Risk Identification - Disease Management & Wellness
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1 Risk Identification - Disease Management & Wellness
2 It s All About Health Better Health For Your Members For Your Benefit Plan For Your Bottom Line Your Partnership with MCM Provides an Integrated Solution to Achieving Better Health
3 MCM - Background for Maximizing Performance EXPERIENCE Care Management Pioneer - Founded in 1986 Serving 500+ Plans with over 450,000 Lives Management Team Averaging 20+ Years of Industry Experience CLINICAL MANAGEMENT MODEL Board Certified Medical Director Board Certified Onsite Associate Medical Directors Board Certified Physician Advisors Registered Nurse Care Managers Integrated Quality Improvement Program CREDENTIALS Independent Physician Directed URAC Accredited UM & CM Licensed in All States
4 Are You Managing What Matters? Key Factors Driving Costs Health Plans Focus on Illness Versus Risk Identification, Prevention and Wellness Chronic Disease Epidemic Lack of Appropriate Care
5 Illness Versus Prevention - Options Wait for a Sentinel Event to Take Place Hospitalization Surgery Emergency Room Visit Life Threatening Illness Then Manage the Care as Best as Possible OR Identify Member Health Risks Identify Gaps in Care Provide Members Education on Appropriate Care RN Health Coach to Promote Better Management and Positive Lifestyle Changes
6 Chronic Disease Facts Affects 1 in 10 People Nationwide MCM Data Shows a 24% Prevalence of: Asthma Diabetes Coronary Heart Disease Chronic Obstructive Pulmonary Disease Chronic Disease Accounts for 70% of Health Dollars 50% of People with Chronic Disease are Not Receiving the Care Required to Stay Healthy
7 MCM Solutions for Better Health Integrate Risk Identification and Maximize Performance Results MCM s fully integrated Optimal Health Solution provides the tools to manage the health of all members across the continuum of care
8 Stand Alone Health Risk Assessment Solution Web based access Risk Identification Instant member feedback, risk identification Customized educational links targeted to identified risk Fully integrated with Care and Disease Management Encourages movement to better habits Group Report identifies preventable risk and helps plans focus interventions and educational programs
9 Onsite Biometric Testing Available for All Members and Participants Simple Finger Stick Testing for Key Risk Areas Total Cholesterol HDL & LDL Triglycerides Blood Sugar Body Mass Index Height & Weight Blood Pressure Risk Identification Onsite Test Result Distribution and Comparison with Expected Values Immediate Participant Engagement and Education with MCM s Registered Nurse Health Coaches Plan Summary Report of Risks
10 Identify Risk MEDai Predictive Modeling Solution Incorporates Medical and Pharmacy Claim Data Initial Analysis of 2 Years of Data Monthly Data Updates Risk Identification Identifies Individuals With a Chronic Disease With Gaps in Chronic Care Guidelines Actual and Forecasted Health Risk Actual and Forecasted Health Costs Web Based Reports Summary of Health Plans Risk and Costs
11 Optimal Health Disease Management Management of Disease Entities with Highest Potential for Impact Diabetes Asthma COPD Coronary Heart Disease CHF High Cholesterol High Blood Pressure Stroke and Cerebral Vascular Disease State of the Art Predictive Modeling Integration with Screening Data, UM, CM and HRA s Focused on Compliance with National Care Standards and Lifestyle Issues Individual Registered Nurse Health Coach Engage Every Member with Chronic Disease
12 Optimal Health Disease Management Program Announcement Incentives Maximize Program Participation. Positive Incentives Work Best! It s a New Benefit!!. Announce the Program to All Covered Members via Meetings or Flyers Custom Announcement Letters, Flyers and Welcome to Optimal Health brochures provided for each plan. Buy-in from Management Combined with Effective Announcement Produces Self-Referral! Continue Optimal Health Member Awareness with Newsletters, Posters and Benefit Fairs
