QualityMetric and Magellan Presentation at AHIP Conference 2009

Comparative Effectiveness in Action
promote transparency • prove value • measure success

Measuring Success and Proving Value:
Using self-reported health outcomes to assess treatment effectiveness,
evaluate ROI, and promote transparency within healthcare.

Proprietary and confidential content subject to NDA 1


Agenda
I Introduction……....……………….……(Gus Gardner, President/COO, QualityMetric)
– Defining health: the first step toward measuring it
– SF-12 Health Survey Measurement Model
– Introducing today’s speakers
II Program Overview…......(Joann Albright, PhD, SVP, Magellan Health Services)
– Magellan overview and definitions
– Program goals and lessons learned
– SF-BH™ Assessment demo and reports
III Results and Conclusions…....(John E. Ware, Jr., PhD, CSO, QualityMetric)
– Health burden analysis for total population
– Analysis of improved health outcomes post treatment
– Impact on medical expense trends and lost work days
IV Q & A Session………………….….…(Gus Gardner, President/COO, QualityMetric)



Gus Gardner, President/COO, QualityMetric

I Introduction



Defining Health

“Anyone who can define health can
transform the context of medicine.”

- Stan Davis in Future Perfect



A Definition of Health

In 1948, the constitution of the World
Health Organization (WHO) defined
health as "a state of complete
physical, mental, and social well-being
and not merely the absence of disease
and infirmity."



Defining Comparative Effectiveness
“That the funding appropriated in this paragraph shall be used
to accelerate the development and dissemination of
research assessing the comparative effectiveness of
health care treatments and strategies, through efforts that:
(1) conduct, support, or synthesize research that compares
the clinical outcomes, effectiveness, and
appropriateness of items, services, and procedures that are
used to prevent, diagnose, or treat diseases, disorders, and
other health conditions…”

- From the American Recovery and Reinvestment Act of 2009



SF-12 Health Survey Measurement Model
Questions Domains Summary
Does your health limit your Physical Functioning
Measures
everyday activities
Or climbing flights of stairs

Accomplished less due to Role-physical
physical health Physical Health
Limited in the kind of work or
other activities Bodily Pain

How much does your pain
interfere with work General Health
How would rate your health

Did you have a lot of energy
Vitality
Has your health interfered
with social activities
Social Functioning Mental Health
Have you accomplished less
because of mental health
Did you work less carefully Role-emotional
because of mental health

Have you felt calm/peaceful
Have you felt downhearted Mental Health



Using Self-reported Outcomes
Throughout the Healthcare Spectrum

76,000,000 Administrations 117 Languages


Today’s Speakers

• Joann Albright, PhD, Senior Vice President
Magellan Health Services
• John E. Ware, Jr., PhD, Chief Science Officer
QualityMetric Incorporated



Joann Albright, PhD, Senior Vice President, Magellan Health Services

II Program Overview



About Magellan
Diversified specialty managed health care
company currently focused on behavioral
health, radiology, and specialty pharmacy.

Radiology Specialty
Behavioral
NIA Pharmacy ICORE



Magellan Behavioral Health
• Behavioral health covered lives: 40 million
• Credentialed providers: 60,000
– Psychiatrists, psychologists, social
workers, counselors, family therapists, psychiatric
nurse specialists, substance abuse
professionals, others
• Provider facilities: 6,200 locations
– Psychiatric/substance abuse inpatient hospital or
unit, residential treatment, supervised living, partial
hospitalization, intensive outpatient, outpatient



Magellan Vision Statement

“To use our behavioral health expertise to improve
health care outcomes for individuals and families
fighting illness, needing counsel or seeking
support with life’s challenges.”



Common Terms
Clinical Measurement Outcomes Measurement

Use of standardized measures to Indicator of change and requires
assess such areas as clinical at least two data points, ideally
severity, health status and one at the start of treatment and
functioning another at some later time
Patient
Reported
Outcomes Management Outcomes Clinical Outcomes

Systematic effort to improve the Measured effects of interventions,
effectiveness of treatment or lack of interventions, on primary
services throughout a health care and secondary consumers
system



Goals
• Empowerment
Members • Recovery-improved health status & productivity

• Evidence-based treatment support
Providers • Profiling/R4Q

Care Management/ • Empirically driven reviews
Coaching • Engagement/risk management

• Measure/monitor treatment effectiveness
System Improvement • Efficiencies – screen and stratify

• Competitive advantage
Value Added • Industry leader

• Medical cost reduction
Return on Investment • Profit/reinvestment



Plan of Action
Scientifically
Sound
Measures

Embed in
Leverage
Clinical Maximize
Outcomes
Management Technology
Information
Programs

Monitor and
Improve
Performance



Modes of Administration
Paper (& Pencil)

Phone (IVR)

Computer (Desktop, Online, Enterprise)

