24/7 NurseLine & Future Moms Program Overview. September 29, am Central/ 12 pm Eastern

Transcription

1 24/7 NurseLine & Future Moms Program Overview September 29, am Central/ 12 pm Eastern

2 Today s webinar We will provide in depth overviews of two 360 Health Programs- 24/7 NurseLine and Future Moms with the main objective being to provide you with the tools to increase employee awareness of the programs available and thus increase program engagement. The call will last approximately 45 minutes. All lines will be muted but through the live meeting software you will be able to ask questions and we will pause to repeat and answer them. Our main presenter today is Lance Geiger 2

3 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: group.anthem.com/360health State specific phone numbers for the programs are printed on the materials available through the above referenced website. 3

4 Comprehensive Wellness Benefits Better Health = Financial Advantage Fully Insured Core Programs Care Management 24/7 NurseLine Future Moms ComplexCare ConditionCare MyHealth Advantage 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 Healthy Lifestyles Worksite Wellness EAP Pharmacy Benefit Management Staying Healthy Reminders 4

5 State Specific Phone Numbers Each state has one program phone number for all 360 Health programs. That means can employees can access all the programs by calling one central phone number. Indiana Ohio Kentucky Wisconsin Missouri These phone numbers are on the promotional materials available on group.anthem.com/360health 5

6 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 6

7 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 7

8 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 8

9 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 9

10 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 10

11 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 11

12 24/7 NurseLine: Call Statistics In 2009, the top five most frequent reasons for calls to the nurse line were: 22% Pediatrics 9% Digestive 5% Dermatology 9% Bone, Muscle or Joint 6% Cardiovascular 12

13 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 13

14 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 14

15 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 15

16 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 16

17 The Case for 24/7 NurseLine (cont d.) NurseLine provides members with access to health information at the right time, helping to avoid potentially unnecessary medical costs. Members who use the NurseLine are 50% less likely to go to the emergency room for non-emergency cases. * *Membership has not been normalized for possible differences in demographics, geography or benefit design. 17

18 24/7 NurseLine: Member Satisfaction Verbatim Comments I called the 24/7 NurseLine to ask about my 6 year old's fever and rash. She suggested I take him to his doctor (which I did) and she asked if she could call me back in a couple days to check on my son, which she did. I really appreciated the call back! I think this is a great program. I had burned myself in the corner of my eye. It saved me time from going to the ER or the walk in clinic. Keep the program. It is a form of emotional peace and security to know we have someone to call and to talk to right away. We have a high deductible so all medical visits are thought through and it is also not easy to get in to a provider right away. It was fantastic. The nurse was patient and took plenty of time to make sure that she understood exactly what my condition was. She gave me good advice and made me feel much better. Without the hotline, I wouldn't have gone to see a doctor, and I would have been worried about my condition through that night. I really appreciated her guidance. If nothing else, it gave me peace of mind. I typically just go to Web MD when I have a medical concern, but the diagnoses there are usually quite grave and do not ask nearly as detailed questions as the nurse did. I was so happy to be able to speak to a live person who took the time to truly understand my condition and was able to help me determine the best next step to take. I was impressed by the professional service I received. It was helpful to speak with a nurse on a weekend when I was traveling away from home. 18

19 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 19

20 Future Moms: Program Overview Future Moms provides individualized support to expectant moms to help achieve healthier pregnancies and deliveries. Follows progress from the first trimester through delivery and newborn care 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 & EAP 20

21 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): 21

22 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 22

23 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 HMC 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 23

24 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 24

25 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 25

26 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 26

27 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 27

28 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 28

29 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 29

30 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 30

31 Future Moms: Measurable Results NICU costs decrease significantly for members engaged in our maternity program. Admits per 1,000 were 50-60% lower for participants than for non-participants. Source: data for large national client with 130,000 members 31

32 Program Results 93% of Future Moms members rate the program as excellent or very good. 1 99% of Future Moms members say they would recommend the program to others. 1 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. 2 1 Source: 2008 member satisfaction study 2 Source: Q member satisfaction study 32

33 Future Moms: Member Satisfaction Verbatim Comments I love this program and as a first time mom, I am very thankful to have had access to the nurses that were extremely helpful every time I called and had questions and concerns. I can definitely say that I had a healthy and wonderful pregnancy and part of it was thanks to this amazing program. I like the fact that the nurses offer the option of a follow-up call to make sure that whatever the situation may be or may have been, they do actually call. And if they don't get you, they call again. It makes you feel like they really care and they seem very interested in whatever you speak to them about. They also try to help you out with whatever you may be needing assistance in. It's a great program. I am so happy this program was available. The program was very useful and of great help during and after my pregnancy. I would definitely use this program again. Great program. Assisted me through my pregnancy. Made me feel more comfortable about concerns throughout my pregnancy. Knowledgeable staff. I appreciated the information and being able to talk to a nurse at all hours. Especially at night and on weekends when my doctor was not available. The information calmed me down and reassured me that everything was ok and normal. I am very satisfied and thankful for this program. The book was helpful and the materials. I also liked talking to the nurses they were friendly and supportive. I liked that they followed up after because I was feeling overwhelmed and they helped me manage my feelings. This program is a win because it prevents illnesses which also helps insurances until lowering the costs. I felt very confident and glad I could talk to a nurse about my pregnancy and symptoms. Every pregnant women should be referred to this program. I had a great deal of knowledge from reading other resources before enrolling in Future Moms, but it was nice to have the program available when I was looking for additional information on gestational diabetes. It was nice to talk to a nurse at that point. I wish I had enrolled in the program earlier, it would have saved me some money on the other books that I bought before I enrolled. Thanks! 33

34 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 34

35 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 35

36 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 Wellness Calendar 36

37 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 37

38 Thank you for your time today! If you have questions about this presentation or your benefits, please contact your Anthem Blue Cross and 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. 38