13 Optimal Health Disease Management Identification of Chronic Disease MCM Identifies Members with Chronic Disease Through Predictive Modeling, HRA s, Health Screenings, Case Management and UM. Health Screening Data can Increase Chronic Disease Identification up to 20% The Identification and Assessment Process is Conducted by MCM each Month Using New Data Risk Navigator Predictive Modeling Data Analysis Helps Identifies Individuals with Gaps in Care MCM Registered Nurses s Conduct All Member Identification Assessments
14 Optimal Health Disease Management Member Engagement After Identification ALL MEMBERS Identified with a Chronic Disease are Included in the Engagement Process The Engagement Process Takes Days. It Includes 3 Letters and 3 Phone Calls. Phone Numbers are Crucial for Success Engagement Starts with an Introduction Letter Distributed to All Members with Chronic Disease, Followed by a Phone Call in About 7 days Two Additional Mailings and Follow-Up Phone Calls are Conducted for Identified Members. The First Mailing Includes Educational Material Keyed to the Members Risk as well as the Standards of Care for their Chronic Disease
15 Optimal Health Disease Management Health Coaching - Management Track RN Health Coach Assigned to Each Member Custom Compliance Plan Developed for Member and their Physician Calculate and Track Compliance Scores Based on Standards of Care for Disease Category Customized Education Material Keyed to Each Members Specific Needs Goal Setting for Positive Lifestyle Changes Regarding Diet, Nutrition, Smoking and Exercise Health Coach Follow-up Before and After Each Health Care Encounter Promotion of Plan Prevention & Wellness Benefits, as well as UM, CM Programs
16 Optimal Health Disease Management Educational - Management Track Educational Material Keyed to Member Risk and Compliance Level Promote use of Existing Member Assistance or Wellness Resource Web-based Educational Links RN Care Managers Offered to Members Quarterly Contact with All Members
17 Optimal Health Disease Management Measuring Disease Management Plan Impacts Disease Management is a Marathon Not a Sprint. It Does Not Include Quick Fixes and Requires a Long Term Commitment from the Plan. Compliance and Dollar Impact in Months Optimal Health Quarterly Reports Member Status Report Disease Management Activity by: Disease State Member Status No PHI MEDai Risk Navigator Employer Profile Includes Data on Risk, Utilization, Care Compliance and Diagnoses Driving Costs.
18 Better Health and Wellness Solutions HealthInfoLine 24/7 Nurse Assistance MCM Better Health Portal Web Based Personal Health Portal Powered by Mayo Clinic Understand your Risks Make Behavior Changes Manage Current Conditions Reliable Health Information
19 HealthInfoLine - 24 x 7 Nurse Line Health and Wellness Solutions Did you know that 55% of Emergency Room visits are Not Necessary Education and Treatment Alternatives Could Replace 25% of Doctor and Clinic Visits One Simple Call can Provide Plan Members.. Advice from Registered Nurses in Making Healthcare Decisions Education and Treatment Alternatives Information on Hundreds of Health and WellnessTopics
20 Comprehensive personal health management portal Highly personalized for each user Medically reviewed, hosted and updated by Mayo Clinic
21 Mayo Clinic Health Assessment Exclusive state-of-the-art Health Assessment designed to: Raise health awareness Promote behavior change Serve as a health measurement tool for both individuals and organizations
22 Mayo Clinic Health Assessment 11 Risk Factors Alcohol use Blood pressure Blood sugar Cholesterol Emotional health Exercise Nutrition Safety Tobacco Triglycerides Weight
23 Health Assessment Action Plan Available immediately upon completion of HRA Risk level Low (0-1) Moderate (2-4) High (5-7) Very High (8+) Notes both Risks and Strengths Links to tailored messaging, MCM DM programs, plan resources and tools Results Assessed by MCM RN s
24 Health Assessment Drives Secure Messaging Secure messaging triggered by Health Assessment completion Action Plan Reminders Alerts at two weeks, one month, and six months after Health Assessment prompting participant to return to the application Chronic Condition Alerts Monthly messages for self-management of hypertension and diabetes Messages Appear in My Tools sidebar
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