24/7 Nurseline and Future Moms. Presenters: Blanche Callahan

Transcription

1 24/7 Nurseline and Future Moms Presenters: Blanche Callahan

2 Agenda Goal: Learn about 24/7 NurseLine and Future Moms including how to promote the programs in the workplace. Frequently Asked Questions: 24/7 NurseLine and Future Moms are included in your Anthem benefit offering at no additional cost. Promotional resources like posters, fliers, and promotional templates are available at: 2

3 Comprehensive Wellness Benefits Better Health = Financial Advantage Fully Insured Core Programs Included in benefits Care Management 24/7 NurseLine Future Moms ComplexCare ConditionCare Healthy Lifestyles Online Tools and Resources MyHealth@Anthem MyHealth Assessment MyHealth Record Condition Centers Online Community Specialoffers@Anthem AudioHealth Library Time Well Spent Also Available ConditionCare: Support ConditionCare: Kidney MyHealth Coach MyHealth Advantage Worksite Wellness EAP Pharmacy Benefit Management Staying Healthy Reminders 3

4 24/7 NurseLine: Program Overview Our 24/7 NurseLine provides access to a registered nurse over the phone 24/7, anytime, anywhere for assistance or just to hear a reassuring voice. Helps members understand their symptoms Increases understanding of medical condition or prescribed course of treatment Helps ensure members access the right care in the right setting 4

5 24/7 NurseLine: Goals 24/7 NurseLine seeks to: Promote self care via immediate access to health information and education Promote care and treatment by network providers Provide immediate information on symptoms appropriately Help lower health care costs by providing callers with medical information to assist them in deciding which level of care to seek Provide seamless integration with our other care management programs Help increase participant satisfaction with their health care plan 5

6 24/7 NurseLine: Key Features The 24/7 NurseLine program features include: A skilled clinical team - RN license (BSN preferred) Bilingual RNs, language line, and hearing impaired services Immediate physician support, as needed Personal Health Counseling Comprehensive Audio Health Library Program promotional pieces available Quality assurance Clinical record reviews Satisfaction surveys 6

7 24/7 NurseLine: Benefits Both members and employers benefit from 24/7 NurseLine: Members Credible information that s free, 24/7, 365 days a year Saves time Proactive call backs Health benefits integration Employers Cost Avoidance Appropriate use of services Employee satisfaction with health benefits 7

8 24/7 NurseLine: Advantages & Differentiators We started with NurseLine 20 years ago: Not affiliated with a hospital Objective resource whom they can trust Timely information independent from any particular institution All RNs Personal return calls Access to integrated system platform Virtual environment disaster resistant Experienced staff physician support Medical Director is assigned to each call center Extensive knowledgebase more than 5,000 topics 24/7 access incorporates AudioHealth Library s extensive resources 8

9 24/7 NurseLine: Advice & Information Program 24/7 NurseLine advice and information is based on: Identifying the appropriate level of care Acute/emergent procedures HealthWise Knowledgebase 125 complex medical problems 135 symptom assessments 500 health topics 600 medical tests and procedures 5,000 self-help support groups 120 CancerNet topics 5,000 drug treatments 9

10 Poll #1 In 2009, the most frequent reason for calls to the nurse line was: a. Cardiovascular reasons b. Digestive issues c. Pediatrics (Relating to child) d. Bone (Sprains/breaks/fractures) e. Dermatology (Rashes, etc) 10

11 24/7 NurseLine: Call Statistics In 2009, the top five most frequent reasons for calls to the nurse line were: Pediatrics: 22% Digestive: 9% Bone: 9% Cardiovascular: 6% Dermatology: 5% 11

12 24/7 NurseLine: 360 Health Integration 24/7 NurseLine seamlessly integrates communication and coordination with other 360º Health programs via: Responding nurse may direct the caller to the primary physician ConditionCare primary nurse manager is automatically notified if a program participant calls 24/7 NurseLine and may initiate a follow-up phone call to the member Program and resource referrals for ongoing assistance Automatic tracking process 12

13 24/7 NurseLine: Staffing Experienced nurses are trained to address common health care concerns such as medical information, education, access to health care, diet, social/family dynamics and mental health issues. 134 Registered Nurses; 20 Master s prepared All calls are answered by a Registered Nurse Average nursing experience is over 19 years Wide variety of specialty areas Intensive, ongoing training Quality assurance management oversight and review 13

