• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Medica Focuses on Prevention of Cancer, Heart Disease and Other Health Events Through Targeted Routine-Health Reminders

Posted on: Monday, 30 October 2006, 15:00 CST

With a first-of-its-kind program, Medica is using personalized health reminders to target its members who need routine-health checkups. This focus on health improvement helps reduce health care costs at the same time. Medica is the only local health plan that currently offers such annual personalized preventive health care reminders, setting itself apart as an industry leader in providing this level of comprehensive customized information to members.

Medica's "Checkup Checklist" program for 2006 includes 230,000 members--a mix of seniors, state public program enrollees, and commercial members (i.e., those receiving coverage through their employer). Only members needing services are targeted through the program. A cover letter commends the member for getting needed care if it was received, and then the one-page Checkup Checklist health report--customized individually to each member--gives a "snapshot" of any remaining preventive care needs, indicating checkups that are overdue as well as any coming due in the next 12 months. Customized stickers are also included, reflecting the member's name along with needed checkups; stickers are intended for use on a calendar so the member sets up and keeps doctor appointments.

"We want our members to take charge of their health," said Dr. Charles Fazio, chief medical officer at Medica. "To help them become as healthy as possible, we're giving members a summary of needed preventive health checkups. We hope to empower them to prevent health problems before they can occur by sharing information about which particular exams, immunizations and tests would be uniquely beneficial to them, based on medical guidelines."

Given today's busy schedules, the Checkup Checklists are a helpful, time-saving tool for recipients, providing them with a convenient, multi-year overview of their preventive health needs. The members have this health information at their fingertips and can plan for one or more doctor appointments as necessary.

Keeping people healthy ultimately saves lives, but doing so in a focused manner also helps to control ever-rising health care costs. Studies show an estimated one-half of all medical costs are attributable to illnesses that can be prevented. Routine preventive health checkups are invaluable in detecting problems as early as possible. Of course, the trick is getting patients in to see the doctor in time.

"We've got lots of health care claims data to give us the big picture and we're able to put it to good use by targeting our members who could benefit from Checkup Checklists," said Dr. Fazio. "The sooner a doctor detects a health issue, the better off the patient is. By getting needed routine checkups, we all can stay healthier and can even prevent adverse health events from occurring down the road." He added: "Our interventions are aimed at doing the right thing for patients' long-term health, at ensuring that they get the right care at the right time. And while our focus is on maintaining and improving their quality of health, we're able to help mitigate rising health care costs at the same time."

Initial program results

After piloting its Checkup Checklist project in 2005, outcomes showed that members who received customized health information were more likely to schedule routine appointments than those who did not receive it. A phone survey taken soon after the pilot indicated that, overall, members liked receiving the checklist and thought it was useful. In the largest survey group, with commercial members, 70 percent said they intended to take action based on the information they received.

When claims data were later scrutinized, results indicated that member follow-through was also promising. The attached table shows examples from the 2005 pilot, illustrating how these reminders had a statistically significant impact on the behavior of members. The table summarizes the measures that saw the biggest impact in the rate of members getting the intended checkup.

For example:

The reminder urging adult commercial members to go to the doctor for a preventive health visit correlated to a 27.2 percent improvement over the control group result. Extrapolating that rate across the 2006 targeted population means 1,321 additional commercial members are projected to get this exam over the next year.

A reminder for children regarding a preventive health visit correlated to a 21.6 percent improvement over the control group. Extrapolating that percentage across the targeted population for 2006 amounts to 3,268 additional children projected to go to the doctor's office for a preventive exam in 2006-2007.

How the program works

Based on member input, Medica found that members like to receive concise, personalized information because it helps prepare them for discussions with their doctor about getting the best and most appropriate care. In response, Medica developed its Checkup Checklist program, through which select Medica members receive the personalized reminders each year.

Each member's individualized report is generated from Medica claims information about the status of preventive care needs, indicating what checkups are overdue or coming due. These routine recommendations are based on national clinical guidelines. Members are advised if an examination, screening or immunization is needed and are told dates to schedule needed services. On the checklist, 20 some clinical measures are applied based on age and gender of the member. The routine preventive care measures include:

All infant, child, adolescent and adult immunizations (flu, pneumonia and tetanus shots)

Adult and well-child preventive exams

Cholesterol screening

Breast, cervical and colorectal cancer screenings

Blood lead screening (for children in state public programs only)

Members are also encouraged to discuss additional care such as smoking cessation options, additional vaccinations or screening for sexually transmitted diseases (STDs). As part of the mailing, some members also receive inserts highlighting Medica programs or health information applicable for their situation. And of course, there's the call to action: Members are encouraged to schedule appointments with their clinic. After all, the immediate goal of the program each year is to encourage members to talk with their primary care provider about getting needed routine health services.

