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

Sunday, Sept. 7, 1:30 - 2 p.m.
PACESETTERS SERIES · SPECIAL INTEREST SESSION

DMAA conducted an in-depth, comprehensive study on the state of the disease management and wellness industry. This study was specifically designed to deliver new quantitative insights regarding size of the industry, performance of disease management and wellness programs, future growth plans and industry trends. This session will present the final report, which identifies the most prevalent payer-sponsored disease management programs, program measures of success and the disease management programs that most effectively reduce care costs.

Elaine Mischler, MD, is the principal of Mischler Consultants LLC and works primarily with self-funded employers on health care strategy and innovation. She is the co-chair of DMAA's Market Analysis Committee. Dr. Mischler is a physician executive with more than 30 year of experience as a clinician, teacher, speaker and researcher in academic, community health organizations, health benefits administration and managed health care.

For nearly three years, this care management program has been providing relationship-driven, hands-on care management in collaboration with a Medicare health plan in caring for the sickest and most frail Medicare patients living in a community (1 percent to 3 percent of the Medicare population). This presentation will focus on the needs of this population, patient identification, successful interventions, clinical improvement outcomes that improve quality of life and cost reductions of more than 30 percent that have continued over time.

John Charde, MD, is the vice president of strategic development for Enhanced Care Initiatives Inc. He has worked in managed care for 25 years in various physician executive roles. For the past eight years, Dr. Charde has been involved in developing and implementing chronic care programs nationally.

Dirk Wales, MD, is the chief clinical officer for HealthSpring. He received his doctorate from Wright State University and internal medicine training from Northwestern University. He has served in a variety of roles in medical management for the past 12 years.

The Billings Clinic is one of 10 participants in the Centers for Medicare and Medicaid Services Physician Group Practice Demonstration Project evaluating innovative approaches to chronic diseases within the provider setting. This project has demonstrated over the past two years extremely positive results reducing hospitalizations in excess of 40 percent for all cause admissions when compared with this population's prior rates of hospitalization. In addition, the project has documented a total of $2.8 million savings, which included a $2.3 million savings to Medicare resulting from averted hospital admissions from January 2006 to December 2007. Through the use of remote telemonitoring coupled with effective enrollment, engagement and retention strategies, this project was able to reach heart failure patients in their large, mostly rural area. This session will explore methods used to better engage Medicare members by better engaging the physicians and other caregivers that treat them.

F. Douglas Carr, MD, serves as the medical director of education and systems initiatives for Billings Clinic. He received his doctorate from Northwestern University and master's in medical management from Tulane University. He is board certified in internal medicine.

Randall E. Williams, MD, is the CEO of Pharos Innovations, a patient behavioral change technology company. He received his doctorate and training as a cardiologist specializing in heart failure care from Johns Hopkins University. He also is an assistant professor at Northwestern University's School of Medicine.

By incentivizing Medicaid providers to employ evidence-based guidelines for screening and treating chronically ill patients, two state Medicaid programs believe they can enhance health outcomes and reduce utilization. Through collaboration with provider stakeholder groups, the Pennsylvania and Wyoming pay-for-performance/participation programs aligned evidence-based guidelines and clinical interventions with monetary incentives. Staffs worked closely with provider practices to help them understand the financial and clinical benefits, as well as launch new initiatives to support change. Hear about the programs from a state and physician perspective—including barriers to implementing the programs—and the impact this approach has had on improving bottom lines, patient education work flows and health outcomes. A comparative study in Pennsylvania suggests that patients whose primary care provider participated in pay-for-performance/participation programs have lower inpatient admissions and claims costs.

James Bush, MD, FACP, is Medicaid medical director for the Department of Health's Office of Health Care Financing, with the State of Wyoming. He has been a practitioner of internal medicine, chief of staff at Poudre Valley Hospital, president of the Colorado Society of Internal Medicine and Fort Collins IPA and a faculty member at the University of Colorado.

David Kelley, MD, MPA, is CMO for the Public Welfare Office of Medical Assistance Programs, with the Commonwealth of Pennsylvania. He oversees the clinical and quality aspects of the program that provides benefits to more than 1.9 million recipients. Dr. Kelley has implemented a newly expanded primary care case management program and three pay-for-performance programs.

This session will discuss a study conducted in a Medicare fee-for-service demonstration project to determine how to improve enrollment and engagement rates in a disease management program for dual-eligibles in Florida offered through Medicare, a typically hard-to-reach population. The session will discuss the process and outcomes of the study. Attendees will learn which techniques can be helpful to improve enrollment and engagement rates in a Medicare fee-for-service population; how to interpret results for enrollment and engagement; and opportunities for replication.

Linda M. Magno serves as director for the Medicare Demonstrations Group for the Centers for Medicare and Medicaid Services. She has held senior policy leadership positions with the American Hospital Association and CMS' predecessor, the Health Care Financing Administration. She earned a master's in public affairs from Princeton University.

Christobel E. Selecky is president and CEO of LifeMasters Supported SelfCare Inc. She has served in a variety of capacities with DMAA since 2000, including immediate past President. Ms. Selecky is on the advisory boards of the Health Industry Forum and Robert Wood Johnson National Advisory Committee on eHealth Technologies.