The Healthy Aging Project:
Positioning Group Health as a “trusted resource” for Healthy Aging
Karen Lewis Smith, Director Medicare Strategy
Chris Fordyce MD, Medical Director Healthy Aging Project
Practice Change Fellows, January 2009
Session Overview
• Overview of Group Health (GH)
• Business case for the Healthy Aging Project (HAP)
• HAP: Vision, core content and usages
• Filling out the Chronic Care Model in Healthy Aging
• The Medical Home
• Aligning the business and clinical imperative for the Medicare
population: education and support in Healthy Aging
• Provider supports
Group Health Cooperative
• Consumer governed, not-for-profit organization founded in 1947
• Integrated model: Local community-based health plan + delivery system
• Service Area: 20 counties in WA and 2 counties in N. ID
• 575,000 Members
• 9,750 staff, including 889 Group Health Permanente Group physicians
• Facilities: 1 Hospital, 25 primary care clinics, 6 specialty units,
• Contract with 44 hospitals and 9,100 physicians
• All lines of business
GH Medicare:
Strategically Important LOB
• Strong legacy, core competency for organization
• Medicare enrollment is significant to GH
• 10% of enrollment but 30 % of revenue
• Profitable LOB – Significant contributor to margin
• GH Medicare enrollment has been significant to WA state
• 8% of total Medicare eligible's in state – 13% in current service area
• 40% of total MA enrollees in WA
• However: we have been losing 1 – 2K Medicare members for past couple of
years AND our market position is being significantly challenged
2008 MA Plans
$350
= GHC
= HMO
$300
= PPO
= PFFS
$250
= MSA
$200
$150
$100
$50
$0
Washington State Segment Growth
Health Plan
HMO
Arcadian
Pacificare (United)
Molina
CHPW
Essence
Puget Sound Health Partners
Group Health
PFFS
Humana
Sterling
Other
United
PPO
Regence (Asuris)
Total:
Enrollment
% Increase
January-08
3,455
31,786
496
1,669
336
1,720
56,435
183
15,272
951
6,222
1,326
24,920
7,080
7,741
1,143
9,648
6,129
1,519
81%
5,639
9,886
4,247
75%
121,196
146,850
25,653
21%
* 85% of the growth in HMO plans came from 4 niche players
Source: CMS
∆
January-07
2,792
32,304
221
194
57,418
663
(518)
275
1,475
336
1,720
(984)
5%
*
Take Away Messages
To be successful, GH needs to play differently in the Medicare space
• Honed HMO product offerings
• SNP
• Value-based benefit design
• Choice products
•PPO
• New service areas
• Go where the Seniors are growing
• Non-product initiatives
• The Healthy Aging Project
The Business Case for HAP
•Highlights our distinguishing strengths:
•Primary care based structure w/health promotion/prevention as core
competency
•
•Chronic disease management expertise
•High tech/High touch applications
•Leader in evidence based medicine and
Established
• Significant
nation’s first
contribute
population-based
to the bodybreast
of
cancer screening
work onprogram
evidence based healthy aging
•
Developed
• First
“Freeprovide
and Clear”,
evidence
the endorsed
that widelyasused
one of the
heart
most
drugs
effective
may protract brain against
•
smoking cessation
Alzheimer's
programs
•
Developed
• First
first to
evidence
link physical
basedactivity
physical
and
activity
social
• Developed
the Chronic
Care
Model,
currently
being
program
w/proven
isolation
as
results
the
two
most
statistically
•National leader in e-health and secure
used by WHO online
important
determinant of healthy aging
messaging
• Rated #1 in State
for
diabetes
careyoga
and registered
7th in
nation
Firstoftoour
connect
and
massage
• •50%
population
on with
(HEDIS)
improvements in chronic back pain
www.ghc.org
• Our Medicare Plan
was
one ofrefill
America’s
Best
Developed
evidence
onordered
key geriatric
• •75%
of named
prescription
online
Health Plans (US News
and
World
Report)
syndromes and threats to functional
healthy aging status and quality of life
• Part of national “think tank” conducting
ground braking research on the
anticipated effect of the Baby Boomers
as they age
•Adds to the intellectual capital of the organization and the community
• Contributes to organizational growth goals – enrolled lives and lives
“touched”
Overview of HAP
Vision: Position GH as a “trusted resource” for healthy aging