14 24/7 NurseLine: Member Outreach and Engagement We see a higher participation rate with clients who incorporate more program promotion. On average, 2-4% of members will call the NurseLine in a given year Spanish speaking nurses available Network Services Language line available Satisfaction Survey cover letter Branded promotional materials available 14

15 24/7 NurseLine Satisfaction Surveys % % felt more positive about their health plan due to the availability of Nurse Advice Line 94% were comfortable speaking to a nurse by phone 50 Felt more positive about their health plan due to the availability of 24/7 NurseLine Were comfortable speaking to a nurse by phone Followed the nurses recommendation 92% followed the nurses recommendation **Based on 2007 responses for all business 21,411 Surveys 15

16 24/7 NurseLine: Reporting Metrics 24/7 NurseLine reports are provided quarterly and include the following data*: Total number of contacts Total contact reasons Unique member contacts Number of calls requiring clinical evaluation Most frequent nurse recommendation Contact category distribution: administrative, clinical evaluation, or other Top 5 symptoms Caller precall intent & nurse recommendation: call 911, seek emergency care, seek urgent care, unsure, call healthcare professional, seek healthcare professional, self care *Availability varies based on size, please see Anthem representative for more details 16

17 Future Moms: Program Overview Future Moms provides individualized support to expectant moms to achieve healthier pregnancies and deliveries. Follows progress from the first trimester through delivery Offers early-risk assessment along with both standard support and high-risk management Obstetrical nursing support for both high-risk and non-high-risk expectant mothers Post-delivery follow-up, including postpartum depression assessment, education and referral to BH & ESP 17

18 Poll #2 On average, employers pay how much more for preterm babies? a. 3 times more b. 10 times more c. 15 times more d. 25 times more Sources: Estimates come from Thomson Reuters research findings as contracted by March of Dimes; and Preterm Birth: Causes, Consequences, and Prevention, a report published by the Institute of Medicine (2006): 18

19 The Case for Future Moms High-risk pregnancies, premature births and infant mortality can have a significant impact on health care costs: Average cost of a preterm baby in the U.S. = $64,713 Average first-year medical costs: $49,033 = preterm infants $4,551 = full-term births Direct healthcare costs to employers: $41,610 for every premature baby $2,830 for every full-term baby Employers pay 15 times more for preterm babies Productivity/synergy loss= $2,766 Sources: Estimates come from Thomson Reuters research findings as contracted by March of Dimes; and Preterm Birth: Causes, Consequences, and Prevention, a report published by the Institute of Medicine (2006): 19

20 Future Moms: Goals Future Moms, is designed to help expectant mothers focus on early prenatal interventions, risk assessments, and education in order to help: Promote healthy pregnancies and healthy babies Recognize signs and symptoms of complications related to pregnancies Reduce low birth-weight births Reduce pregnancy-related medical costs 20

21 Future Moms: Key Features A key component of Future Moms is a comprehensive, systematic and personalized management approach for the participants. Key features include: A thorough assessment and risk stratification for each participant An assigned primary registered nurse with OB experience 24/7 toll free telephonic access to registered nurses Education on pregnancy care and topics Lifestyle management and behavioral change counseling Pharmacy and nutritional counseling Coordination of services and referrals Screening for pre-delivery and postpartum depression 21

22 Future Moms: Benefits Both, members and employers, benefit greatly from the Future Moms program as the program helps to: Members Promote healthier behaviors Improve birth outcomes Provide proactive intervention and support Educational materials- on proper self-care and pregnancy management goals Increase understanding and control of health risks/conditions Increase understanding of appropriate health care utilization Reduce preventable conditions & related medical costs Employers Improve employee productivity Reduce absenteeism Increase employee satisfaction 22

23 Future Moms: Advantages and Differentiators Since 1989, Future Moms has helped welcome more than 200,000 babies into the world. Other key differentiators include: First maternity management program NCQA full accreditation Experienced nurses in obstetrics and/or perinatology Lactation consultants and nurses certified in smoking cessation 24/7 access to our nurses Personalized approach Successful management of high-risk participants The program integrates effectively with other 360º Health programs 23

24 Future Moms: Identification of Members Members are identified using a variety of opt-in methods: Physician and/or self referrals Case management referrals Customer service inquiry reports Physician & health clinic interaction Promotion- via newsletters, benefit information, and workplace distribution 24

