Care Continuum Alliance

Last updated
Care Continuum Alliance
Formation1999-03-01
Legal statusAssociation
Headquarters Washington, DC
Coordinates 38°53′41″N77°01′21″W / 38.894624°N 77.022593°W / 38.894624; -77.022593
Region served
Worldwide
Membership
Organizations & individuals
Main organ
Board of directors
Website www.carecontinuum.org

The Care Continuum Alliance (formerly DMAA: The Care Continuum Alliance [1] ) is an industry trade group of corporations and individuals that "promotes the role of population health improvement in raising the quality of care, improving health outcomes and reducing preventable health care costs for individuals with chronic conditions and those at risk for developing chronic conditions". [2] It supports "care continuum services" such as "health and wellness promotion, disease management, and care coordination" by means of "advocacy, research, and the promotion of best practices in care management". [2]

Contents

Current structure

The Care Continuum Alliance "represents more than 200 corporate and individual stakeholders". [2] Membership categories include: [3]

The Care Continuum Alliance is governed by a Board of Directors and a structure of committees, subcommittees and work groups. The organization maintains a professional staff in Washington, D.C., to perform day-to-day administration. In 2008, the Care Continuum Alliance reported that it paid $80,000 in lobbying expenses to Sonnenschein Nath & Rosenthal. [4]

History

The organization was formed in March 1999 as the Disease Management Association of America (DMAA). [5] [6] Its stated purpose was "educating the health care industry, government, employers and the general public about the important role that disease management programs play in improving health care quality and outcomes for people with chronic conditions". [5] The organization's first President was Al Lewis, who described an "irreversible trend toward more disease management" but with some barriers such as state privacy laws. [7] [8]

In early 2003, the Care Continuum Alliance hired Baker, Donelson, Bearman, Caldwell & Berkowitz to advocate for its interests in the U.S. executive and legislative branches. [9] The Medicare Prescription Drug, Improvement, and Modernization Act passed later that year was described as a "major victory" for the Care Continuum Alliance and the firm, in that the law "authoriz[ed] payment for services provided by its [i.e., the Alliance's] members to people with chronic illnesses". [10]

In December 2006, the title of the top position of the Board of Directors changed from "President" to "Chairman," and the chief staff officer's title changed from "Executive Director" to "President and Chief Executive Officer (CEO)". [11] Tracey Moorhead, the current President and CEO, has been quoted in the newsmedia concerning not only the Care Continuum Alliance but also chronic conditions in general. [12]

As part of a three-year rebranding to its current name, the organization announced a transitional name change ("DMAA: The Care Continuum Alliance") and new mission in September 2007 to reflect the expansion among its membership to services and products along the entire care continuum—from workplace wellness and prevention to disease management and more complex interventions. [13]

Also in 2007, the Care Continuum Alliance redefined this expanded care focus as "population health improvement" and published its "population health improvement model" [14] to document the change.

Major publications

Among the Care Continuum Alliance's notable publications are:

Outcomes Guidelines Report (2006, 2007, 2008, 2009, 2010)

In recent years, Care Continuum Alliance research activities have focused heavily on measuring outcomes in population-based interventions, such as wellness and care management. These activities were conducted at least partly in response to a 2004 Congressional Budget Office analysis that concluded that published studies "do not provide a firm basis for concluding that such programs generally reduce total costs". [15] [16]

In 2006, the group initiated a project to build industry consensus on measuring clinical and financial outcomes in wellness and population health management and published the first volume of its oft-cited Outcomes Guidelines Report in December of that year. [17] [18] The usefulness of the first volume was questioned because the guidelines were voluntary in nature and "equivocate[d] on a number of key issues, preventing true standardization even if they were adopted industry wide". [16] In September 2007, the Care Continuum Alliance produced a second volume, [19] with a greater emphasis on clinical outcomes (the first had focused mainly on financial measures). [20] [21] The organization released third and fourth volumes of its guidelines in 2008 and 2009, respectively. Volume 3 continued a "collaboration with NCQA and other contributors to expand and refine measures in all areas—in particular, methods and measures that allow meaningful comparisons across programs". [22] The Care Continuum Alliance released a fifth volume of the guidelines Oct. 14, 2010, at its 2010 annual meeting, in Washington, D.C. [23]

Population Health Improvement: A Market Survey Report (2010)

This market analysis collected responses from 135 purchasers and providers of health and wellness services and explored a variety of metrics, such as intervention types, use of incentives and measures of success. The analysis also examines market trends, including purchasing expectations, insourcing versus outsourcing of services and use of integrated data platforms. The survey found that 73 percent of purchasers planned to offer population health improvement programs within the 12 months following the survey's release and that 76 percent planned to do so by the end of 2011. Of those already purchasing programs, 84 percent expected additional purchases. [24]