•Create a national model for preventive care for older adults in the framework of the
chronic disease model and guided by the new medical home model for primary care
•Create a platform on which we build a reputation that will make people want to
come to us for care and information
Foundational Thinking
•GH is a steward and content expert for the evidence base around healthy aging
•Our purpose is to package healthy aging resources in a way that is easily
accessible to the aging population both in our clinics and in communities where they
live
•In packaging, we will draw on our own expertise and, where indicated/necessary,
will select the appropriate organizations w/content expertise to partner w/and broker
the programs they’ve developed
Healthy Aging Project:
The Toolkit
Focus: Develop core content and tools in healthy aging with focus
on prevention, health promotion and self management
Step 1: Development of a Healthy Aging Toolkit
• Phase 1 toolkit focus is on health promotion/prevention, key
geriatric syndromes and advanced planning
• Phase 2 will add prevention/management of chronic diseases and
topics of special interest to seniors
• Toolkit products to include: 1)Screening and assessment; 3)Clear,
evidence based interventions; 3)Goal setting/individualized
wellness plan; 4)Tracking tools and support; 5)Educational
resources for both patients and providers
Healthy Aging Program:
Toolkit Uses
• Internally in clinical practice
• Physical exam/group visits
• Backbone of curriculum for MDs around approaches to geriatric
care
• Through MyGroupHealth and Incontext
• Member education
• In the community locally and nationally
• Community forums
• As part of an offering to senior retirement communities
• As foundation for furthering a policy agenda on healthy aging
Healthy Aging Program:
Building it out
•Videos/DVDs
•Companion collateral materials
•Health Risk Assessment connectivity
•Web-based functions and services
•“Ask the expert” function
•Access to discussion rooms
•Access to Healthwise tools
•Related healthy aging products
•Ability to customize and package for unique needs/populations
Beautiful young people
are an accident of nature,
but beautiful old people
are works of art.
--Eleanor Roosevelt
Chronic Care Model
Community
Health System
Health Care Organization
Resources and
Policies
SelfManagement
Support
Informed,
Activated
Patient
Delivery
System
Design
Productive
Interactions
Decision
Support
Clinical
Information
Systems
Prepared,
Proactive
Practice Team
Improved Outcomes
The Medical Home:
Group Health’s commitment
•Rollout to all Primary Care Clinics in the next 18 months
•Decreased panel sizes, template flexibility
•Significant increase in MD’s, mid levels and support
staff
•Pilot demonstrated in 12 months significantly increased
patient and staff satisfaction
•Cost neutrality
•‘The relationship between the personal care physician
and the patient is the core of all we do.’
Healthy Aging Toolkit
Phase one: 12 module introduction
Healthy Aging Overview
General Preventive Care
 Screenings, immunizations, chronic disease management
Key Geriatric Syndromes:
 Physical Activity
 Social Activation
 Memory
 Nutrition
 Falls
 Depression
 Urinary Incontinence
 Advance Planning
 Medication Management
Putting it all together: Planning for the ‘What If’s’
Health Enhancement Project
Group Health and Pac Med patients >70 yo
Geriatric Syndrome screening, assessment, intervention
and follow-up by ARNP/MSW team based in a senior
center
Evidence-based interventions known to improve overall
health outcomes with clear roles for each of the multidisciplinary team
Shown to decrease healthcare costs, improve function
and QOL in 6-12 months
Partnerships between health plans, patients,
practitioners and community resources
Social and Physical Activity:
The Biggest Bang for the Buck!
There are only 2 things shown to statistically
significantly affect overall health outcomes for
the Medicare Population: social isolation on the
negative side and regular physical activity on the
very positive one.
There is no more important ‘prescription’ to
write, individualize and assure compliance with
than regular PA for all patients, whether robust
or frail, living independently or in nursing
homes.
