The 2nd meeting of the Subcommittee on Wellness of the Blue Ribbon Panel on Public Employee Health Benefits was held on Tuesday, June 21, 2005, at 10:00 AM, in Room 113 of the Capitol Annex. Representative Bob M. DeWeese, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Representative Bob M. DeWeese, Chair; Representative Harry Moberly Jr. Wanda Mitchell-Smith, and J.P. Wiles.
Guests: Jackie Simmons, Passport Health Plan; Jeanne Spencer Weiner, Richard Lane and Jude Thompson, Anthem Blue Cross Blue Shield of Kentucky; Joey Payne, Bryan Loy, Holly Divine, Jody Ensman, Julia Costich and Margaret Nowak-Rapp, University of Kentucky.
LRC Staff: Alisha Miller and Terisa Roland.
Representative DeWeese stated the purpose of the subcommittee was to look at preventable causes, wellness, disease management and the aging population. He said there are many things he would like to change and fix about the healthcare system but the task of this subcommittee is limited to looking at the teachers' and state employee's health insurance plan.
The discussion began with a presentation from Jackie Simmons, Director of Wellness and Disease Management, Passport Health Plan. Passport is a Medicaid managed care organization that services Jefferson County and 16 surrounding counties and provide all Medicaid services, except for behavioral health services. Information was included in a packet that was handed out to the subcommittee.
Ms. Simmons stated there are about 3,000+ providers, based on both rural and urban health care. Their responsibility is to be good stewards of the Medicaid dollars entrusted to them, but they also need to provide good quality health care and want their members to have good health outcome. She stated it is very important to have good cost effective care. They have a health management program that consists of disease management, care coordination, case management, and quality management program. Most of their recipients are women, children, and individuals with chronic illnesses. Other Programs include prenatal care, early periodic screening diagnosis and treatment program (which is children's preventive health care), asthma disease management program, and the diabetes disease management program. Passport is interested in asthma disease management because in 2000 asthma was responsible for about 5,000 deaths in this country. It costs the health care industry about $11 billion. In the first quarter of 2005, there were about 7,500 members diagnosed with asthma. Ms. Simmon stated the disease management program works best if members can get on the appropriate medications and see doctors when they need to. She stated the program is based on an educational model. They have case managers and disease managers who contact members by phone as well as house visits. Ms. Simmons said a new program, Choices Program, calls for a pharmacist and a physician representative go to Passport's providers and talk to them about pharmacist utilization.
A Power Point presentation given by Ms. Simmons and included in the packet was discussed. A summary is as follows:
Kentucky is 13th in the nation for diabetes. Seven percent of Kentuckians in 2002 had diabetes. There are about 330,000 undiagnosed diabetes cases in Kentucky; diabetes is the 5th leading cause of death. In 1999, four percent of Passport membership had a prescription for diabetic medicines, either oral medicine or insulin. Ninety-eight percent also had prescriptions for other medications for other diseases.
Ms. Smith asked how many counties were covered. She said that she heard some of the counties were not covered. Ms. Simmons stated that information was provided in the packet handed out. She also stated that some counties may not have had specialists in all rural counties but Primary Case Physicians were available in all.
Next on the agenda was Jude Thompson, President, Anthem Health Plans of Kentucky. He said Blue Cross/Blue Shield has been providing health care benefits to Kentuckians for nearly 70 years. He said they focus a tremendous amount of their resources to encourage prevention, wellness, and early testing to prevent illnesses. Joining Mr. Thompson were Spencer Weiner, Anthem's Central Regional Program Manager for Health Care Management, and Dr. Richard Lane, Anthem Health Plans of Kentucky's Medical Director. Their presentation to the subcommittee was Anthem's historical and present capabilities in wellness and disease management. Mr. Thompson stated that because they were asked to appear, it did not affect their ability to submit a proposal for the current RFP for state employee health care benefits in 2006. He said their comments today pertained to programs and practices currently in place for the Commonwealth.
Spencer Weiner, a registered nurse, serves as the Program Manager for Anthem's Central Regional Health Care Management activities. She stated that it is very important that chronic diseases be targeted before they actually happen. The industry is moving from an illness model to a wellness model. Ms. Weiner then discussed some of the options that Anthem has for education and empowerment, for wellness, prevention, disease management, and patient safety and advocacy as well as predictive modeling. She said, ultimately, the goal is to not only to contain cost, but really maintain the health of the people that is served. Ms. Weiner stated that looking at health care cost related to risk, its startling that 5% of members equal 55 percent of the cost. The five percent are those classified as high risk; those with multiple diseases, chronic diseases, and multiple diagnosis of obesity, diabetes, and heart disease.
