The Practitioner Connection
Volume XXVI, 2nd Quarter

PREVENTIVE HEALTH PROGRAMS

Cigna Behavioral Health maintains several Preventive Health Programs for participants. In 2007, three separate programs provided early intervention and support to empower participants to better manage and to reduce the impact of progressive conditions.

Attention Deficit Hyper-Activity Disorder (ADHD)
Description of the Program: Based on the first claim with the target diagnosis. Information packets are mailed and Web site information educates and supports treatment. Survey of helpfulness is conducted approximately 30 days after informational mailing.

In 2007, 7,749 cases were identified and surveys mailed to participants. The National Care Center mailed 32%, Dallas distributed 32%, Chesapeake mailed 29%, and 11% were distributed by Glendale. An additional 1909 informational packets were mailed in response to requests during other phone contact with participants. Our Web site, which also contains these materials, received 6,486 visits to the ADHD resources page. 420 surveys were returned, for a response rate of 5.87%. Respondents were 83% mothers, 14% fathers, largely in the 35-54 age range, approximately 82% with at least some college education, with 16% minority representation. The children were 95% aged 5-12 and 89% reside in 1-3 child households.

Highlights of program feedback for effectiveness, based on the surveys:
1. Scores for helpfulness, use, and completeness of program materials were high, and were largely improved in 2007. Use of program materials and tools in treatment and ratings for helpfulness in understanding the child scored higher in 2007 than 2006.
2. Use of program tools in the treatment process remains stable at 65%. 90% of respondents would recommend the program materials and tools to others.
3. There was a modest increase in perception of practitioner skill, and a 5% increase in satisfaction with treatment progress in 2007.
4. The 2007 program emphasized the importance of Best Treatment Practice: Medication use and compliance and Behavioral Treatment. A new question-set was added to the 2006 survey, and in 2007 it reveals that approximately 85% of treatments now include medications, an increase from 42% in 2006. 56% reported use of behavioral treatment in 2007 compared with 8% in 2006.
5. Further, survey report for outcome effectiveness indicates 69% rates for medication compliance and 91% of cases experience improved family relationships as a result of behavioral interventions.

A national workgroup of practitioners and providers reviewed the ADHD Preventive Health Program and suggested shortening materials sent to parents and refocusing materials and intervention sets on practitioners, with increased encouragement to use these in treatment, as well as strengthening the link to pediatricians. In response, a 2007 national workgroup has refocused program materials based on these suggestions, encouraging best treatment practices, support for medication use, adherence, and compliance and behavioral treatment through additional practitioner outreach. Higher levels of medical-behavioral integration remain desirable since primary care physicians share treatment for this population.

National Care Center's Depression Preventive Health Program
Description of the Program: For participants aged 18 and over, any admission in a year with a Diagnosis of Major Depression triggers mailing of two separate packages of educational information, community resources, and treatment support tools at time of Diagnosis Identification and 30-days later, to the participant’s home. A survey of helpfulness is included in the second information packet.

Both mailings additionally direct participants to 's behavioral website for supplemental materials. Those who lack Internet access can receive the materials from 's Advocacy Department upon request. 2007 results are still being collated. Data below is for 2005 and 2006.

Interventions were intended to increase participant understanding of depression, to encourage beneficial self-care/monitoring, and to support outpatient treatment engagement with the hope of reducing disease impact and progression. Satisfaction results, although having limited power, suggest program materials are helpful and impact the participant's experience.

Depression Screening In Disease Management
Description of the Program: Depression screening and intervention is administered to participants diagnosed with low back pain, diabetes, heart disease, asthma, chronic obstructive pulmonary disorder(COPD), obesity, and targeted chronic medical conditions. The screening is done initially and at one year intervals using components of the highly validated Prime-MD depression screening tool developed by Pfizer Corporation. Those who screen positive receive outreach and intensive care management, educational and other resource materials. Where consent is given care guides and other resource materials are made available to their Primary Care physician. Referral for behavioral treatment is also available, as appropriate.

Within all of the listed programs in 2007, 382,193 participants received depression screening. 13,030 participants, or 3%, screened positive for depression across all programs and consent was given for Primary Care physician notification in 41% of these cases. The highest positive depression screening of 7% was seen in the COPD population and the highest rates of 46% for consent to notify the Primary Care Physicians were seen in the Diabetes population. Lowest rates of 3% for depression incidence were seen in Obesity and Chronic Targeted Medical Conditions populations while the least consent to notify Primary Care Physicians was 3% in the Obesity population. Screening will continue in 2008, and additional disease populations will be considered, as appropriate.

New Directions For 2008
maintains a library of over 600 educational articles and tools for participants, who may access this information via the Web site or through request or suggestion during contact with staff. A review of these educational materials is underway, based on volume distribution and annual demographic/diagnostic assessment. Future development of Preventive Health programs are being considered in the areas of identified need as a result of this review.

Other Featured Articles:

KEY FINDINGS OF THE QUALITY AND UTILIZATION MANAGEMENT PROGRAM

AUTISM AND OTHER PERVASIVE DEVELOPMENTAL DISORDERS

EAP SUBSTANCE ABUSE ASSESSMENT AND MANAGEMENT REFERRALS

PROVIDER SATISFACTION SURVEY

CLAIM OFFSETTING PROCESS

GAPS IN CARE FOR BIPOLAR DISORDER

MEDICAL MANAGEMENT PROGRAM

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