701 Pennsylvania Ave. N.W.
Suite 700
Washington, DC 20004
(202) 737-5980
dmaa@dmaa.org
www.dmaa.org

Price
Members (DMAA, CMSA, NAM, AAPPO): $200
Non-members: $200

Sunday, Sept. 7, 8 - 9 a.m.

Using data from 380,000-plus members for the Hawaii Medical Service Association for a four-year period, this program rigorously evaluated the health risk and economic impact of participation in a wellness and disease prevention program over time for program participants verses non-participants. After statistically adjusting for age, gender, morbidity and baseline health care costs, participants demonstrated significant favorable changes in biometric measures and psychobehavioral risk. Return on investment ratios ranged from $2:1 to $3.3:1 depending on the year, analysis and filters used. Predictive modeling of increasing health care cost trajectories indicated a $505 savings per participant. Learn how to recognize the methodological challenges and potential solutions for rigorously demonstrating risk and cost reduction in a "naturalistic" setting; and opportunities for enhancing wellness and disease prevention initiatives with online interventions.

Caryn Ireland is the vice president for Integrated Services Inc., a wholly-owned subsidiary of Hawaii Medical Service Association (HMSA) that provides health enhancement services for members, employers and physicians. In this role, she is responsible for HealthPass, a unique statewide preventive health program for HMSA members.

Victor J. Strecher, PhD, MPH, is a professor and director for the Center for Health Communications Research, as well as director of cancer prevention and control at the University of Michigan. He is professor and director, Center for Health Communications Research, University of Michigan. In 1998, he founded HealthMedia, an Ann Arbor-based company that disseminates tailored, award-winning interventions for health promotion, disease prevention and disease management.

Sunday, Sept. 7, 9:10 - 10:10 a.m.

Health plans, employers and disease management vendors have a shared interest in a solid low back pain program. However, variability in the forces that drive low back pain utilization complicates the ability to evaluate programs. Learn about an innovative approach to segmenting the low back pain population into five clinically relevant categories, allowing vendors the ability to measure results with minimal clinical information loss. The results from a pre-post comparison study will be presented by low back pain segment with specific utilization, such as physical therapy, chiropractic, radiology and narcotic duration. Hear about the challenges and solutions encountered in the context of a comprehensive low back pain program evaluation in a large (>100,000 lives) health plan population as well as the factors that contribute to increased duration of narcotic analgesic usage for individuals with low back pain.

Thomas Kotsos, BS, is the manager of reporting and data analysis at HMC. Previously, he was a research scientist at CardioWorks and a clinical researcher in the Department of Medicine at the University of Illinois Hospital. He earned a bachelor's in biomedical engineering from the University of Illinois at Chicago.

Antonio P. Linares, MD, FAAFP, is regional vice president and national medical director for Anthem National Accounts. Previously, he was vice president of medical affairs at Lumetra; vice president of medical affairs at Adventist Health; and vice president and medical director at CIGNA Healthcare. He earned his doctorate at Case Western Reserve University.

Sunday, Sept. 7, 10:20 - 11:20 a.m.

The Healthcare Effectiveness Data and Information Set (HEDIS) includes specifications for the measurement of important clinical indicators. However, in the management of individuals with rare chronic disorders (e.g., cystic fibrosis, lupus, multiple sclerosis, rheumatoid arthritis) there are additional clinical indicators that require evaluation and intervention strategies. Hear about a collaborative approach to developing two such measures, chosen for their population applicability and significance, including specifications, calculation agreements, clinical interventions and quality improvement efforts. Specifically, this project focuses on the development of analytic measures and clinical intervention strategies to address guidelines from the American College of Rheumatology for appropriate disease modifying antirheumatic drug lab monitoring in rheumatoid arthritis and for surveillance of glucocorticoid-induced osteoporosis in long-term steroid users.

Jason G. Cooper, MS, is director of analytics and outcomes at Accordant A CVS/Caremark Company. He earned a bachelor's and master's in computer science from West Virginia University and a master's in biomedical engineering from Duke University. Mr. Cooper has performed NASA spaceflight software IV & V and led a non-profit research division.

Geraldine McNamara, BSN, RN, is director of population management at Blue Cross Blue Shield of Massachusetts. She has a bachelor's in nursing from Boston College and more than 25 years of hands-on clinical experience with 13 years experience in developing and implementing medical and disease management programs in the managed care setting.

Sunday, Sept. 7, 8 - 9 a.m.

Outliers are the few members of a population who incur extraordinarily high claims costs. Left unresolved, outliers could distort the cost-saving measurement for the care management program. Three methods for identifying outliers are recommended in the DMAA Outcomes Guidelines Report: the stop-loss method, the percentile distribution method and the standard deviation method. DMAA also lists two ways for treating outliers once they are identified: capping claims dollars above a threshold or removing outlier members and their entire claims costs. Learn about a study that developed a set of criteria to evaluate the effectiveness of different outlier solutions—combinations of outlier definition and treatment methods. The recommended outlier solution based on these criteria produces more valid, robust and stable cost-saving measurements.