Physical Activity Recommendations:
The Surgeon General Report
• Endurance: moderate aerobic activity 5
days a week for at least 30 minutes
• Flexibility: stretch every day
• Strength training: 2-3 days per week
• Balance training: 3 times a week for
those in need
GHC Senior Care Integration Model
POPULATION CONTINUUM
Health Status Sub-populations
End of life
Frailty
Hospice, home care, palliative care
2-4%
(~700 or 1% use 20% of hospital days)
Functional decline
Active Chronic Disease
Preventive Care, Physical activity programs, chronic care
management, case management, Hospital, SNF, NH, BH
Preventive Care, physical activity programs, chronic care
management, PT, OT, ST, MSW, BH
80%
(100% of reimbursement by 2007)
Preventive Care, Physical activity programs, chronic care
management, RN’s, clinical pharmacists, specialty care, BH
At risk for functional decline
Preventive Care, Physical activity programs
At risk for chronic disease
Preventive Care, Physical activity programs
Robust and healthy
20%
Preventive Care, Physical activity programs
Evidence Based Clinical Guidelines
Increasing physical activity levels is
the most important intervention for
virtually ALL chronic disease
management and prevention
programs.
In diabetes the evidence clearly
shows exercise and diet interventions
are better than metformin in
controlling A1C’s (NNT 6.9 for
exercise and 13.9 for metformin).
Diabetes Care 2000 DPP; 23:16191629
Group Health Physical Activity Programs
Moving toward a Full Spectrum Formulary
Silver Sneakers
Enhance Fitness
Coop In Motion
Zoo Walkers
Diabetic Exercise Kit
Home exercise videos
Heart Care and COPD programs
Clinic based groups and classes
(Dancing Ladies and a Few Good Men)
Take Care Products
HEDIS/HOS
Advanced Directives and
End of Life Resources
•Living Will
•Durable Power of
Attorney
•Durable Power for
Health Care
Decisions
•POLST
•Resources to be
used widely:
•Home Care
•Palliative Care
•Hospice
Advanced Planning:
Considering the ‘What-Ifs’
What if:
I can no longer drive?
I cannot cook or clean regularly?
I am temporarily unable to care for
myself?
I cannot do regular bathing ?
I am permanently unable to care for
myself?
I cannot manage all my finances?
The power goes out?
I get sick?
The phone goes out?
I am unable to walk easily?
I develop dementia?
Someone is trying to break in my
house?
There is a natural disaster?
Group Health Permanente Group
1. ALL providers seeing older patients need a fundamental
expertise in geriatrics.
2. Possible ‘certificate in geriatrics’ to be tied to
practice/compensation.
3. Providers and entire multidisciplinary team to offer
modules and expertise ‘in the communities where older
people live’.
4. Module development across multiple specialty lines.
5. Tie to ‘Art of Aging’ for PBS.
6. Encouragement to volunteer/sponsor education in Healthy
Aging.
Healthy Aging Toolkit
Phase Two
•Chronic Disease Management modules: arthritis, osteoporosis,
diabetes, heart disease, lung disease, neurologic disease,
fibromyalgia, chronic fatigue, cancer
•Modules on topics of Special Interest: Pain management,
digestion, skin care, sleep, downsizing, vision and hearing
problems, sexuality, emergency planning, community resources
•Web-based functions and services: ‘Ask the Expert’, Chat
rooms
•All built out on the myGroupHealth.org website and integrated
into patient care in the Medical Home Model
The Chronic Care Model for
Healthy Aging
1. Self Management support: modules on healthy aging
essentials and areas of interest; screening and
assessment, E-B intervention plans, goal setting,
tracking tools and educational resources; chronic
disease self management classes live and online
2. Delivery system design: Medical Home Model
3. Decision support: guidelines and protocols, EPIC,
Incontext and provider training
4. Clinical Information Systems: fully integrated with
EPIC and myGroupHealth.org.
Building Partnerships…
On To
Organizing Wisdom:
Healthwise Story
Questions/Discussion