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QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
QualityMetric and Magellan Presentation at AHIP Conference 2009
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QualityMetric and Magellan Presentation at AHIP Conference 2009

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Measuring Success and Proving Value: Comparative Effectiveness in Action

Measuring Success and Proving Value: Comparative Effectiveness in Action

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  • 1. Comparative Effectiveness in Action promote transparency • prove value • measure success Measuring Success and Proving Value: Comparative Effectiveness in Action Using self-reported health outcomes to assess treatment effectiveness, evaluate ROI, and promote transparency within healthcare. Proprietary and confidential content subject to NDA 1
  • 2. Comparative Effectiveness in Action promote transparency • prove value • measure success Agenda I Introduction……....……………….……(Gus Gardner, President/COO, QualityMetric) – Defining health: the first step toward measuring it – SF-12 Health Survey Measurement Model – Introducing today’s speakers II Program Overview…......(Joann Albright, PhD, SVP, Magellan Health Services) – Magellan overview and definitions – Program goals and lessons learned – SF-BH™ Assessment demo and reports III Results and Conclusions…....(John E. Ware, Jr., PhD, CSO, QualityMetric) – Health burden analysis for total population – Analysis of improved health outcomes post treatment – Impact on medical expense trends and lost work days IV Q & A Session………………….….…(Gus Gardner, President/COO, QualityMetric) Proprietary and confidential content subject to NDA 2
  • 3. Comparative Effectiveness in Action promote transparency • prove value • measure success Gus Gardner, President/COO, QualityMetric I Introduction Proprietary and confidential content subject to NDA 3
  • 4. Comparative Effectiveness in Action promote transparency • prove value • measure success Defining Health “Anyone who can define health can transform the context of medicine.” - Stan Davis in Future Perfect Proprietary and confidential content subject to NDA 4
  • 5. Comparative Effectiveness in Action promote transparency • prove value • measure success A Definition of Health In 1948, the constitution of the World Health Organization (WHO) defined health as "a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity." Proprietary and confidential content subject to NDA 5
  • 6. Comparative Effectiveness in Action promote transparency • prove value • measure success Defining Comparative Effectiveness “That the funding appropriated in this paragraph shall be used to accelerate the development and dissemination of research assessing the comparative effectiveness of health care treatments and strategies, through efforts that: (1) conduct, support, or synthesize research that compares the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions…” - From the American Recovery and Reinvestment Act of 2009 Proprietary and confidential content subject to NDA 6
  • 7. Comparative Effectiveness in Action promote transparency • prove value • measure success SF-12 Health Survey Measurement Model Questions Domains Summary Does your health limit your Physical Functioning Measures everyday activities Or climbing flights of stairs Accomplished less due to Role-physical physical health Physical Health Limited in the kind of work or other activities Bodily Pain How much does your pain interfere with work General Health How would rate your health Did you have a lot of energy Vitality Has your health interfered with social activities Social Functioning Mental Health Have you accomplished less because of mental health Did you work less carefully Role-emotional because of mental health Have you felt calm/peaceful Have you felt downhearted Mental Health Proprietary and confidential content subject to NDA 7
  • 8. Comparative Effectiveness in Action promote transparency • prove value • measure success Using Self-reported Outcomes Throughout the Healthcare Spectrum 76,000,000 Administrations 117 Languages Proprietary and confidential content subject to NDA 8
  • 9. Comparative Effectiveness in Action promote transparency • prove value • measure success Today’s Speakers • Joann Albright, PhD, Senior Vice President Magellan Health Services • John E. Ware, Jr., PhD, Chief Science Officer QualityMetric Incorporated Proprietary and confidential content subject to NDA 9
  • 10. Comparative Effectiveness in Action promote transparency • prove value • measure success Joann Albright, PhD, Senior Vice President, Magellan Health Services II Program Overview Proprietary and confidential content subject to NDA 10
  • 11. Comparative Effectiveness in Action promote transparency • prove value • measure success About Magellan Diversified specialty managed health care company currently focused on behavioral health, radiology, and specialty pharmacy. Radiology Specialty Behavioral NIA Pharmacy ICORE Proprietary and confidential content subject to NDA 11
  • 12. Comparative Effectiveness in Action promote transparency • prove value • measure success Magellan Behavioral Health • Behavioral health covered lives: 40 million • Credentialed providers: 60,000 – Psychiatrists, psychologists, social workers, counselors, family therapists, psychiatric nurse specialists, substance abuse professionals, others • Provider facilities: 6,200 locations – Psychiatric/substance abuse inpatient hospital or unit, residential treatment, supervised living, partial hospitalization, intensive outpatient, outpatient Proprietary and confidential content subject to NDA 12