Kejian Niu is staff vice president of analytics and research at HMC. Previously, Mr. Niu spent 12 years in financial industry developing and executing quantitative solutions for marketing and risk management. He has worked as research faculty member at University of Virginia.

Sunday, Sept. 7, 9:10 - 10:10 a.m.

The DMAA Outcomes Guidelines recommends using the average difference between historical chronic and non-chronic trends to adjust for the current year non-chronic trend. This recommendation is built on the assumption that the relationship between the chronic and non-chronic trend is relatively stable. The DMAA Methodology Workgroup tested this assumption using a large population with success. Hear more about the methods used to test the trend assumption, as well the results and its implications for trend adjustment using the DMAA recommended method.

Herman Jenich, MPP, CPHW, CHCA, is vice president of informatics for HMC and leads a multidisciplinary team responsible for client reporting, research and methods development, and data management. He has 18 years of experience in health care analytics and received his master's in public policy from the John F. Kennedy School of Government at Harvard University.

Kejian Niu is staff vice president of analytics and research at HMC. Previously, Mr. Niu spent 12 years in financial industry developing and executing quantitative solutions for marketing and risk management. He has worked as research faculty member at University of Virginia.

Sunday, Sept. 7, 10:20 - 11:20 a.m.

From year to year, large random fluctuations in claim costs can increase or reduce actual savings from a disease management program. Sponsors of disease management programs want to know how large a group or sample is necessary so that the effect of random fluctuations does not overwhelm the effect of claims reductions. Understand how to measure the fluctuations in calculated disease management savings in large commercial populations using an adjusted historical control methodology (the methodology that has become the industry standard and which is codified by the DMAA Outcomes Guidelines Report). Recognize the minimum sample size and confidence intervals to demonstrate program savings, as well as the use of a simple model for determining validity of program savings.

J. Ramsay Farah, MD, MPH, FAAP, FACPM, FASAM, CPE, CMRO, is chief medical officer for Calvert Health Partners. Previously, he was chief medical director of medical management for Nationwide Better Health, the medical director for quality improvement at Sierra Military Health and four other institutions. His extensive leadership includes numerous appointments as department chief or chair at hospitals, organizations and gubernatorial appointments.

Thomas C. Messer, ASA, MAAA, is vice president for Solucia Inc. He is a credentialed actuary and consults on disease management, risk adjustment applications, Medicaid and commercial health plans. He has previously been responsible for Medicare and commercial actuarial services at leading health plans. Mr. Messer holds a doctorate in mathematics from Duke University.

Sunday, Sept. 7, 8 - 9 a.m.

Traditionally, wellness programs are evaluated using either a variation of the adjusted historical control model as applied to disease management programs or a methodology that assigns a dollar value to the change between two points in time in each risk factor measured in the population. The first method is difficult to apply in a population setting in which all members are receiving interventions (case management, disease management, wellness) because there is no longer a "non-managed" population. Discover an evaluation of the dollar value of risk factors, using a commercial health plan data set. Understand how to develop a predictive model that relates health risk factors and claims costs; estimate the savings from risk factor reduction due to an intervention program; and illustrate the use of the dollar values to calculate savings from risk factor reduction.

Ian Duncan, FSA, FIA, FCIA, is president of Solucia Inc., a firm specializing in disease management program financial success and measurement. He has 30 years of experience in health care and insurance product design, management, financing, pricing and delivery, and serves on the boards of the Massachusetts Health Insurance Connector and the Freelancers Insurance Co.

Sunday, Sept. 7, 9:10 - 10:10 a.m.

Indirect costs associated with health risks attributable to lost productivity may be several times larger than direct medical costs. Identification of key health risk drivers of productivity impairment is critical in the allocation of resources. This study identified key risk driver of productivity impairment using a multivariate regression approach. The model accounted for 12.1 percent (p=.000) of the variance in productivity impairment and included stress, depression, obesity, one or more chronic conditions, inactivity and impaired sleep. The model can be used to help decision-makers to better understand the unique contribution of each health factor to lost productivity within an employer setting; make decisions regarding resource allocation; and estimate the expected cost savings if the health risk were to be modified.

Paul Medrek, MD, MPH is director of occupational medicine at Baystate Health, a 10,000-employee integrated health care system in western Massachusetts. He has been involved with building a first-class wellness program, including a health risk assessment, integrated data warehouse and wide array of wellness and disease management programs.

Steven M. Schwartz, PhD, is the director of research for HealthMedia. He has been the research director for Oakwood Healthcare and the coordinator of behavioral medicine services for the University of Michigan. Dr. Schwartz has published in the areas of health and behavior.

Sunday, Sept. 7, 10:20 - 11:20 a.m.

The DMAA Outcomes Guidelines initiative, now in its third year, continues to develop guidelines in areas of outcomes measurement for disease management, wellness and other population health improvement programs. This session will review the new guidelines released at the conference, including guiding principals for evaluating a wellness program, measure recommendations for the operational aspects of a program, self management, presenteesim, medication adherence and criteria for selecting a population.

Sue Jennings, MPH, PhD, is an independent consultant focusing on supporting disease management programs. Prior to becoming a consultant, she was a senior director at Pfizer Health Solutions Inc. She is co-chair of the DMAA Outcomes Steering Committee.