Ms. Spencer added that these are the people who need to be targeted if we want to maintain and contain health care cost. Ms. Spencer listed program options that Anthem has available for these members. The first set of options discussed centered on their well members. These include website capabilities, newsletters, and other tools that Anthem gives their members. They also have work site wellness options, preventive education, health risk assessments, and a 24-hour, 7 day a week nurse line. Anthem has contacted and works with partners at various places such as Jenny Craig, smoking cessation programs, and discounts for members on health items. They also have a healthy solutions newsletter. This newsletter is also available online but is sent out to all members.
Ms. Weiner stated that one of the most exciting things is the work site wellness program. Anthem can facilitate health fairs on site or bring people in to do blood pressure and blood glucose checks and also lipid screenings. They can also tailor health fairs based upon the needs of a group. Anthem can also tailor communication plans, and with this they partner with their employer groups and find out what their needs and expectations are. For example, Anthem can have a monthly mailing sent out to their members, provide a spotlight on a chronic disease or a health issue, or send out posters, brochures, and pay roll stuffers for education of the members. Anthem can also facilitate therapeutic table and chair massages where they can include and when they actually have this education about stress relieving behaviors and activities that members can do to help them throughout the day.
Ms. Weiner then discussed other wellness tools available such as, extensive web based tools that can be accessed online, reminders on breast cancer and cervical cancer screening to their female members, immunization reminders for childhood and adolescence immunizations, and reminders of flu shots. There are also obesity programs. This year Anthem started a school nurse grant program for kids which is centered around obesity. It’s a grant that schools can earn to go towards educational materials about obesity and choices that kids can make so they can become healthier adults by better choices.
Anthem also provides a health risk assessment tool that serves multiple purposes. It is available for both paper and online. These are confidential questions on current health and lifestyle choices. The assessment can identify behavior trends, look at risk factors, and help indicate health and behavior changes to encourage a healthier population.
Ms. Weiner discussed briefly the low to moderate health risk members and what can be done for them. The options included utilization management, care counseling or case management, maternity care, coronary service centers, and patient safety. Anthem also manages acute episodes of chronic care through pre-certification as well as case management to ensure proper usage of services. Their utilization management and case management both have the highest rated NCAQ.
Dr. Richard Lane, Medical Director at Anthem discussed their case management care counselor program. He said the semantics get very confusing. He stated case management historically has been that sort of service that the health plan provides when someone becomes severely ill. They provide extra care, a nurse who calls and basically coordinates the benefits, making sure the patient get to a rehabilitation hospital. This is the traditional case management. He said that what has been discovered is that as they have moved into the era of disease management, there is something in between. Disease management is really about managing a population of people. You take your low group of people with diabetes or heart disease and you try to do things for them, whether it be informational as in mailings, or specific calls. It involves using a number of tools to identify people who are at risk, people who may not be particularly ill at the moment. He further stated that there is an incredibly good response from members when enrolled in this program. Care counselor's have between 70-80 percent acceptance when they call out. It is a complete change from the provisions utilization.
He stated this program is out across most of the central region at this point and has a very positive impact on its member’s health. It has also had an impact on the cost of care. He stated that Anthem has data that shows the return on investment pays itself back two to three fold which is unusual in the health care industry.
Ms. Weiner stated one way they are managing cost of care trends is with monoriting radiology. Other programs mentioned were maternity care and patient Safety I.R.I.S. program - Interactive Real-Time Information Sharing. She closed by stating that Anthem Blue Cross-Blue Shield has multiple options for any employer group to manage their health care cost as well as making sure their members have the best health care possible.
Representative DeWeese asked if the services were provided in all counties of Kentucky. Ms. Weiner stated yes.
Chairman DeWeese opened the afternoon session with a couple of reminders for the Subcommittee: next meeting Tuesday, June 28, 2005 where more testimony from other groups will be heard. Another meeting scheduled July 12-13, 2005 – the first day is devoted to getting final resolutions and recommendations from the subcommittee. Then on July 13, 2005, the recommendations will be presented to the overall committee.
The next presentation was from University of Kentucky: Self Insured Wellness and Disease Management Programs.
Joey Payne, Director of Employee Benefits with UK discussed opportunities for savings that are available through life style case management and disease management he described strategies that have been employed to capture some of the savings and how some of the plan designed have been structured. He also said that they would give detailed information about in-house programs that have developed and some of the outcomes they have achieved.
The presentation was broken into five parts: clinical guidance including a discussion on Humana's disease management and pharmacists care. A diabetes education care program that is done in house there is also life style case management which is the health and wellness area, HealthTrak is a health assessment that over 5,500 employees have participated in (Employees and Retirees) specialty prescriptions, and managing costs as it relates to high claim patients.
He stated the presentation will give an employer perspective as an organization that has purchased disease management from Humana for their participants who are in the Humana Plan. They have also developed their own in- house programs.
