Charts the rapidly changing course care management and health promotion programs will take over the next several years, as they adjust to reform-law requirements and new tools like social marketing websites. Co-edited by Al Lewis of the Disease Management Purchasing Consortium and AIS’s Jill Brown, with a foreword by David Nash, M.D., of Jefferson School of Population Health, the book includes chapters on health reform, medical homes, wellness incentives, behavior change, social media, outcomes measurement, behavioral economics, coordinated care, build-versus-buy decisions, building internal disease management programs, improving Medicare star quality ratings, and more.
Along with a new focus on how wellness and disease management programs are helped — or hindered — by the health reform law, Disease Management and Wellness in the Post-Reform Era also brings expert insight into DM’s basic building blocks, including:
Table of Contents
Foreword — David B. Nash, M.D., M.B.A. Dean, Jefferson School of Population Health
Introduction — Jill Brown, Executive Editor, AIS
Chapter 1: Disease Management of the Future and its Role in the Health Plan of the Future — Al Lewis
- The Future of DM and Wellness
- Other Future Trends
- The Role of DM in Health Plans of the Future
- What the Government Will Do to Facilitate Either Option
Chapter 2: Population Health Management and Health Care Reform — Tracey Moorhead
- Medical Loss Ratio
- Support for Wellness, Prevention and Health Promotion
- Delivery System Reform
Chapter 3: Disease Management and the Medical Home — Stephen Wilkins, MPH
- The Conceptual Origins of the Medical Home
- The Patient-centered Medical Home Defined
- What is Patient-Centeredness?
- The Evidence Supporting Patient-Centered Care
- The Case for Integrating Disease Management and the Medical Home Model
- What Will Disease Management Look Like in the Medical Home?
- Realizing the Potential of the Patient-Centered Medical Home — Key Enabling Factors
Chapter 4: Integrating Wellness Into the Health Care System — Richard Safeer, M.D.
- The Importance of Wellness in Chronic Disease
- Economic Considerations
- Role of Health Plans
- Mandated Preventive Services Coverage
- Culture of Health
- Addressing the Skeptics
- The Future
Chapter 5: Incentivizing People to Take Care of Themselves — Melissa Tobler
- The Evolution and Pervasiveness of Incentives
- Incentives Influence Behavior
- How Successful Are Incentives?
- Current Use of Incentives
- Health Care Reform’s Impact on Incentives
- The Future of Incentives
Chapter 6: Lessons Learned in Worksite Wellness — Al Lewis
- Lesson 1: All Wellness Programs Are Not Created Equal, so Pick the Program that Fits Your Culture and Budget
- Lesson 2: If You Build It, They Won’t Come
- Lesson 3: Make Wellness a Management Priority
- Lesson 4: Recognize and Overcome Organizational Impediments
- Lesson 5: Find Common Ground with Workers Compensation
- Lesson 6: Don’t Try To Change the World, Just Your Organization
Chapter 7: High-Impact Paradigms for Changing Behaviors to Enhance Health, Productivity and Well-Being — James O. Prochaska, Ph.D., and Janice M. Prochaska, Ph.D.
- High-Impact Paradigms for Changing Behaviors
- A Population Paradigm to Complement the Individualized Patient Paradigm
- The Action Paradigm Complemented by the Stage Paradigm
- The Passive-Reactive Paradigm Complemented by the Proactive Paradigm
- The Impact Paradigm Complements the Efficacy Paradigm
- The Home-Based Paradigm Complements the Clinic-Based
- Clinician and Computer Paradigms
- The Multiple-Behavior-Change Paradigm Complements Single Behavior
- The Coaction Paradigm Complements the Modular Paradigm
- The Integration Paradigm Complements Fragmentation
Chapter 8: Social Networking and Population-Based Health Management — Jaan Sidorov, M.D., MHSA
- What Is Social Networking?
- Implications of Social Networking in the Distribution of Health-Related Information
- Implications for Disease Management, Prevention and Wellness Programs
- Considerations for Care Management Programs in the Adoption of Social Networking
- Nine Considerations for Social Networking
Chapter 9: Emerging Insights about Measuring Disease Management Outcomes — Al Lewis
Chapter 10: Health Behavioral Economics — Murat V. Kalayoglu, M.D., Ph.D., and Peter Salovey, Ph.D.
