AHA joint initiative www.uad-cvd.org

  11. Recent National Developments www.uad-cvd.org

  12. ObesityInAmerica.Org www.uad-cvd.org

  13. Number and Percentage of U.S. Population with Diagnosed Diabetes, 1958-2009 CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

  14. Source: 2005–2008 National Health and Nutrition Examination Survey.

  15. Estimated lifetime risk of developing diabetes for individuals born in the United States in 2000 CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

  16. Source: 2007–2009 National Health Interview Survey estimates projected to the year 2010.

  17. Distribution of Age at Diagnosis of Diabetes Among Adult Incident Cases Aged 18–79 Years, United States, 2008 16.8% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

  18. Distribution of Age at Diagnosis of Diabetes Among Adult Incident Cases Aged 18–79 Years, United States, 2008 15.1% 16.8% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

  19. Rate of new cases of type 1 and type 2 diabetes among youth aged <20 years, by race/ethnicity, 2002–2005 <10 years 10–19 years Source: SEARCH for Diabetes in Youth Study NHW=non-Hispanic whites; NHB=non-Hispanic blacks; H=Hispanics; API=Asians/Pacific Islanders; AI=American Indians

  20. Where We Are Now www.uad-cvd.org

  21. Claims Analysis Results for a Basic Trade • Member employee population is aging.

  22. Claims Analysis Results for a Basic Trade • Prevalence of diabetes and hypertension are increasing.

  23. Claims Analysis Results for a Basic Trade • Prevalence of diabetes and hypertension are increasing.

  24. Our Premise • Multiemployer funds are a unique niche in health care coverage • There is no research foundation on what works best for multiemployer funds • Multi-employer funds have unique strengths • Very stable populations • A high degree of trust www.uad-cvd.org

  25. What UAD Does for H&W Funds • Provide information: An objective , non-commercial resource on chronic disease prevention and control • www.uad-cvd.org • Perform studies: • Claims data analysis • Conducts pilot studies to provide evidence-based best practices • Communications • Screening and early detection • Incentives • Centers of excellence/”medical homes” www.uad-cvd.org

  26. UAD/CVD Organization www.uad-cvd.org

  27. Staying Focused on Key Risk Measures • Weight/BMI • Blood sugar • Blood cholesterol • Blood pressure • Smoking www.uad-cvd.org

  28. Recommendations to Funds WWW.UNITEDAGAINSTDIABETES.ORG

  29. UAD/CVD Algorithm www.uad-cvd.org

  30. Eligible Participants Notify about Program Health Risk Appraisal Identify participants at risk for disease Claims data Identify participants with disease using HEDIS criteria

  31. Eligible Participants Notify about Program Health Risk Appraisal Identify participants at risk for disease Claims data Identify participants with disease using HEDIS criteria Medical Screening Exam HbA1c, BP, Total Non-HDL, Smoking

  32. Eligible Participants Notify about Program Health Risk Appraisal Identify participants at risk for disease Claims data Identify participants with disease using HEDIS criteria Medical Screening Exam HbA1c, BP, Total Non-HDL, Smoking No Disease HbA1c< 5.8 No CVD Non- Smoker Pre-DM HbA1c 5.8-7.0 Pre-CVD Blood pressure DP 80-90/SP 120-130 Cholesterol Total non-HDL: 120-130 mg/ml DM HbA1c>7 CVD Blood pressure DP >90/SP >130 Cholesterol Total non-HDL: >130 mg/ml Smoker No DM No CVD

