Complete Health Solutions. Copyright 2010, Health Advocate, Inc.

Transcription

1 Complete Health Solutions

2 Health Advocate The nation s leading independent health advocacy and assistance program Offered by more than 7,000+ clients nationwide Serving more than 16 million Americans Covers the employee, spouse, dependents, parents and parents in-law An expert staff of healthcare and insurance professionals A strong and recognized brand enjoying a reputation for being objective and well-respected A privately-held company founded in 2001 Financially strong, profitable and debt-free

3 Th i t b di l d Y t t h h t th i th i h b t d R t t t d th th fil i If th d till h t d l t th i d th i t it i The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. Health Advocate Serves America

4 Where Do You Start?

5 External Appeals Administration Tobacco Cessation

6 Health Advocate s Core Program Personal Health Advocate - RN s supported by Medical Directors and claims and benefits Experts Care Locator - Nationwide service, network coordination, common care needs, DME, Dental Services Advocates of Excellence - Centers of Excellence, complex care, coordination, 2 nd opinion service Health Advocate CareCoach - Medical information using the HealthWise database, pricing tools Benefits Advantage - Claims, referrals appeals, grievances, paperwork Help Health lthad Advocate CareQuest - Additional outside services and resources

7 A Truly Integrated Care Model Personal Health Record CATE ADVO Health Information Health Risk Appraisals Online Medical Info Self Care Tools Cost Information Provider Quality Info LTH A HEAL HEALTH ADVOCATE Patient Physician Rlti Relationship Individual Health Interventions Wellness Programs Decision Support Disease Management Case Management Nurse Triage Line HEALTH ADVOCATE HEALT TH AD Provider Network Member Service DVOC CATE Health Benefits Claims Admin

8 Reasons for the First Call Rx Advc 6% Care Coord 4% Sr Care Nav 4% Ben Advant 13% Mind Mat 2% Advc Exc 5% Care Locator 20% Cov Advant 11% Fee Negot 2% Hlth Coach 4% Care Qwest 2% Claims Assist 27%

9 Reasons for the First Call Admin Services 53% Clinical Services 47%

10 Clinical Utilization Distribution

11 Pricing Tools Health Cost Estimator Pre-service Pricing Decision Support Tool Part of Core Health Advocate Service Cost estimates based on episode of care National reference claims database No Additional Cost Medical Bill Saver Post-service / Post-claim Pricing Review Tool Optional Service at an Additional Cost Specialized Internal Unit to Negotiate Specific Claims Can Save Member and Employer Significant $$$ Sample of 128 Cases, Charges = $425,986, Discount 48%

12 MedChoice Support Program

13 MedChoice Support Program

14 Health Advocate EAP Full Service EAP with a national presence Flexible visit models Inexpensive telephonic program Complete online Work-Life program Onsite crisis management Continuing professional staff development program Targeted HR staff counseling, and support around personnel management

15 24- Hour Nurse Line Round the clock access to trusted health advice Can help avoid unnecessary trips to the emergency room Gets people to the right care at the right time Helps employees make better decisions and use their benefits wisely

16 Administrative Solutions FMLA Administration Researches requests for coverage under FMLA Speak with doctors, review medical records Provide summary to the HR/Benefits staff Internal Appeals Administration For self-insured employers who retain fiduciary responsibility Research all aspects of the case Provides summary to internal appeals review group Helps company comply with new federal regulations External Appeals Administration For self-insured employers Health Advocate has contracted with 3 IRO s Provides complete administration of the appeals process consistent with new federal regulations

17 Health Advocate Wellness Program A Personal Wellness Coach is the Focal Point for Participants Online, Personalized Web Portal Health Risk Assessment Immediate Results Health information and Interactive tools Unlimited Chat and Telephonic Coaching Personal Health Record Incentive Management Communications Management Reports Add-On Options : Workplace Programs (i.e., biometric i screening, on-site coaches, etc.)

