DHS estimates of year-over-year savings topped $6 million for the program, which targeted 11,000 of the health plan's 85,000 members with medical management programs for diabetes, asthma and congestive heart failure.
"The Colorado-based company's work more than doubled the contract's guaranteed savings for asthma and diabetes patients, for whom savings returned $4.40 and $4.80, respectively, for every dollar the state paid the company," according to a DHS news release published earlier this year. (McKesson estimated savings of $23 million, but a spokesman there acknowledged that much of the sum was based on changes in the health plan, rather than disease management activities.)
The program's biggest savings came from its 3,200 diabetes patients -- despite the fact that it generally takes longer than one year to see results from this population, and considering that the Oregon Health Plan, the state's safety net for poor, uninsured residents, did not cover diabetes test strips for members during eight months of the program's first year, said Dr. Tom Turek, medical director for DHS' medical assistance program.
"The savings from diabetes came from decreased hospital admissions, and a reduced readmission to hospitals for people who had their condition under control when they left the hospital," Turek said, adding that outpatient office and provider costs increased moderately.
Clinical indicators of the program's success included improvement in the numbers of people taking recommended medications like aspirin or ACE inhibitors to protect kidney function. There was also increased knowledge about the disease, better management of blood sugars and lower lipid counts among diabetes patients with high cholesterol, Turek noted.
While McKesson was able to get participation for 93 percent of the people it contacted, it was only able to reach 40 percent of the target population due to logistical problems, said Andy Arends, senior program manager at McKesson, selected by DHS from the nine groups that submitted project bids.
"That number, 40 percent, is actually very high," said Arends.
Among the Medicaid population, some people move frequently and others are homeless or lack access to a telephone. Many don't speak much English, and "some clients have reservations about direct contact from government workers," said Turek. Others have trouble obtaining transportation to the doctor's office.
McKesson employs five nurses in Oregon who spend a great deal of time tracking down these individuals -- identified through the medical claims they file -- and managing their cases.
"The lengths these nurses go to track people down are incredible," said Arends, who told stories of nurses who found their quarry at bars or in far-flung mobile homes with no phone.
He said once potential clients are contacted, most are happy to receive the free health support, Arends said.
"Although it has an antiquated data management system, the state has done a good job of maintaining internal data integrity," said Arends. "We identify people through the claims they incur, and if we can't trust the claims we are sunk."
People who choose to enroll undergo a disease-specific health risk assessment, which is used to develop an individualized care plan. After that, patients receive regular health education and coaching from nurses via phone or personal visit. Members and caregivers also track and analyze participants' clinical test results, and nurses provide support for medical decisions.
In addition, participants have access to a 24-hour nurse advice line.