Why prevention is key

Preventive care helps to maintain or improve a person's health through vaccinations or by detecting high cholesterol or even cancer, preferably at an early stage. The Harvard School of Public Health led a study that determined a mere nine controllable factors account for one-third of all cancer deaths. According to the American Cancer Society, finding cancer early and in a localized stage can mean a 90 percent survival rate over five years, but if the cancer goes undetected and spreads to other organs or lymph nodes, the survival rate drops to 65 percent.

The cost of cancer care to individual patients and society is extremely high--estimated by the National Institutes of Health at nearly $210 billion in total medical costs and lost productivity in 2004. Some cancers are truly preventable, though, and can be caught in a pre-cancer stage and eliminated. As an example, if just one of the thousands of men or women projected to get additional preventive health services (as indicated in Addendum A) in the next year as a result of the Checkup Checklist program gets an exam and has cancer detected early--or heart disease or other serious medical condition--he or she can not only prevent personal suffering but also save thousands of dollars per year in treatment costs. This would hold true for cervical cancer, most colon cancers and many breast cancers detected through early screenings (e.g., mammogram, Pap test) promoted through the Checkup Checklist program.

About Medica

Medica is a 1.3 million-member health insurance company headquartered in Minneapolis and active in the Upper Midwest. The non-profit company provides health care coverage in the employer, individual, Medicaid, Medicare and Medicare Part D markets in Minnesota and a growing number of counties in North Dakota, South Dakota and Wisconsin. Medica also offers national network coverage to employers who also have employees outside the Medica regional network.

Medica has the highest accreditation status, Excellent, from the National Committee for Quality Assurance (NCQA®) for its Minnesota Medicaid HMO plans and commercial health plans in Minnesota and North Dakota. Medica's vision is to become the community's health plan of choice, trusted for its integrity, respected for its service, and admired for its commitment to innovation and efficiency.

Addendum A: Direct Interventions Had Impact onWhether Members Received Services

Column A: Preventive measure -- Recommended health checkups that showed the most improvement. The "affected population" is one of three measured: commercial members (i.e., receiving health care coverage through their employer), state public program enrollees in Minnesota Health Care Programs (MHCP), or seniors.

Column B: Control group -- Percentage of members in control group that received preventive health service.

Column C: Targeted group -- Percentage of members in targeted group that received intended preventive health service.

Column D: Impact of mailing -- Percentage showing additional members who got checkups after 2005 pilot mailings, as compared to members who got no reminder. This relative percentage is determined by taking the difference of percentages for control group vs. intervention group (columns B and C), divided by percentage of control group (column B).

Column E: Estimated number of members, projected for 2006-2007, who will get recommended services due to interventions. This number is calculated through extrapolation, multiplying the percentages in columns B and C by the 2006 targeted population size, and then taking the difference between the two. Note that commercial members make up 60% of 2006 targeted population, MHCP enrollees constitute 37%, and seniors make up only 2%.

Preventive measure (and affected population)

Control group

Targeted

group

Impact of mailing

Members to get service due to intervention (estimated)

Tetanus shot (MHCP)

16.7%

24%

43.7% more got checkups than those who didn't receive mailings

1,069 

Pneumonia immunization (seniors)

8.8%

11.9%

35.2% more

135 

Adult preventive checkup (commercial)

8.1%

10.3%

27.2% more

1,321 

Adult preventive checkup (seniors)

9.7%

12%

23.2% more

75 

Colorectal cancer screen (MHCP)

30.7%

37.6%

22.5% more

138 

Children's preventive exam (commercial)

29.2%

35.5%

21.6% more

3,268 

Tetanus shot (commercial)

9.8%

11.9%

21.4% more

513 

Cholesterol test (seniors)

29.7%

35.1%

18.2% more

29 

Tetanus shot (seniors)

22.6%

25.8%

14.2% more

31 

Cholesterol test (commercial)

13.9%

15.8%

13.7% more

349 

Colorectal cancer screen (seniors)

34.9%

38.4%

9.7% more

21 

TOTAL IMPACT, simply in these 11 areas:

More than 5,500 additional

people to get shots, exams, or tests due to interventions

(some will get reminders for more than 1 service)

Other areas--for instance, children's immunizations--also showed some promise, but the numbers were too small to draw definitive conclusions.

Source: Business Wire

More News in this Category