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HomeMy WebLinkAboutMINUTES - 12172002 - C.141 TO: BOARD OF SUPERVISORS Contra FROM: FAMILY AND HUMAN SERVICES COMMITTEE }; =' ';;, DATE: DECEMBER 9, 2002 °;... . `"' t SUBJECT: PILOT ON INCREASING PARICIPATION IN HEALTH unty CARE AND PREVENTION BEHAVIORS /0 SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION Recommendation: 1. ACCEPT the report from the Health Services Director regarding a program utilizing small incentives to promote increased patient participation in the management of chronic diseases and high risk pregnancies 2. RECOGNIZE that increasing consumer participation has been shown to improve health outcomes,and that small incentives have been used successfully by Contra Costa Health Plan and other Health Plans to motivate patients to take a more active part in managing their health care. 3. RECOGNIZE that the Contra Costa Health Plan is participating in a Robert Wood Johnson (RWJ)grant program that is aimed at improving quality of care using incentives. 4. AUTHORIZE the Health Services Director or his designee to utilize small incentives to promote increased patient participation in programs to promote improved management of chronic diseases, high-risk pregnancy and preventive health care. 5. APPROVE up to$30,000 annually in incentives funded by Health Plan premiums to increase participation in health care and prevention behaviors and to participate in the RWJ Quality Initiatives Pilot Program. 6. DIRECT the Health Services Director to report annually on the program to the Contra Costa Health flan Joint Conference Committee and Board of Supervisors Family and Human Services Committee. Background: CCHP is charged with improving members' health status by providing access to primary care and preventive health measures in order to avoid more costly and unnecessary emergency, specialty and/or tertiary care services. In order to achieve the best outcomes,CCHP is again requesting authority to use modest incentives as a way to increase participation with ongoing and preventive care, such as immunizations,well child visits, prenatal care, and routine screening tests. Additionally it is essential to address chronic health conditions in early stages while they are still treatable and preventable. To maximize use of preventive health care services, the plan makes use of various innovative strategies that go beyond typical curative care. Health promotion activities, health education classes, case management of high-risk health conditions, and outreach activities that increase health awareness and promote members' ability to take responsibility for their own health are examples of these strategies. Utilizing incentives is another innovative way the plan works with its members to improve their health. CONTINUED ON ATTACHMENT: x YES SIG URE: XX RECOMMENDATION OF COUNTY ADMINISTRATOR x RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER u� SIGNATURE(S): MARK DESAULNIER DERAL D. GLOVER ACTION OF BOARD ON Dece nber 17, 2002 APPROVE AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENTNone- } AND CORRECT COPY OF AN ACTION TAKEN AND ENTERED ON THE MINUTES OF THE BOARD AYES: NOES: OF SUPERVISORS ON THE DATE SHOWN. ABSENT: ABSTAIN: ATTESTED Decambpr 17. 2002 JOHN SWEETEN,CLEFIK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact Person: Milt Camhi(5-6000) CC: CAO BY: DEPUTY SUBJECT: PILOT ON INCREASING PARiCIPATION IN HEALTH CARE AND PREVENTION BEHAVIORS To further promote active and ongoing participation in these activities,it is customary and effective for health plans to use incentives such as small rewards for completing certain educational requirements. Over the past year CCHP has used incentives to increase participation in asthma self-management including asthma education and to increase participation in prenatal care by high-risk women. In addition,this year CCHP,working in collaboration with other publicly approved health plans,has been awarded a RWJ Grant to improve quality of care utilizing incentives targeted at adolescent well-care,well child care from 3-6 years and pediatric obesity. CCHP is seeking authority to continue our incentive program. Incentives range from $10- $25 certificates (or in kind incentives)for food or baby supplies or products to promote disease control such as hypoallergenic products for asthma patients. Each program offering incentives shall monitor the program quarterly to assure that the money is being used as intended.No one individual shall receive duplicate incentives or participate in more than two(2)different incentive programs per year.Furthermore,the plan will comply with Federal and State regulations regarding the use of incentives.The total cost of the program for a year will be less than$30,000. This program shall be reviewed by the Chief Executive Officer CCHP, the Health Services Director, the CCHP Joint Conference Committee, and the Board of Supervisors' Family and Health Services Committee. Source of Funds: Enterprise 11 (funded by Contra Costa Health Plan premiums) Report to the Family and Human Services Committee Contra Costa Board of Supervisors December 9, 2002 By Kate Colwell M.D Assistant Medical Director Contra Costa Health Plan Recommendation We are recommending that the Board of Supervisors approve $30,000 per year from Contra Costa Health Plan (CCHP) premiums for small incentives to members in order to increase participation in health care and prevention behaviors. Background In 2001 the Board of Supervisors approved utilization of small incentives to promote increased patient participation in management of chronic diseases, high-risk pregnancy and preventive health care. Incentives range from $10- $50 certificates for food or baby supplies, or products to promote disease control such as hypoallergenic products for asthma patients; most certificates are for $25 or less. Each program offering incentives shall monitor quarterly to assure that the incentives are being issued as intended. No one individual shall receive duplicate incentives or participate in more than two(2)different incentive programs per year. Incentives to change behavior are rapidly gaining acceptance as an effective way to motivate participation in self-care. Health professionals can recommend and educate, but cannot change health outcomes unless patients choose to embrace healthy changes. As a physician I can tell you that telling people what to do is only so effective. Showing people how it is in their self-interest to change is more effective. Health Plans throughout the country are increasingly using incentives to promote healthy behavior. New Rewarding Results Grant to pilot different Incentives A year ago I reported to you about our perinatal program and our asthma disease management program and I have updated material to show you on those programs, but first I want to tell you a little bit about our new"Rewarding Results"grant. Robert Wood Johnson Foundation (RWJ) is a prominent national foundation that makes grants to innovative health