Bryan Loy, Vice President of Clinical Innovation, Humana said his presentation would give a brief summarization of Humana’s Clinical Intervention Strategy and describe the UK/ Humana experience as it relates to disease management specifically. He said as a claims payer, it is a challenge to identify those members and where they are to deliver the appropriate message in preparation for a lifetime of health or preparation for a lifetime of living with a chronic disease or an acute health event. It also involves trying to identify those touch points where they can engage the member with a level of guidance, when they need it most. He stated that Humana determined how to identify the patients that need information the most. The learning capacity for someone immersed in the setting of an acute illness is far different from the well who has the curiosity of a potential risk of a particular disease. He stated Humana, has developed strategy teams to address chronic and acute and non-chronic and non-acute clinical settings within a particular disease condition. He also discussed options for membership guidance.
Humana also offers education and care programs in congestive heart failure, coronary artery disease, diabetes, neo-natal intensive care, end-stage renal disease and complimentary kidney disease, rare-disease management control program (e.g. rheumatoid arthritis), cancer program, and asthma/diabetes control program.
Amy Nicholas, Pharmacist, UK College of Pharmacy said UK is not unique in facing rising health care costs. She stated President Todd is innovative enough to think of creative ways to control costs. The Pharmacist Reach Program provides medication therapy management services to all plan members, collaborates with the wellness program, reviews the medications of the patients, develops a care plan that the patient can use to work with their physician to understand why they are taking their medications, and communicates the findings with their health care providers. The main component of the pharmacist care program is the diabetes education and management program. The program works with the patients on the care for the patient and has been recognized on the state and national level.
Jody Ensman, Operations Manager for Health and Wellness, UK, said they provide services to all employees, retirees, and spouses of the university. He discussed lifestyle case management and their Behavioral Health Improvement Program (BHIP) and HealthTrak Rewards Program. Through these programs, they can educate and help employees change their lifestyles through a variety of programs.
The BHIP is a telephonic counseling program. There are seven interventions that were developed in house with UK's health and wellness staff. All of the interventions are research based and had physician involvement throughout the entire process. The telephonic counseling is a proactive out-come based health risk modification system.
Mr. Ensman stated that UK offers an additional lifestyle case management program – the HealthTrak Rewards Program. It is based on an on-line health risk assessment. The goals are to educate individuals about their health, to inform individuals about the resources that are available to them to manage their health, and to begin to encourage utilization of their personal page. There is an incentive to participate in this program. Participants can earn up to $10 per month or up to $120 per year simply by participating, however they must go to their personal health page every month in order to receive the incentive.
Julia Costich, Professor, Health Services Management, UK – stated The HealthTrak program is important, because UK believes very strongly in value based purchasing. It is not just a feel good moral boosting program. She said this kind of intervention is to actually improve employee health status and to maintain the health status of the employees who are currently healthy. The health assessment piece is an on- line assessment only. She said they look at demographics and are enrolling people who are somewhat less healthy based on their utilization of services than the average employee. The HealthTrak enrollees have 18% higher pre-enrollment medical costs, so they are not just reaching healthy people stated Ms. Costich.
Margaret Nowak-Rapp, Pharmacist, Prescription Drug Benefit Program, UK, works in managing the prescription benefit for the UK health plans. She said they carved out the prescription benefits of the medical health plan that the employees selected – so that all groups have the same prescription benefit, the same drug formulary, and same relationship, etc. She discussed the high cost patients use high costs drugs. She said that you can define a specialty pharmacy medication as something that is high cost and can be an injection or it can be an injection that is self administered under the skin, in the muscle. She said it can also be an IV infusion that may last ten minutes to four hours, a high cost oral medication, or it might be an inhaled medication. All of these can be self administered or they may, in the case of the infusion, have to be administered by a health care provider. These medications can be used either within the patient’s home or in a particular outpatient setting. Ms. Nowak-Rapp stated that what these drugs all have in common is that they are treating relatively rare complex chronic conditions. These conditions contribute to the high cost care associated with these patients and can be very expensive. She stated they are trying to determine whether they would help purchase the medications on behalf of the physician who would administer it in their office or on behalf of the patient who would self administer it in the home. She said currently they are looking at what is happening with Medicare reimbursement.
Ms. Mitchell-Smith asked how long they have been self-insured. Ms. Ensman said UK went self -insured in 1997. She also said the disease management initiatives started taking place in the 2001-02 time frame, about the time President Todd took over at UK.
Representative DeWeese asked if this program would work for 250,000 people. Mr. Payne said he did not think there would be a problem. He said the HealthTrak program is interested in purchasing some of the protocols that they have developed. He said what is unique about their plan is the health assessment/health status and having programs to put them into to address their needs.
Business concluded and the meeting adjourned at 3:30 pm.