Organization Calls for MLR to Recognize Population Health as Aspect of Clinical Care

DMAA: The Care Continuum Alliance points to 'significant positive impact on quality and health outcomes' that wellness, disease and case management programs provide in letter to National Association of Insurance Commissioners.

WASHINGTON - DMAA: The Care Continuum Alliance, an association representing stakeholders in population health management, told the nation's insurance commissioners today that wellness, disease management and other population-based services should be counted as costs related to clinical care when calculating a health plan's medical loss ratio (MLR).

"Specifically, wellness, disease and case management services improve and support the health of populations and are important components of population health management programs," DMAA: The Care Continuum Alliance said in a letter to the National Association of Insurance Commissioners (NAIC). The NAIC is developing guidance to federal regulators on three expense categories used to calculate the MLR - medical and administrative costs and a third category created by the recently passed health care reform law: quality improvement activities.

"Population health management programs and services educate patients and promote self-management skills; provide coaching and nurse support; ensure safe transitions in care; improve medication adherence and management; coordinate care between providers and care settings; and enhance quality through evidence-based decision support, data analytics, disease registries and other technologies," DMAA: The Care Continuum Alliance told the NAIC. "These services are primarily provided by licensed, clinical health care practitioners in and across numerous health care delivery settings and offer benefits far beyond cost containment and claims adjustment activities."

DMAA: The Care Continuum Alliance noted in the letter that it has previously communicated to NAIC its belief that existing NAIC accounting principles regarding this issue do not appropriately recognize the "significant positive impact on quality and health outcomes that disease and case management programs provide." The group pointed out that a February 2010 paper on minimum loss ratios from the American Academy of Actuaries describes "case management, disease management, 24-hour nurse hotlines, wellness programs" as more "akin to benefits than administrative expenses" and appropriately factored into the value of benefits for the calculation of medical loss ratio.

DMAA: The Care Continuum Alliance told the NAIC that it supports classification of population health management services as either medical expenses or quality improvement expenses in the MLR formula.

A copy of the letter to NAIC from DMAA: The Care Continuum Alliance is avalable at http://www.dmaa.org/pdf/NAIC_Sec2718_043010-FINAL.pdf

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About DMAA: The Care Continuum Alliance
DMAA: The Care Continuum Alliance convenes all stakeholders providing services along the care continuum toward the goal of population health improvement. These care continuum services include strategies such as health and wellness promotion, disease management, and care coordination. DMAA: The Care Continuum Alliance 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. DMAA's activities in support of these efforts include advocacy, research and the promotion of best practices in care management.

DMAA: The Care Continuum Alliance represents more than 200 corporate and individual stakeholders—including wellness, disease and care management organizations, pharmaceutical manufacturers and benefit managers, health information technology innovators, biotechnology innovators, employers, physicians, nurses and other health care professionals, and researchers and academicians. Visit DMAA on the Web at www.dmaa.org.