Disease Management and Wellness: Results of a Market Research Survey (2008)

Among other findings, this survey of health plans, employers, and disease management and wellness program providers determined that "84% of health plans and employers offer one or more wellness programs" and that "diabetes, coronary artery disease and asthma represent the top three conditions for disease management program enrolment". [25] [26]

Participant Satisfaction Survey (2006)

Developed with support from J. D. Power and Associates, this tool consists of four modules on "access to care, coordination of care, improvements to quality of life and ability to self-manage chronic conditions". [27] A report prepared for the Agency for Healthcare Research and Quality cites the survey tool as a potential measure for patient self-management support programs. [28]

Dictionary of Disease Management Terminology (2004, 2006)

The first (2004) edition of this book defined 126 terms related to disease management. [29] The second edition appeared in 2006. [30]

Media accounts

Related Research Articles

<span class="mw-page-title-main">Medicaid</span> United States social health care program for families and individuals with limited resources

In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding.

The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care. It has become the predominant system of delivering and receiving American health care since its implementation in the early 1980s, and has been largely unaffected by the Affordable Care Act of 2010.

...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as Health Maintenance Organizations and Preferred Provider Organizations.

<span class="mw-page-title-main">American College of Cardiology</span> Medical association

The American College of Cardiology (ACC), based in Washington, D.C., is a nonprofit medical association established in 1949. It bestows credentials upon cardiovascular specialists who meet its qualifications. Education is a core component of the college, which is also active in the formulation of health policy and the support of cardiovascular research.

<span class="mw-page-title-main">Agency for Healthcare Research and Quality</span> United States government agency

The Agency for Healthcare Research and Quality is one of twelve agencies within the United States Department of Health and Human Services (HHS). The agency is headquartered in North Bethesda, Maryland, a suburb of Washington, D.C.. It was established as the Agency for Health Care Policy and Research (AHCPR) in 1989 as a constituent unit of the Public Health Service (PHS) to enhance the quality, appropriateness, and effectiveness of health care services and access to care by conducting and supporting research, demonstration projects, and evaluations; developing guidelines; and disseminating information on health care services and delivery systems.

Disease management is defined as "a system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant."

<span class="mw-page-title-main">Population health</span> Health outcomes of a group of individuals

Population health has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group". It is an approach to health that aims to improve the health of an entire human population. It has been described as consisting of three components. These are "health outcomes, patterns of health determinants, and policies and interventions".

In the healthcare industry, pay for performance (P4P), also known as "value-based purchasing", is a payment model that offers financial incentives to physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures. Clinical outcomes, such as longer survival, are difficult to measure, so pay for performance systems usually evaluate process quality and efficiency, such as measuring blood pressure, lowering blood pressure, or counseling patients to stop smoking. This model also penalizes health care providers for poor outcomes, medical errors, or increased costs. Integrated delivery systems where insurers and providers share in the cost are intended to help align incentives for value-based care.

A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts for more than three months. Common chronic diseases include diabetes, functional gastrointestinal disorder, eczema, arthritis, asthma, chronic obstructive pulmonary disease, autoimmune diseases, genetic disorders and some viral diseases such as hepatitis C and acquired immunodeficiency syndrome. An illness which is lifelong because it ends in death is a terminal illness. It is possible and not unexpected for an illness to change in definition from terminal to chronic. Diabetes and HIV for example were once terminal yet are now considered chronic due to the availability of insulin for diabetics and daily drug treatment for individuals with HIV which allow these individuals to live while managing symptoms.

Workplace wellness, also known as corporate wellbeing outside the United States, is a broad term used to describe activities, programs, and/or organizational policies designed to support healthy behavior in the workplace. This often involves health education, medical screenings, weight management programs, and onsite fitness programs or facilities. It can also include flex-time for exercise, providing onsite kitchen and eating areas, offering healthy food options in vending machines, holding "walk and talk" meetings, and offering financial and other incentives for participation.

Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting and analysis of error and other types of unnecessary harm that often lead to adverse patient events. The frequency and magnitude of avoidable adverse events, often known as patient safety incidents, experienced by patients was not well known until the 1990s, when multiple countries reported significant numbers of patients harmed and killed by medical errors. Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization (WHO) calls patient safety an endemic concern. Indeed, patient safety has emerged as a distinct healthcare discipline supported by an immature yet developing scientific framework. There is a significant transdisciplinary body of theoretical and research literature that informs the science of patient safety with mobile health apps being a growing area of research.

