Sue Palsbo, PhD AAHP Quality Conference: Health Plan Strategies with Clinical Impact

1. Sue Palsbo, PhD AAHP Quality Conference: Health Plan Strategies with Clinical Impact October 26, 2001

2. Acknowledgements • Evaluation conducted by: Susan Palsbo, PhD; Thilo Kroll, PhD; Melissa McNeil, MSW, MS; David Bauer, MPA. • RFP Shape: Peter Fitzgerald, MSc (AAHP); Marian Parrott, MD, MPH (ADA). • Funded by: The Commonwealth Fund

3. Presentation Outline • Description of TOD • History of the 3 Community Partnerships • Evaluation Methodology • Results • Implications

4. Description of TOD • Joint venture of ADA and AAHP • 3 Components • Worksite interventions • National survey of diabetes programs • Community partnerships • Accomplishments to date

6. Site Demographics

7. More Site Characteristics 1 3 Albuquerque Kansas Westchester 2 City 1 Bernallilo County 2 Clay and Jackson Counties. Total population for the MSA is 1,776,000. 3 Westchester County

8. Site Characteristics

9. Albuquerque, NM • Location • Origin • Interventions • Accomplishments

13. Westchester County, NY • Location • Origin • Interventions • Accomplishments

19. Kansas City, MO • Location • Origin • Interventions • Accomplishments

20. Evaluation Methodology • Formative • Group and organizational theory • Fuzzy set scoring • 50 measures

21. Causal Complexity Need Governance Alignment Composition Market Characteristics Coordination Integration Differentiation

22. Scored Characteristics

23. Scored Characteristic

25. Need Common mission Common motivation all K A W A K Composition AAHP or ADA Key players W A K W A W Coordination & Integration Active meeting coord. Local site coordinator Mutual ownership K all W A K 0 fully out 0.5 neither in nor out 1.0 fully in Results- Degree of Membership

26. Alignment Match between problems addressed and partnership composition K W A Market Characteristics Stage of insurance mkt Collaborative environ % hlth plans AAHP K A W K W A K A W A W OUTCOME Established Sustained K A W K 0 fully out 0.5 neither in nor out 1.0 fully in Results - Degree of Membership

27. Requirements to establish: 1. Active coordinator 2. Contributions by each participant (in-kind or financial) 3. Neutral, outside party to convene the Partnership that is acceptable to all 4. Strong local champion 5. Agreement that there is a clear need for community-wide intervention 6. Willingness by participants to work on mutual objective 7. Relatively stable healthcare market 8. All key participants comprise small, core group Conclusions

28. Conclusions • Requirements to sustain: 1. Accomplish a visible, clearly beneficial, low-cost intervention within 12 months. 2. Local site coordinator. 3. Link up with external body that has, as its mission, working with physicians on quality.

29. Implications • TOD Community Partnerships are a good model for industry-wide initiatives on chronic conditions and for developing interventions with community physicians. • “Leveling the playing field” through collaboration, instead of risk adjustment, is good approach to encouraging investment in tackling chronic, disabling conditions.

30. Importance of Market Structure • Market structure has a less important role in the creation of health community partnerships than has been found in prior research. • Market structure is more important in determining the success of the quality intervention, particularly at the level of individual community physician.