care projects. Recognizing the increasing use of incentives across the country, they have begun awarding grants to groups that can evaluate the effectiveness of different types of incentives toward changing behavior. No single public health plan has the financial or administrative resources available to develop and administer multiple incentive programs for each quality project. Working collaboratively, though, a group of health plans can use different incentives and compare effectiveness. We are participants in a grant that was awarded in September 2002 to Integrated Healthcare Associates in Walnut Creek to bring together eight Local Initiative Health Plans(public Medi-Cal health plans) in order to compare the effects of different incentives on behavior change. We will be participating in 3 out of 4 selected measures in order to compare the effects of financial and/or non financial incentives on our members and providers, compared to the effects of similar and different incentives by other health plans. The money in this grant is not for incentives; the incentives must be paid for by the health plans. The grant funding is data collection and analysis by an outside firm. We are considering small incentives for increased health prevention visits for children three to six years old and for adolescents, and to improve pediatric obesity. 1. Some plans have already used CDs, movie tickets and similar small gifts to encourage teenagers to see a doctor and get preventive care. We would like to try something similar to improve our low rates of teenagers who are getting preventive care. 2. We have not yet decided on member incentives for increased 3-6 year old health visits but they would probably be similar to our ongoing asthma and perinatal programs. 3. We will also consider how to offer modest incentives to providers to increase their attention to pediatric obesity. This grant has a year for planning and development, a year for implementation and then data collection and analysis in the third year to tell us if we really did change behavior. Up to now,we have not had the luxury of such an in depth look at our incentive program, so in 2005 I should be able to give you much more precise information about exactly how much our incentives are effecting behavior and better estimates of how much we've saved. Turning now to our existing programs: Perinatal. The charts in your packet represent data that has been collected continuously since the inception of the Baby Watch incentive program in 2000. It is cumulative data for 370 women who have participated in the program and 3255 women who did not choose to participate. Chart 1: "Weeks Pregnant When Initiated Prenatal Care" This chart shows that women who participated with Baby Watch initiated care at the l It"week of pregnancy. This is compared to non-participants, who entered care at an average of the 15`h weeks of pregnancy. This indicates that the program is successful in incentivizing women to initiate prenatal care one month earlier than non-participants. Chart 2: "Average Number of prenatal Visits Completed" This chart shows that women in the Baby Watch program completed an average of 10 prenatal visits, compared to an average of 9 visits for non-participants. We believe that the extra visit may represent the earlier initiation of care reflected in the information in the first two charts. Chart 3: "Neonatal ICU Admission Rates" This chart shows that women in Baby Watch experienced a 1.62% rate of NICU admissions, compared to a 2.37% rate of admission for non-participants. This seems like a small difference, and in fact, is specifically.75%difference. It becomes significant when you consider the average cost of an NICU admission. Looking at a simple calculation, if you apply the 2.37% non Baby Watch admission rate to the 370 women in the Baby Watch group that would have occurred without the program,we could have experienced roughly 9 NICU admissions instead of 6. On average these cases cost $50,000 per baby, but it's not unheard of to have five to ten times this average cost for a complicated NICU baby. Charts 4 and 5: "Prenatal care in the first trimester"and"Check Ups After Deliver These are our HEDIS rates for 2000, 2001 and 2002 HEDIS is the Health Employer Data Information Set, a quality report card that allows for comparisons between health plans. Because of the restrictions necessary to allow for meaningful 2 comparisons between plans, HEDIS rates undercount the number of members who receive a service. These charts show the steady progress we've made at the health plan in encouraging women to get recommended prenatal and postpartum care. We believe the use of incentives through the Baby Watch program has strongly contributed to improvement in pregnancy care. Chart 6"Members Perspective on Incentives" The next chart is a brief survey of prenatal members perspectives on how the incentives helped there. As you can see, half of the members felt that incentives helped them to increase their knowledge or self-care, Asthma Disease Management Chart 7. "CCHP HEDIS Asthma Measure Rates" This chart gives a comparison of 2001 and 2002 HEDIS—rates for the "compliance with appropriate asthma medications" measure. This shows a very significant increase in compliance with appropriate asthma medications. We believe that some part of the increase we saw is caused by a change in the technical requirements that allowed more drugs to be counted. The other part of the increase is due to our aggressive outreach that includes member incentives for participating with education about improving self-management skills. Regulatory Compliance In September,just as we were receiving the Robert Wood Johnson Grant the Federal Office of the Inspector General came out with an opinion about the use of incentives by providers. Their opinion focused on illegal attempts to incentivize Medicaid and Medicare patients to choose one doctor over another, but the language was sufficiently vague that it has been unclear whether or not it would apply to health plans. The California Department of Health Services, which administers the Medi-Cal program, has been very supportive of incentive programs to improve health care participation and health outcomes. They are currently seeking a legal clarification of whether any of the opinion applies to public health plans. If they do determine that we are affected by this opinion, we will of course comply. It may mean providing in kind incentives (baby food instead of a certificate to Target) and in smaller amounts, but we feel confident that we can comply with this opinion if necessary and still continue with our incentive programs. Summary In closing. I hope I've shown you that we are able to show steady improvement in members who participate in our asthma and perinatal programs. It is clear from some of the member comments that the incentives are important in helping them choose increased participation in their health care and self-care. 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