A Patient Safety Organization (PSO) is a group, institution, or association that improves medical care by reducing medical errors. Common functions of patient safety organizations are data collection, analysis, reporting, education, funding, and advocacy. A PSO differs from a Federally designed Patient Safety Organization (PSO), which provides health care providers in the U.S. privilege and confidentiality protections for efforts to improve patient safety and the quality of patient care delivery

Case management is a managed care technique within the health care coverage system of the United States. It involves an integrated system that manages the delivery of comprehensive healthcare services for enrolled patients. Case managers are employed in almost every aspect of health care and these employ different approaches in the control of clinical actions.

Chronic care management encompasses the oversight and education activities conducted by health care professionals to help patients with chronic diseases and health conditions such as diabetes, high blood pressure, systemic lupus erythematosus, multiple sclerosis, and sleep apnea learn to understand their condition and live successfully with it. This term is equivalent to disease management for chronic conditions. The work involves motivating patients to persist in necessary therapies and interventions and helping them to achieve an ongoing, reasonable quality of life.

In the United States, health insurance helps pay for medical expenses through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.

Connected health is a socio-technical model for healthcare management and delivery by using technology to provide healthcare services remotely. Connected health, also known as technology enabled care (TEC) aims to maximize healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and better self-manage their care. It uses readily available consumer technologies to deliver patient care outside of the hospital or doctor's office. Connected health encompasses programs in telehealth, remote care and disease and lifestyle management, often leverages existing technologies such as connected devices using cellular networks and is associated with efforts to improve chronic care. However, there is an increasing blur between software capabilities and healthcare needs whereby technologists are now providing the solutions to support consumer wellness and provide the connectivity between patient data, information and decisions. This calls for new techniques to guide Connected Health solutions such as "design thinking" to support software developers in clearly identifying healthcare requirements, and extend and enrich traditional software requirements gathering techniques.

David M. Eddy is an American physician, mathematician, and healthcare analyst who has done seminal work in mathematical modeling of diseases, clinical practice guidelines, and evidence-based medicine. Four highlights of his career have been summarized by the Institute of Medicine of the National Academy of Sciences: "more than 25 years ago, Eddy wrote the seminal paper on the role of guidelines in medical decision-making, the first Markov model applied to clinical problems, and the original criteria for coverage decisions; he was the first to use and publish the term 'evidence-based'."

Workplace health promotion is the combined efforts of employers, employees, and society to improve the mental and physical health and well-being of people at work. The term workplace health promotion denotes a comprehensive analysis and design of human and organizational work levels with the strategic aim of developing and improving health resources in an enterprise. The World Health Organization has prioritized the workplace as a setting for health promotion because of the large potential audience and influence on all spheres of a person's life. The Luxembourg Declaration provides that health and well-being of employees at work can be achieved through a combination of:

The Donabedian model is a conceptual model that provides a framework for examining health services and evaluating quality of health care. According to the model, information about quality of care can be drawn from three categories: “structure,” “process,” and “outcomes." Structure describes the context in which care is delivered, including hospital buildings, staff, financing, and equipment. Process denotes the transactions between patients and providers throughout the delivery of healthcare. Finally, outcomes refer to the effects of healthcare on the health status of patients and populations. Avedis Donabedian, a physician and health services researcher at the University of Michigan, developed the original model in 1966. While there are other quality of care frameworks, including the World Health Organization (WHO)-Recommended Quality of Care Framework and the Bamako Initiative, the Donabedian Model continues to be the dominant paradigm for assessing the quality of health care.

Health care quality is a level of value provided by any health care resource, as determined by some measurement. As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good quality of life, cure illnesses when possible, to extend life expectancy, and so on. Researchers use a variety of quality measures to attempt to determine health care quality, including counts of a therapy's reduction or lessening of diseases identified by medical diagnosis, a decrease in the number of risk factors which people have following preventive care, or a survey of health indicators in a population who are accessing certain kinds of care.

Value-based insurance design is a demand-side approach to health policy reform. V-BID generally refers to health insurers' efforts to structure enrollee cost-sharing and other health plan design elements to encourage enrollees to consume high-value clinical services – those that have the greatest potential to positively impact enrollee health. V-BID also discourages the use of low-value clinical services – when benefits do not justify the cost. V-BID aims to increase health care quality and decrease costs by using financial incentives to promote cost efficient health care services and consumer choices. V-BID health insurance plans are designed with the tenets of "clinical nuance" in mind. These tenets recognize that medical services differ in the amount of health produced, and the clinical benefit derived from a specific service depends on the consumer using it, as well as when and where the service is provided.