- Cognitive Biases in Health Behavioral Economics
- Applications of Health Behavioral Economics in Disease
- Management and Wellness
Chapter 11: Care Coordination: Making the Most of Every Interaction — Kara Trott
- Missed Opportunities and Higher Costs Result From Fragmented Environment
- Intercepting Patients Early, Walking With Them Through the Process
- Measuring the Impact of Care Coordination
- Two Examples of Organizations That Have Made Care Coordination Work
- Improve Costs and Outcomes by Making the Most of Every Interaction
Chapter 12: Disease Management — To Build or Buy — David W. Plocher
- Strategic Considerations
- How Strategy Varies by Type of Service
- How Strategy Is Affected by Service Contents
- The Past Five Years
- Current Market Requirements Influencing the Decision
- When Is Outsourcing the Better Option?
- Is There a Middle Ground? Licensing Pieces of DM Company Product Inventory
- What’s Next?
Chapter 13: How to Start an Internal Medicare Disease Management Program — Scott Breidbart, M.D., and Lorraine McDonald, R.N.
- Why Start an Internal Disease Management (DM) Program?
- Define the Population
- Time to Go Live
- Program Scope
- Member Identification and Stratification
- Clinical Program Content
- Recruiting and Staffing
- Clinical System
- Member and Provider Materials
- Future Directions in Medicare DM
Chapter 14: Your Future’s in the Stars — Molly Doyle, MBA, and Sarah Baker
- Some History on Medicare Advantage
- CMS Star Ratings
- CMS Announces Changes to Star Ratings
- Proposal to Accelerate and Expand Bonus Payments
- A View From the Top
- Assembling Your Team
- Getting Started
- Plan of Attack
- Looking Ahead
Chapter 15: What Disease Management Executives Need to Know About Risk-Adjusted Medicare Reimbursement — Zach Gerbarg, M.D., CPC
- The Development and Impact of Risk-Adjusted Reimbursement
- The Physician Challenge in Risk-Adjusted Reimbursement
- Retrospective ICD-9 Code Capture Programs and Their Limitations
- The Growth of Prospective ICD-9 Code Capture Programs
- Steps to Implementing a Prospective Severity-Adjustment Documentation and Coding Program to Improve Care
- Integrating Prospective Programs into Medical-Management Activities
- Nursing Home and SNF Case Study
- Al Lewis is President of The Disease Management Purchasing Consortium International, Inc., based in Wellesley, Mass.
- Tracey Moorhead is president and chief executive officer of the Care Continuum Alliance, which convenes all stakeholders providing services along the care continuum toward the goal of population health improvement.
- Stephen Wilkins, MPH, is the principal and founder of Smart Health Messaging.
- Richard Safeer, M.D., F.A.A.F.P., is Medical Director, Preventive Medicine at CareFirst BlueCross BlueShield.
- Melissa Tobler, RN, BSN, is the national practice leader for health strategies at Hays Companies.
- James O. Prochaska, Ph.D., is director of the Cancer Prevention Research Center and a professor of clinical and health psychology at the University of Rhode Island.
- Janice M. Prochaska, Ph.D., is president and chief executive officer of Pro-Change Behavior Systems, Inc., based in Kingston, R.I.
- Jaan Sidorov, M.D., MHSA is a seasoned primary care physician with a working familiarity with health insurance, corporate governance, health service research, disease management and health care quality. He runs the Disease Management Care Blog, is the author of over 35 peer-reviewed publications, and a presenter at 60 health conferences.
- Murat V. Kalayoglu, M.D., Ph.D. is Chief Science Officer at HealthHonors – a Healthways Company.
- Peter Salovey, Ph.D. is the Provost of Yale University and the Chris Argyris Professor of Psychology.
- Kara Trott is founder and CEO of Quantum Health, Inc., based in Columbus, Ohio.
- David W. Plocher, M.D., is vice president of Ingenix Consulting, providing services to payers and providers on strategic collaboration, payment reform, health management and performance measurement.
- Scott Breidbart, M.D., is manager, medical director at Indianapolis-based WellPoint, Inc.
- Lorraine McDonald, R.N., has extensive experience in development of internal disease management programs. She is currently senior director of Medicaid clinical programs for a large national payer organization.
- Molly Doyle, MBA is vice president of product management at Health Dialog.
- Sarah Baker is product manager for senior products at Health Dialog.
- Zach Gerbarg, M.D., CPC is principal and co-founder of Eagle Medical Management, LLC, a health care consulting firm with particular expertise in diagnosis documentation and coding for risk-adjusted reimbursement.
- Health plan executives
- Disease management company executives
- Employer groups
- Employee benefit managers
- Coordinators of state health programs
- Pharmacy benefit company managers
- Pharmaceutical industry managers
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