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

Monday, Nov. 24, 8:30 - 9:30 a.m.
PACESETTERS SERIES

This presentation will highlight an advanced medical home demonstration project between an integrated health system and health insurance company, a novel approach that enhances care coordination for primary care patients and intensifies chronic condition care to improve health and financial outcomes. The presentation will define the advanced medical home, describe the model of care delivery and review outcomes. Building on the success of an earlier diabetes program and restructuring nurse roles to keep increased nurse salary costs to a minimum, the demonstration project focuses on diabetes, coronary vascular disease and hypertension and integrates preventive care services. The population, adults seen at one of four project clinics, is estimated at 3,164 patients.

Wanda Hanson, RN, MSN, coordinator, chronic disease, MeritCare Health System

Wanda Hanson, RN, MSN, is chronic disease coordinator at MeritCare Health System. She received her bachelor's in nursing from the University of North Dakota and her master's in gerontological nursing from the University of California, San Francisco. Ms. Hanson is experienced in hospice and home care.

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Monday, Nov. 24, 9:15 to 10:15 a.m.
SPECIAL INTEREST SESSION

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.

Christobel E. Selecky, president & chief executive officer, LifeMasters Supported SelfCare Inc.

Christobel E. Selecky is president and chief executive officer 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.

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Co-existence of mental health and substance abuse (MH/SA) with medical illness is significant. Estimates of comorbidities range from 20 percent to 80 percent in primary care, with a 25-year disparity in life expectancy between the general population and those with serious mental illness. A solution to documented access issues might be integration of mental health practitioners within primary care. Hear about a community model from Cherokee Health Systems that couples primary care education with screening and treatment of common MH/SA conditions by co-locating behavioral health providers in the primary care clinic and organizing integrated practice teams. This model provides practical applications of behavioral health, including medication adherence, health behavior change, chronic pain management, weight management and smoking cessation. Outcomes presented include demonstrated effectiveness in improving outcomes, ensuring appropriate utilization, reducing medical costs and raising patient and provider satisfaction.

Dennis Freeman, PhD, chief executive officer, Cherokee Health Systems
Adrienne Mims, MD, MPH, medical director, GAMMP, APS Healthcare Inc.

Dennis Freeman, PhD, has served as the chief executive officer of Cherokee Health Systems since 1978, a community-based provider of integrated primary care and behavioral health services in Tennessee. Former Surgeon General Dr. Satcher presented him with the 2007 Best Practices in Primary Care Award at the National Center for Primary Care conference.

Adrienne Mims, MD, MPH, is medical director of a disease management program, GAMMP, at APS Healthcare Inc. Previously, she was a physician administrator in health promotion, disease prevention and patient education, and maintained a clinical practice in family medicine and geriatrics.

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In 2007, DMAA began developing a second survey tool for its members to use in assessing the satisfaction of those they serve. Phase I of the Provider Satisfaction initiative included three focus groups with physicians from across the United States to hear their experiences with population health improvement programs. Phase II will be the development of the actual survey instrument. Session participants will hear the focus group findings to include physicians' evaluations of disease management programs in relation to their practice of medicine. The survey instrument will be introduced and the key aspects of the tool highlighted.

Claudia L. Schur, PhD, vice president & deputy director, Center for Health Research & Policy, Social & Scientific Systems

Claudia L. Schur, PhD, is vice president and deputy director of the Center for Health Research and Policy at Social & Scientific Systems. Dr. Schur has more than 20 years of experience in designing surveys and analyzing health care data sets to improve the information available to policymakers.

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Employers can play a role in helping their employees find both a medical home and improve the impact of disease management services by providing workplace health care services combined with disease management. This session will present results of an intensive year-long study of integrated disease management for employees, retirees and dependents of a large manufacturing company. Learn about improvements in engagement and enrollment rates attained by leveraging the trusted clinician in the workplace; higher retention rates at six months and one year compared with published retention rates from traditional telephonic disease management programs; and enhanced clinical outcomes among integrated disease management participants. The results of this study suggest that by coordinating the "trusted clinicians" at the workplace with remote telephonic nurse coaches—aligning care givers into a single, integrated delivery model—not only creates a true medical home but also brings us closer to realizing the potential value of population heath management, which includes healthier employees, reduced health care costs, increased productivity and reduced absenteeism.

Sharon Glave Frazee, PhD, vice president, health informatics & research, Take Care Health Systems

Sharon Glave Frazee, PhD, is the vice president of health informatics and research for Take Care Health Systems.

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Managed care organizations and provider groups have been separately using disease management approaches to assist their members and patients with chronic diseases. To support the medical home model, a health plan partnered with a provider group to increase patient activation and integrate diabetes disease management. This initiative increased member engagement from 23 percent to 47 percent and provided more efficient care delivery resulting in improved clinical outcomes, exceptional care and a flexible project structure with high portability potential. Understand a common clinical framework for improving chronic illness care, how to adapt the model for use in other settings and key factors to deliver successful outcomes.

David Brumley, MD, MBA, medical director, health management, Blue Cross Blue Shield of Massachusetts

David Brumley, MD, MBA, is the medical director of health management at Blue Cross Blue Shield of Massachusetts. He chairs the DMAA Quality Awards Committee. He previously served as senior medical director at Oxford Health Plans, with Medical Scientists Inc. and Blue Cross Blue Shield of Rhode Island.

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