  33. Eligible Participants Notify about Program Health Risk Appraisal Identify participants at risk for disease Claims data Identify participants with disease using HEDIS criteria Medical Screening Exam HbA1c, BP, Total Non-HDL, Smoking No Disease HbA1c< 5.6 No CVD Non- Smoker Pre-DM HbA1c 5.6-6.4 Pre-CVD Blood pressure DP 80-90/SP 120-139 Cholesterol Total non-HDL: 120-130 mg/ml DM HbA1c >6.5 CVD Blood pressure DP >90/SP >140 Cholesterol Total non-HDL: >130 mg/ml Smoker No DM No CVD Annual Medical Exam Provide Self-mgt Guide Lifestyle Change Medications as Needed Daily Aspirin (if high risk) Annual Medical Exam No Co-morbidity Co-morbidity Provide Self-mgt Guide Lifestyle Change Medications as Needed Daily Aspirin Annual Medical Exam Smoking cessation Daily Aspirin for Men age >45 and Women age >55 Annual Medical Exam Evaluate for Depression Evaluate for Depression PBM review For Smokers Smoking Cessation Provide Self-mgt Guide Lifestyle Change Medications as Needed Daily Aspirin Annual Medical Exam Refer to Specialty Practice For Smokers Smoking Cessation PBM review Lab value review (if available) Provide Self-mgt Guide Lifestyle Change Medications as Needed Daily Aspirin Annual Medical Exam PBM review Lab value review (if available) Quarterly case mgr review Annual Case Mgr Review For Smokers Smoking Cessation For Smokers Smoking Cessation Case Mgr Review:Quarterly PBM review Lab value review (if available) PBM review Lab value review (if available) Case Mgr Review Depression: Monthly Other: Quarterly Case Mgr Review Monthly www.uad-cvd.org

  34. How to Implement Algorithm:STEP 1 DESIGNATE A STAFF MEMBER • Responsible for implementing UAD program • UAD will provide training and technical support www.uad-cvd.org

  35. How to Implement Algorithm:STEP 2 NOTIFY PARTICIPANTS ABOUT PROGRAM • Participation is key to program success • Continuous communication is key to program participation • UAD can provide communications materials www.uad-cvd.org

  36. How to Implement Algorithm:STEP 3 START IDENTIFYING PARTICIPANTS WITH DIABETES OR CVD RISK • Offer HRA • UAD has developed a HRA targeted to our funds • Start mining your claims data • UAD has developed a Claims Analyzer tool www.uad-cvd.org

  37. How to Implement Algorithm:STEP 4 ENCOURAGE PARTICIPANTS AT RISK TO GET A MEDICAL SCREENING • All participants over age 45 • All participants under age 45 at risk • All men 35-45 • UAD has developed a screening guideline www.uad-cvd.org

  38. How to Implement Algorithm:STEP 5 PROVIDE PRO-ACTIVE DISEASE MANAGEMENT SUPPORT TO PARTICIPANTS WITH DISEASE OR EARLY SIGNS OF DISEASE • Smoking cessation • Disease management guide • Daily aspirin • Centers of excellence for patients w/ multiple disorders • Disease/case management support • Make use of UAD Guidelines and materials www.uad-cvd.org

  39. How to Implement Algorithm:STEP 6 MONITOR PARTICIPANTS WITH DISEASE TO MAKE SURE THEIR TREATMENT IS BEING OPTIMIZED • Use medical and pharmacy claims data www.uad-cvd.org

  40. Does it work?Results from 5 years of experimentation in one Fund www.uad-cvd.org

  41. Comparison of DM Participants to Matched Controls • Compliance: DM better on all HEDIS scores www.uad-cvd.org

  42. Comparison of DM Participants to Matched Controls • Compliance: DM better on all HEDIS scores • Costs: DM declined 22%; controls 2% www.uad-cvd.org

  43. Comparison of DM Participants to Matched Controls • Compliance: DM better on all HEDIS scores • Costs: DM declined 22%; controls 2% • DM intensity impact on costs: • Coaching (intense): 41% • Newsletters (less intense): 29% www.uad-cvd.org

  44. Multiemployer Fund Compared to Commercial Health Plans • Compared to PPOs: MF DM Participants did as well as PPOs on most HEDIS Scores www.uad-cvd.org

  45. Multiemployer Fund Compared to Commercial Health Plans • Compared to HMOs: MF DM Participants did not do as well as HMOs on most HEDIS Cores www.uad-cvd.org

  46. Does a more Proactive DM Program Expose Trustees to Greater Liability? www.uad-cvd.org

  47. In the fund studied, trustees had no problem obtaining a Health Benefit Purchaser’s Liability Insurance Policy at very little additional premium cost www.uad-cvd.org

  48. The Uncertainty Factor www.uad-cvd.org

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