25 Future Moms: Member Outreach and Engagement The Future Moms program utilizes an industry-leading, technologyenhanced, personal touch approach: Outbound contact to members meeting program criteria Get In Touch letter- to introduce the program and encourage enrollment Mailings to all identified participants Healthy Returns System (HRS)- houses all clinical and demographic information Outreach at a teachable momentleverage the opportunity to reach willing participants Implement appropriate interventions- to achieve health goals based on assessment 25

26 Future Moms: Ongoing Management Individual intervention goals are established based on participant s medical status, maternity risk factors, and provider s plan of care. Periodic assessments-monitoring and providing educational information Contact High-risk participants-monthly or as frequently as daily Program interventions and communications- via phone and mail Pharmacist or Dietician telephone contact Coordinate services and referrals Progress updates- inform associate case managers of progress Maintain contact- maternity care provider and health services vendor(s) Post partum follow up- (2-4) weeks after delivery Birth kit-mail to new mom s home Satisfaction survey 26

27 Future Moms: Member Education Materials Future Moms maintains ongoing contact with participants throughout the pregnancy and after the delivery. Communication includes: Prenatal Kit Your Pregnancy Week by Week pregnancy book Maternity Care Guide Eating for Two brochure Delivery Option brochure Postpartum brochure Birth Kit Keeping Yourself Home pamphlet Online information 27

28 Future Moms: 360 Health Integration Future Moms, seamlessly integrates communication and coordination with other 360º programs, including: Wellness initiatives Preventive care programs Integrated care and condition management Catastrophic case management Behavioral health Pharmacy Dental Employee assistance program (EAP) Care coordination & utilization management 28

29 Future Moms: Incentives Consider incentives to increase member participation in the Future Moms program Monetary gifts Gift cards Baby supplies: car seats, new baby baskets Extra days off 29

30 Program Results Future Moms participants incur fewer NICU costs than those that do not participate; NICU admits per 1,000 were 50 60% lower for members than for non members. 1 93% of Future Moms members rate the program as excellent or very good. 2 99% of Future Moms members say they would recommend the program to others. 2 93% of Future Moms members agree they had an excellent experience in speaking with a staff member. And 90% feel the staff member provided the member with valuable information. 3 1 Source: data for large national client with 130,000 members 2 Source: 2008 member satisfaction study 3 Source: Q member satisfaction study 30

31 Future Moms: Provider Engagement Future Moms encourages physician feedback and collaboration to improve program outcomes. Our multi-level approach to collaborating with physicians includes: Self-help resources for members Maternity nurse telephone access 24/7 Conservation of valuable office staff time Spanish-speaking consultants- help facilitate communication Coordination of authorizations and arrangements-for home health services Update the provider on member performance 31

32 Future Moms: Reporting Metrics Program Activity: Registration numbers Participation rate Participant demographics Risk assessment rate Clinical risk factors Program completion Program satisfaction Program Outcomes: Participant delivery outcomes Low birth weight rate Gestational age at birth IP facility maternity expense per member IP facility maternity expense related to pre-term complications IP facility infant prematurity expense Postpartum assessment Customized ad hoc reports available *Availability varies based on size, please see Anthem representative for more details 32

33 Promotional Resources at Your Fingertips Make sure your employees know the 360 Health programs available to them. Go to Here you will find: Program posters with phone numbers Program fliers with phone numbers templates that promote programs Time Well Spent 2010 Promotional Calendar 33

34 Promotional Ideas Hang posters or fliers in common areas like the cafeteria, break room, stairwells or elevators Post the 24/7 NurseLine phone number where HR resources are housed (bulletin board or intranet). Use the templates to send quarterly or monthly s highlighting one health program or a wellness article from Time Well Spent Provide fliers at Open Enrollment meetings, in your HR office, or on your company intranet site Post the Future Moms flier wherever you house short term disability or maternity leave information. Highlight health programs in your company employee newsletter Add healthy bytes from Time Well Spent to s from company executives 34

35 Please join us for upcoming webinars UPCOMING WEBINARS (All times 11:00 AM PST): October 6: How to Promote Wellness in the Workplace October 13: MyHealth Advantage November 3: Complex Care /ConditionCare December 9: Anthem.com and the member experience Register at 35

36 Thank you If you have additional questions about this presentation or your benefits, please contact your Anthem Blue Cross Blue Shield representative. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-hmo benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia (excluding the City of Fairfax, the Town of Vienna and the area east of State Route 123.): Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 36