  • 13. Comparative Effectiveness in Action promote transparency • prove value • measure success Magellan Vision Statement “To use our behavioral health expertise to improve health care outcomes for individuals and families fighting illness, needing counsel or seeking support with life’s challenges.” Proprietary and confidential content subject to NDA 13
  • 14. Comparative Effectiveness in Action promote transparency • prove value • measure success Common Terms Clinical Measurement Outcomes Measurement Use of standardized measures to Indicator of change and requires assess such areas as clinical at least two data points, ideally severity, health status and one at the start of treatment and functioning another at some later time Patient Reported Outcomes Management Outcomes Clinical Outcomes Systematic effort to improve the Measured effects of interventions, effectiveness of treatment or lack of interventions, on primary services throughout a health care and secondary consumers system Proprietary and confidential content subject to NDA 14
  • 15. Comparative Effectiveness in Action promote transparency • prove value • measure success Goals • Empowerment Members • Recovery-improved health status & productivity • Evidence-based treatment support Providers • Profiling/R4Q Care Management/ • Empirically driven reviews Coaching • Engagement/risk management • Measure/monitor treatment effectiveness System Improvement • Efficiencies – screen and stratify • Competitive advantage Value Added • Industry leader • Medical cost reduction Return on Investment • Profit/reinvestment Proprietary and confidential content subject to NDA 15
  • 16. Comparative Effectiveness in Action promote transparency • prove value • measure success Plan of Action Scientifically Sound Measures Embed in Leverage Clinical Maximize Outcomes Management Technology Information Programs Monitor and Improve Performance Proprietary and confidential content subject to NDA 16
  • 17. Comparative Effectiveness in Action promote transparency • prove value • measure success Modes of Administration Paper (& Pencil) Phone (IVR) Computer (Desktop, Online, Enterprise) Fax PDA (Tablet) Proprietary and confidential content subject to NDA 17
  • 18. Comparative Effectiveness in Action promote transparency • prove value • measure success Smart Measurement® System Proprietary and confidential content subject to NDA 18
  • 19. Comparative Effectiveness in Action promote transparency • prove value • measure success Additional SF-BH Assessment Components • Strengths • Behavioral Symptoms • Work-School Participation • Provider Relationship Proprietary and confidential content subject to NDA 19
  • 20. Comparative Effectiveness in Action promote transparency • prove value • measure success SF-BH™ Assessment Proprietary and confidential content subject to NDA 20
  • 21. Comparative Effectiveness in Action promote transparency • prove value • measure success SF-BH™ Assessment Proprietary and confidential content subject to NDA 21
  • 22. Comparative Effectiveness in Action promote transparency • prove value • measure success SF-BH™ Assessment Proprietary and confidential content subject to NDA 22
  • 23. Comparative Effectiveness in Action promote transparency • prove value • measure success SF-BH™ Assessment Proprietary and confidential content subject to NDA 23
  • 24. Comparative Effectiveness in Action promote transparency • prove value • measure success SF-BH™ Assessment Proprietary and confidential content subject to NDA 24
  • 25. Comparative Effectiveness in Action promote transparency • prove value • measure success SF-BH™ Assessment Proprietary and confidential content subject to NDA 25
  • 26. Comparative Effectiveness in Action promote transparency • prove value • measure success SF-BH™ Assessment Proprietary and confidential content subject to NDA 26
  • 27. Comparative Effectiveness in Action promote transparency • prove value • measure success Proprietary and confidential content subject to NDA 27
  • 28. Comparative Effectiveness in Action promote transparency • prove value • measure success Proprietary and confidential content subject to NDA 28
  • 29. Comparative Effectiveness in Action promote transparency • prove value • measure success Lessons Learned Customers Providers Consumers Organizations Shift from Technology Verbal support Confidentiality process to resources outcomes Administrative Health Training obstacles awareness Implementation barriers Evidence of Multiple Champions value modalities required Proprietary and confidential content subject to NDA 29
  • 30. Comparative Effectiveness in Action promote transparency • prove value • measure success John E. Ware, Jr., PhD, Chief Science Officer, QualityMetric III Results and Conclusions Proprietary and confidential content subject to NDA 30
  • 31. Comparative Effectiveness in Action promote transparency • prove value • measure success Characteristics of Magellan’s Behavioral Health Population Total Sample Sample 2 Sample 3 (n=33,362) (n=9,661)1 (n=1,260)2 Mean Age (SD) 41 (12) 43 (13) 46 (15) % 65 yrs. and older 2.5 4.2 10.4 % Female 66.3 65.9 60.4 1 Patients with two administrations of the SF-BH form. 2 Patients with three administrations of the SF-BH form. Proprietary and confidential content subject to NDA 31
