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FOR IMMEDIATE RELEASE: Advanced Care Management Task Force Activates WASHINGTON, DC - The Advanced Care Management Task Force (ACMTF), a cooperative outcomes research effort between four members of the National Association of State Comprehensive Health Insurance Plans (NASCHIP) and Health Integrated announced today at the National Managed Health Care Congress (NMHCC) initial results of a breakthrough program that manages the nation's sickest of the sick. High-risk health insurance pools are state-created insurance programs designed to serve small, but very important segments of the individual insurance market - those few individuals who have a condition such as cancer, depression, heart disease, stroke, diabetes, AIDS, asthma, MS or other chronic illness which results in their inability to be accepted by a health insurance company. "Consumers in state risk pool programs have access to a comprehensive major medical plan. Although they pay somewhat higher rates for the coverage there is a cap on premiums, and the programs are subsidized. NASCHIP is an association of 30 state risk programs that provide health care coverage for this population," according to Bruce Abbe, NASCHIP Board Member and Vice President of Public Affairs Communicating for Agriculture and the Self-Employed. Within a traditional commercial health plan population, 75% of health plan participants are considered well and account for 20% of the total cost of care; 22% have a chronic illness or acute care condition to comprise 50% of the total; and 3% of the participants have high cost conditions which consume 30% of the total resources. Within the NASCHIP system, statistics show a different cost/condition ratio: 43% of participants have a non-chronic acute condition and consume 30% of the resources; 12% have a chronic illness or acute care condition and account for 20% of the total; and 45% of the participants have high-cost conditions that require 50% of the total resources. Off-setting the costs associated with this small percentage of the population are the findings just released by Health Integrated validating a 3:1 return on a program specifically designed to care for individuals with high-cost health needs. "The market conditions have created a crisis in the availability and affordability of individual health insurance for consumers with pre-existing medical conditions, and it is not going to improve soon," according to Barbara Brett, Executive Director, CoverColorado and Team Leader, ACMTF. "It is clear that enrollment rates from individuals with chronic illnesses will continue to increase amongst state comprehensive health insurance plans nationwide." CoverColorado is a non-profit organization, insuring over 5,000 Coloradoans whose health prohibits or substantially limits access to commercial insurance. "CoverColorado is committed to providing an enduring program of health insurance options that offer choice and cost effective, evidence-based strategies to manage diseases and improve participants' health status," noted Brett. A major challenge facing all risk pool executive directors is finding a steady source of funds for state comprehensive health insurance plan operations. "In a typical plan, about 10 percent of participants are sick and others pay for them, stated Brett. However, in the high-risk business everyone is ill, everyone has a claim or they wouldn't be here. There's not the luxury of having a lot of healthy people to offset the cost (or risk) like most community health plans," continued Brett. Health Integrated's Advanced Care Management Report Card estimates a cost savings of $1.4 million since the program was implemented in May 2002. "We believe CoverColorado's Advanced Care Management Report Card should serve to significantly advance the credibility of advanced care management program outcomes," said Cheri Lattimer, Health Integrated Senior Vice President and ACMTF cooperative research project clinical team member. Health Integrated is very confident that CoverColorado's year-to-date results will positively impact both Colorado stakeholders and taxpayers. Since its inception, CoverColorado's hospital admissions per 1000 have declined from 192.3 to 137.8; bed days per 1000 are down from 968.2 to 543.0; average length of stays were reduced from 5.0 to 3.9; and average cost per inpatient day decreased from $3,675 to $2,764," noted Lattimer. The Health Integrated Advanced Care Management Report Card for the Oklahoma Health Insurance High Risk Pool, which launched a similar program January 1, 2003, reported cost savings during the first 30 days of the program on nine individual cases with total estimated savings of $7,431 - an average savings per case of $826. The vision of advanced care management that acknowledges both medical and behavioral care to improve the efficiency and quality of health care services, is a major priority for the ACMTF. "This new initiative is a wonderful example of how the power of integration can be leveraged to make the kind of achievable improvements in health care quality that meets patient expectations," stated Steve Kinion, Chairman, Board of Directors, Oklahoma Health Insurance High Risk Pool. Kansas, Oklahoma and Washington have united with Colorado, are contracting with Health Integrated, and announce the creation of ACMTF to execute advanced care management programs with their state comprehensive health insurance plans to leverage the experience curve of Colorado. "It's all about integration and understanding how disease management and case management strategies need to work together. By simply putting in place advanced care management tools, techniques and best practices -- and optimizing integrated work flow processes with preemptive interventions -- care facilitation specialists can collaborate 24/7 to ensure cost-effective, optimal health outcomes for health plan participants while improving the economic well-being and quality of life of all involved," states Lattimer. There are many advantages to state comprehensive health insurance plans in joining in the ACMTF cooperative research project. "It is an opportunity to provide input into the development of a national database that will allow state risk pools to review and compare data on costs of care for similar conditions, benchmarking and benefit analysis to develop various business strategies for developing current and future services," according to Les C. Meyer, health care strategist. The ACMTF rationale was created in December 2002. Members agreed that the advanced care management cooperative outcomes research project should focus on a multi-state high-risk pool study that represented a unique health care management population: 1) The participants represent an inordinately high per capita utilization of health care resources; 2) The program claims systems, rules, benefits, and exclusions are not consistent across all states though the participants in each state have a similar demographic profile; 3) There is no unified set of utilization data that can be used to compare programs and populations though participants have very similar health status profiles; and 4) Currently, most programs have minimal care management services in place and thus represent an excellent baseline for measuring and quantifying the impact of advanced care management intervention. There was a consensus amongst ACMTF members that state risk pools work very well together and they are not in competition with each other or with community health plans or other consumer-driven health plan initiatives. This situation created an ideal environment for candid cooperation and collaboration in building an outcomes research study that would benefit the five states involved - and eventually all NASCHIP members, as well as the nation's health care system. The ACMTF will have access to a predictive modeling format that will help estimate future budget costs for participants' care and provide a mechanism on how each state may better control those costs with preventive interventions. The research database will also look at the cost savings associated with greater integration of services versus states that are not providing such services. "The advantage right now to being on the ground floor is providing guidance and direction in developing a very complex system that the health care industry has not had," stated Kinion. Most state comprehensive health insurance plan executive directors, physicians, clinicians and CFO's use systems that provide certain information but never get the chance to provide input in its development. ACMTF team members will also bring consensus to data collection, tracking, monitoring and outcome and cost savings reporting. "State risk pools will continue to face pressures in both program costs and insurance affordability as they provide coverage and care for the sickest of the sick," states Abbe. "More and more NASCHIP state programs are exploring advanced care management as an option to try to address this problem. And it makes sense -- pursuing better care at lower costs for those who need it the most. It is vital to both private and governmental payors, to be able to explore and apply Colorado's and Oklahoma's care facilitation techniques, preemptive interventions and research study methods so that we can objectively evaluate results and further develop effective programs for other state risk pools." About CoverColorado About Oklahoma Health Insurance High Risk Pool About Health Integrated Health Integrated's unique capacity to integrate behavioral health with medical healthcare and its ability to work as a partner to provide comprehensive customized solutions for its clients have resulted in significant cost savings to health plans. Health Integrated's patient-focused, advanced care management approach eliminates fragmentation in care and has produced dramatic expense reduction and improved outcomes. Health Integrated's state of the art technology, professional expertise and proprietary clinically integrated programs provide superior alternatives for payers. Health Integrated has contracts with 32 companies, representing more than 3 million members. More information about Health Integrated is available at www.healthintegrated.com. |