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

Dr. Charlotte S. Yeh, MDChief 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 people build 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 Medigap population

A program not dependent on network, or provider payment strategies

A program that engages the FFS population

BACKGROUND

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.

o Case Management, Disease Management, Depression Management and Prescription Drug Adherence programs.

o Programs* target people with chronic illnesses living in high disease prevalence areas in parts of five states NY, NC, OH, FL, and CA.

o Began in early 2009 and continue today. Unique to the Medicare Supplement Health

Insurance Plan industry.

* AARP Medicare Supplement Plans, insured by UnitedHealthcare Insurance Company

CORE APPROACHRapid Test and Learn Model

1. Incubator Lab• Identify Core Impact Area(s)• Rapid iterative design, implementation and

pilot/test • Evaluation

2. Accelerator Lab• Replicability• Sustainability• Scalability

3. Sharing Success • Internal• Peer-Reviewed Literature• External

KEY PRINCIPLE

“If we are 100% successful, we will

have failed”

INTEGRATED PILOT PROGRAMS

Chronic Illness/ High Risk Case Management (HRCM)

Helping people identified at high predictive risk for catastrophic health

events or deterioration through on site and telephonic case management

Prescription Drug Adherence

Helping people in tandem with disease management programs to comply with and

adhere to evidence based standards of pharmaceutical care for their chronic

disease

Depression Management

Helping people, physicians, and other caregivers identify depression, and to access educational resources, referral

information, condition monitoring, treatment adjustment, and relapse

prevention

Helping individuals afflicted with select chronic diseases reduce their risk of

disease progression, future catastrophic events or deterioration

Disease Management

Integrated Pilot Programs

RESULTS 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

TOTAL PROGRAM SAVINGS

2009

2010

2011

Overall

0 0.5 1 1.5 2 2.5 3 3.5

ROI

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

TOTAL PROGRAM SAVINGS

Program Savings by Payer

The total savings for the program was $8.3 million

INSIGHTS ON ENGAGEMENT

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”

CONSUMER MODEL OF HEALTH CARE“Living Well / Enjoy Life Every Day in Bite Size Pieces”

Healthy / Independent

“I can do this myself”

Episodic / Intermittent

“I am annoyed”

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”

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

THIRD ‘A-HA’: JOURNEY TO CONSUMER ENGAGEMENT

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.

Recruitment Call.Bill mentions wife is in

hospice care. Stepson takes call and requests nurse to not call for one

month

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.

Bill notes he lost his sister in law. Bill shares his religious beliefs and current bible study classes with his

son.

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.

Bill is in ER for chest pain, requests callback

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.

EngagementsContinue

9/23

11/1

12/2

12/20

2/18

3/28

4/4

FINAL WORD

The future is here. Are you ready?

THANK YOU!!Dr. Charlotte S. Yeh, MD

Chief Medical OfficerAARP Services, Inc.

(617) 650-6105cyeh@aarp.org