  • 32. Comparative Effectiveness in Action promote transparency • prove value • measure success SF-12 Shows Significant Mental Health Burden at Baseline in Behavioral Health Sample 2 Best 60 60 Health 55 Norm 55 Norm 50 50 45 * * * 45 40 40 35 * * * 35 30 30 * Worse 25 25 Health 20 20 All scales Mean=50, SD=10, * p<0.05, n=9,661 Proprietary and confidential content subject to NDA 32
  • 33. Comparative Effectiveness in Action promote transparency • prove value • measure success Item Responses Show Emotional Distress in Behavioral Health Sample 2 More 56.5% 52.8% 41.7% 42.2% 23.1% 7.1% 8.7% 6.2% Less % with little or no energy % limited in social % accomplished less at % downhearted or activities work depressed Behavioral Health US Norm n=9,661 Proprietary and confidential content subject to NDA 33
  • 34. Comparative Effectiveness in Action promote transparency • prove value • measure success Measurement of Health Outcomes • Mean changes in SF-12 scores pre and post intervention • Categorical changes in SF-12 scores pre and post intervention • Content-based interpretations of item responses • Interpretation of outcomes in terms of their consequences – screening positive for depression – cost savings per patient, per year – Reduction in work loss days, past 4 weeks Proprietary and confidential content subject to NDA 34
  • 35. Comparative Effectiveness in Action promote transparency • prove value • measure success Behavioral Health Intervention Significantly Improves Mental Health Status in Sample 2 Best 60 60 Health 55 55 Norm Norm 50 50 * * * 45 * * 45 40 * * 40 * 35 35 30 30 Worse 25 25 Health 20 20 All scales Mean=50, SD=10, * p<0.05, n=9,661 Baseline Sample 2 Proprietary and confidential content subject to NDA 35
  • 36. Comparative Effectiveness in Action promote transparency • prove value • measure success Percentages Better, Same, or Worse in Sample 2 Mental Health (MCS) 13% 18% 69% n=9,661 Better Same Worse Proprietary and confidential content subject to NDA 36
  • 37. Comparative Effectiveness in Action promote transparency • prove value • measure success Item Responses Show Emotional Distress Alleviated by Intervention in Sample 2 56.5% 52.8% 41.8% 42.2% 33.8% 17.1% 17.2% 16.3% % with little or no energy % limited in social % accomplished less at % downhearted or activities work depressed Baseline Visit 2 n=9,661 Proprietary and confidential content subject to NDA 37
  • 38. Comparative Effectiveness in Action promote transparency • prove value • measure success Fewer Patients Screen Positive for Depression at Visit 2 83.3% 55.3% Baseline Visit 2 Positive Depression Screen Sample 2, n=9,661 Proprietary and confidential content subject to NDA 38
  • 39. Comparative Effectiveness in Action promote transparency • prove value • measure success Predicted Medical Expenses Decreased at Visit 2 $3,500 $3,400 $3,300 $3,388 Average yearly reduction of $3,200 $311 per patient $3,100 $3,000 $3,077 $2,900 $2,800 $2,700 $2,600 $2,500 Baseline Visit 2 Medical Expense Sample 2, n=9,661 Proprietary and confidential content subject to NDA 39
  • 40. Comparative Effectiveness in Action promote transparency • prove value • measure success Self-reported Lost Work Days Decreased at Visit 2 5 4.5 4 3.5 3 3.3 2.5 2 1.5 1.7 1 0.5 0 Baseline Visit 2 Mean Lost Work Days Sample 2, n=9,661 Proprietary and confidential content subject to NDA 40
  • 41. Comparative Effectiveness in Action promote transparency • prove value • measure success Mental Health Improvements Sustained for Three Months, Behavioral Health Sample 3 (n=1,260) Proprietary and confidential content subject to NDA 41
  • 42. Comparative Effectiveness in Action promote transparency • prove value • measure success Mental Health Improvements are Sustained for Three Months for Sample 3 (n=1,260) Best 60 60 Health 55 55 Norm Norm 50 50 * * * * * 45 * * * * 45 40 40 35 35 30 30 Worse 25 25 Health 20 20 All scales Mean=50, SD=10, * p<0.05, n=1,260 Baseline Sample 3 Proprietary and confidential content subject to NDA 42
  • 43. Comparative Effectiveness in Action promote transparency • prove value • measure success Mental Health Outcomes Improve Over Time for Sample 3 (n=1,260) 55 Norm 50 45 Depression Screen 40 40.2 46.1 35 30 25 20 22.6 15 10 5 0 Baseline Visit 2 (60 days) Visit 3 (180 days) MCS-12 Proprietary and confidential content subject to NDA 43
  • 44. Comparative Effectiveness in Action promote transparency • prove value • measure success Percentages Better, Same, or Worse in Sample 3 Mental Health (MCS) 5% 8% 87% Better Same Worse n=1,260 Proprietary and confidential content subject to NDA 44
  • 45. Comparative Effectiveness in Action promote transparency • prove value • measure success Conclusions • Substantial mental health burden observed at baseline for Magellan’s behavioral health population • Significant and meaningful benefits of intervention include: – % with little or no energy – % limited in social activities – % accomplishing less at work – % downhearted or depressed • Preliminary follow-up data (Sample 3) show that improvements are sustained for 3 months Proprietary and confidential content subject to NDA 45

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