Addressing the Needs of the Uninsured in a Challenging Economic Environment

Slide Presentation by Autumn Dawn Galbreath, M.D.

On March 14, 2002, Autumn Dawn Galbreath, M.D., made a presentation in a Web-assisted teleconference at Session 3, which was entitled "Stretching Scarce Resources: State Strategies to Design Effective, Affordable Benefit Packages."

This is the text version of Dr. Galbreath's slide presentation. Select to access the PowerPoint® slides (840 KB).

Stretching Scarce Resources: State Strategies to Design Effective, Affordable Benefit Packages

Autumn Dawn Galbreath, M.D.
Director
University of Texas Disease Management Center

Slide No. 1

Introduction to Disease Management (DM)

• Systematic, population-based approach
    -  Identifies people at risk
    -  Intervenes
    -  Measures outcomes

Slide No. 2

Important Characteristics

• Best practices throughout the entire continuum of care
• Clinical guidelines
• Reduced cost
• Improvement of measurable outcomes in the quality of care

Slide No. 3

"Management Soup"

• Case Management
• High-Cost Case Management
• Disease Management
• Population Management
• Managed Care

Slide No. 4

Does It Work?

The "literature is now replete with titles in DM, quality improvement, and clinical practice improvement, but...there is not much evidence that {these}...improve efficiency in the care process for the disease."⁹

9-Curtiss F. Lessons learned from projects in disease management in ambulatory care. Am J Health-Syst Pharm 1997;54:2217-29.

Slide No. 5

Summary of the Literature

• 24 trials previously published, only 8 of which are randomized and controlled
• Congestive Heart Failure (CHF): 8 trials
• Diabetes: 3 trials
• Asthma: 1 trial
• Coronary artery disease: 1 trial
• General primary care/postdischarge care: 5 trials

Slide No. 6

Remaining Questions

• Is DM truly cost-effective in a heterogeneous patient population with a forthcoming and straightforward analysis of the economic data?
• Does DM improve clinical outcomes?
• Does DM improve subjective outcomes such as quality of life and patient satisfaction?
• Does DM improve provider satisfaction with the care they are able to provide?
• Is DM better administered in a face-to-face clinic setting or telephonically?

Slide No. 7

South Texas CHF Demonstration Project

• Target enrollment: 1,200 patients
• Target population: Veterans, Military, Medicare, Medicaid, and indigent patients
• Time of Enrollment: 18 months

Slide No. 8

Disease Selection

• High volume
• High cost
• Variation in management
• Propensity for acute decompensation

Slide No. 9

Barriers to DM

• Acute care model of the current health care system
• Lack of integrated information systems
• Lack of provider support
• Limited resources
• Danger of fragmentation of care

Slide No. 10

Lessons Learned

• Provider Buy-In
• Start-Up Costs and Savings Realization
• "Don't promise what you can't deliver"

Slide No. 11

For additional information, contact:

Autumn Dawn Galbreath, MD
Director
University of Texas Disease Management Center
4243 Piedras Drive East Slide No. 240
San Antonio, Texas 78228
(210)567-9700 (office)
(210)756-8184 (pager)
galbreath@uthscsa.edu

Slide No. 12

Disease Management in Uninsured Populations

• Florida Medicaid Disease Management Initiative
• Virginia Health Outcomes Partnership
• Easy Breathing (Hartford, CT)
• National Jewish Asthma Disease Management Pilots

Current as of July 2002

Internet Citation

Stretching Scarce Resources: State Strategies to Design Effective, Affordable Benefit Packages. Presentation by Autumn Dawn Galbreath at Web-Assisted Teleconference, "Addressing the Needs of the Uninsured in a Challenging Economic Environment". July 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/uninsuredtele/session3/galbreathtxt.htm

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