References

  1. ↑ Care Continuum Alliance. Care Continuum Alliance Launches New Brand for Population Health Improvement Retrieved 2010-09-26
  2. 1 2 3 Care Continuum Alliance. About us. Retrieved 2008-10-10.
  3. ↑ Care Continuum Alliance. Care Continuum Alliance membership categories. Retrieved 2008-10-10.
  4. ↑ OpenSecrets Lobbying spending database - DMAA: The Care Continuum Alliance, 2008. Retrieved 2010-10-11.
  5. 1 2 Care Continuum Alliance. Growth in disease management enrollment prompts launch of new association. 1999-03-01. Retrieved 2008-10-13.
  6. ↑ Bonfield, Tim. Changes ahead for cancer patients. Cincinnati Enquirer, 1999-04-12.
  7. ↑ Lewis, Al. Irresistible force called DM facing some immovable objects. Archived 2012-02-15 at the Wayback Machine Managed Care 1999 Nov;8(11).
  8. ↑ Abruzzo, Mark D. Despite what you hear, state privacy statutes no threat to DM. Archived 2012-02-15 at the Wayback Machine Managed Care 2000 April;9(4).
  9. ↑ Care Continuum Alliance. DMAA taps Baker, Donelson as legislative counsel for major advocacy campaign. 2003-05-13. Retrieved 2008-10-13.
  10. ↑ Pear, Robert. Health industry bidding to hire Medicare chief. New York Times, 2003-12-03. Retrieved 2008-10-13.
  11. ↑ Care Continuum Alliance. DMAA approves new board appointments, titles. 2006-12-08. Retrieved 2008-10-13.
  12. ↑ Bridgeford, Lydell C. Health care reform must recognize chronic care. [ permanent dead link ]Employee Benefit News, 2007-07-24. Retrieved 2008-10-13.
  13. ↑ Vesely, Rebecca. Reporter's notebook: disease-management group looks to larger role. Modern Healthcare , 2007-09-18. Retrieved 2008-10-13.
  14. ↑ Care Continuum Alliance. Advancing the population health improvement model. Retrieved 2008-10-13.
  15. ↑ Congressional Budget Office. An analysis of the literature on disease management programs. Archived 2012-02-12 at the Wayback Machine 2004-10-13. Retrieved 2008-10-13.
  16. 1 2 Benko, Laura B. Payers and purchasers: numbers that count. Disease-management industry is taking steps to deliver more reliability, consistency in data on program outcomes. [ permanent dead link ] Modern Healthcare , 2007-01-15.
  17. ↑ Care Continuum Alliance. DMAA releases consensus guidelines on measuring outcomes. 2006-12-04. Retrieved 2008-10-13.
  18. ↑ Llewellyn, Anne. Anne’s weekly e-letter. Disease Management Outcomes Guidelines Report. Archived November 20, 2008, at the Wayback Machine Across My Desk blog, 2006-12-11. Retrieved 2008-10-13.
  19. ↑ Care Continuum Alliance. DMAA releases second volume of acclaimed outcomes guidelines report. 2007-09-16. Retrieved 2008-10-13.
  20. ↑ Care Continuum Alliance. DMAA research initiatives. Retrieved 2008-10-13.
  21. ↑ Krizner, Ken. Updated disease management guidelines impact investment perspectives. Archived 2011-07-14 at the Wayback Machine Managed Healthcare Executive, 2008-01-01. Retrieved 2008-10-13.
  22. ↑ Care Continuum Alliance. Annual report 2007. Archived October 26, 2010, at the Wayback Machine Retrieved 2008-10-13.
  23. ↑ Care Continuum Alliance. Care Continuum Alliance Publishes Fifth Volume of Industry Consensus Standards for Measuring Outcomes Archived December 16, 2010, at the Wayback Machine 2010-10-14. Retrieved 2010-10-14.
  24. ↑ Care Continuum Alliance. Employer Support for Population Health, Wellness Remains Strong, Survey Finds. Archived July 25, 2011, at the Wayback Machine 2010-03-09. Retrieved 2010-10-20.
  25. ↑ Bridgeford, Lydell C. Steady support for wellness and disease management. Employee Benefit News, 2008-09-09. Retrieved 2008-10-13.
  26. ↑ Care Continuum Alliance. DMAA releases first-ever survey on state of disease management, wellness market. 2008-09-08. Retrieved 2008-10-18.
  27. ↑ Care Continuum Alliance. DMAA produces new participant satisfaction survey tool. 2006-12-06. Retrieved 2008-10-18.
  28. ↑ Patient self-management support programs: an evaluation. Final contract report. AHRQ Publication No. 08-0011. Rockville, MD: Agency for Healthcare Research and Quality, 2007 November. Retrieved 2008-10-18.
  29. ↑ Bennett, Amy Bussian. Defining patient safety. Patient Safety & Quality Healthcare, 2005 March/April. Retrieved 2008-10-18.
  30. ↑ Care Continuum Alliance. Annual report 2006. Archived July 25, 2011, at the Wayback Machine Retrieved 2008-10-18.
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