Fax

PDA (Tablet)



Smart Measurement® System



Additional SF-BH Assessment Components

• Strengths
• Behavioral Symptoms
• Work-School Participation
• Provider Relationship



SF-BH™ Assessment



Lessons Learned

Customers Providers Consumers Organizations

Shift from Technology
Verbal support Confidentiality
process to resources
outcomes
Administrative Health
Training
obstacles awareness

Implementation
barriers Evidence of Multiple Champions
value modalities required



John E. Ware, Jr., PhD, Chief Science Officer, QualityMetric

III Results and Conclusions



Characteristics of Magellan’s Behavioral
Health Population
Total Sample Sample 2 Sample 3
(n=33,362) (n=9,661)1 (n=1,260)2

Mean Age (SD) 41 (12) 43 (13) 46 (15)

% 65 yrs. and older 2.5 4.2 10.4

% Female 66.3 65.9 60.4

1 Patients with two administrations of the SF-BH form.
2 Patients with three administrations of the SF-BH form.



SF-12 Shows Significant Mental Health Burden
at Baseline in Behavioral Health Sample 2
Best 60 60
Health
55 Norm 55 Norm
50 50
45 * * * 45
40 40
35 * * * 35
30 30 *
Worse 25 25
Health 20 20

All scales Mean=50, SD=10, * p<0.05, n=9,661



Item Responses Show Emotional Distress in
Behavioral Health Sample 2
More

56.5% 52.8%
41.7% 42.2%

23.1%

7.1% 8.7% 6.2%
Less
% with little or no energy % limited in social % accomplished less at % downhearted or
activities work depressed

Behavioral Health US Norm
n=9,661



Measurement of Health Outcomes
• Mean changes in SF-12 scores pre and post
intervention
• Categorical changes in SF-12 scores pre and post
intervention
• Content-based interpretations of item responses
• Interpretation of outcomes in terms of their
consequences
– screening positive for depression
– cost savings per patient, per year
– Reduction in work loss days, past 4 weeks



Behavioral Health Intervention Significantly Improves
Mental Health Status in Sample 2
Best 60 60
Health 55 55
Norm Norm
50 50
* * *
45 * *
45
40 * * 40 *
35 35
30 30
Worse 25 25
Health 20 20

All scales Mean=50, SD=10, * p<0.05, n=9,661
Baseline Sample 2



Percentages Better, Same, or Worse in
Sample 2
Mental Health (MCS)

13%

18%

69%

n=9,661 Better Same Worse



Item Responses Show Emotional Distress Alleviated by
Intervention in Sample 2

56.5% 52.8%
41.8% 42.2%
33.8%

17.1% 17.2% 16.3%

% with little or no energy % limited in social % accomplished less at % downhearted or
activities work depressed

Baseline Visit 2
n=9,661



Fewer Patients Screen Positive for
Depression at Visit 2
83.3%

55.3%

Baseline Visit 2

Positive Depression Screen
Sample 2, n=9,661



Predicted Medical Expenses Decreased at
Visit 2
$3,500
$3,400
$3,300 $3,388
Average yearly reduction of
$3,200
$311 per patient
$3,100
$3,000 $3,077
$2,900
$2,800
$2,700
$2,600
$2,500
Baseline Visit 2

Medical Expense
Sample 2, n=9,661



Self-reported Lost Work Days Decreased at
Visit 2
5
4.5
4
3.5
3 3.3
2.5
2
1.5 1.7
1
0.5
0
Baseline Visit 2

Mean Lost Work Days
Sample 2, n=9,661



Mental Health Improvements
Sustained for Three
Months, Behavioral Health
Sample 3 (n=1,260)



Mental Health Improvements are Sustained for Three
Months for Sample 3 (n=1,260)
Best 60 60
Health 55 55
Norm Norm
50 50
* * * * *
45 * * * * 45
40 40
35 35
30 30
Worse 25 25
Health 20 20

All scales Mean=50, SD=10, * p<0.05, n=1,260 Baseline Sample 3



Mental Health Outcomes Improve Over
Time for Sample 3 (n=1,260)
55
Norm
50
45 Depression Screen
40
40.2 46.1
35
30
25
20 22.6
15
10
5
0
Baseline Visit 2 (60 days) Visit 3 (180 days)

MCS-12



Percentages Better, Same, or Worse in
Sample 3
Mental Health (MCS)

5%
8%

87%

Better Same Worse
n=1,260



Conclusions
• Substantial mental health burden observed at
baseline for Magellan’s behavioral health population
• Significant and meaningful benefits of intervention
include:
– % with little or no energy
– % limited in social activities
– % accomplishing less at work
– % downhearted or depressed
• Preliminary follow-up data (Sample 3) show that
improvements are sustained for 3 months


QualityMetric and Magellan Presentation at AHIP Conference 2009

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