18 Health Advocate and Wellness Core Health Advocate + Wellness Advocate

19 Among Firms Offering Health Benefits, Percentage Offering a Particular Wellness Programs to Their Employees, by Firm Size, 2009 Offer at Least One Wellness Program* Web-based Resources for Healthy Living* Gym Membership or Exercise Facilities* Smoking Cessation* Wellness Newsletter* Weight Loss Programs* Classes in Nutrition/ Healthy Living* Personal Health Coaching* *Estimate is statistically different within type of wellness program between All Small Firms and All Large Firms (p<.05). Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, Copyright 2009, Health Advocate, Inc.

20 Wellness Incentive Programs

21 Contribution to Premature Death Genetic Behavioral Predisposition Patterns 30% 40% Social Circumstances 15% Environmental Exposure 5% Health Care 10% Schroeder, NEJM 357:12, September 20, 2007

22 US Deaths Related to Behavior ousands) mber of Deaths (tho Num Schroeder, NEJM 357;12, September 20, 2007

23 Focused Tobacco Cessation Program Focused, 13-week program Less expensive than competing programs Uses state-of-the-art the art techniques to help individuals quit Unlimited access to coaches live or online Priced on a per- participant basis Access to discounted Nicotine Replacement perparations

24 The Cost of Obesity Extra Lifetime Medical Costs Attributed to Obesity for 20-year Olds Who Are About 30 to 69 Pounds Over A Healthy Weight White Men: $16,490 Black Men: $12,290 White Women: $21,550 Black Women: $5,340 Extra Lifetime Medical Costs Attributed to Obesity for 20-year Olds Who Are Roughly 70 Pounds Over A Healthy Weight White Men: $16,720 Black Men: $14,580 White Women: $29,460 Black Women: $23,750 Source: Eric Finkelstein, Economist for RTI International: The Journal of Obesity As Reported in USA Today, June 10, 2008

25 Engage Health Solutions Core Advocacy Wellness Advocate Prevention & Chronic Care Messaging Benefits Gateway & Dashboards 25

26 Benefits Gateway & Dashboards Single, toll-free number to help employees reach all benefits programs Live benefits experts connect employees to the right benefits at the right time Personalized Health Information Dashboards organize vendor data in one place Dashboards enable Health Advocate to use information in real-time to impact health behavior Online employer access to the most current performance data Helps ensure employer priorities and strategies are aligned with benefits programs Data can be added incrementally over time 26

27 Benefits Gateway & Dashboards Leveraging Information for Change Six Steps To Changing Behavior 1. Inform 2. Motivate 3. Engage 4. Activate 5. Intervene 6. Measure the Results 27

28 Creating a Member Smart File INFORMATION Demographics Benefits Medical Claims Pharmacy Claims Laboratory Tests Health Risk Assessment Disease Management Treating Physicians Health Advocate Interactions ti Disability Status Work Absence

29 Health Advocate Dashboard 29

30 Data at the Point of Engagement Thanks for calling your Benefits Gateway, Jim. How can I help you today?

31 Addressing Gaps in Care II notice that you haven t refilled your Lipitor prescription since 12/31/2010. Are you still taking this medication? 2010

32 Addressing Gaps in Care While I have you on the phone, I just wanted to let you know that your company has a free program that can help you with questions you may have about managing Asthma. I can help you join if you are interested

33 Client Dashboard 33

34 Client Activity Dashboard 34

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37 Benefits Gateway and Dashboards Single point of access for easy use Low cost and costeffective The ultimate integration tool Motivates actions at the point of engagement Maximizes the value from all associated programs Reduces medical costs and improves clinical outcomes

38 Benefits Gateway and Dashboards Data input can be added incrementally Anywhere, anytime web access to information Current information on the desktop Makes static data usable Highlights opportunities and priorities Personalized and privacy protected t Allows employers to understand and manage their benefit programs

39 Engage Health Solutions Core Advocacy Wellness Advocate Prevention & Chronic Care Messaging Benefits Gateway & Dashboards 39

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42 Use the Data to Identify 3 Groups 42

43 Health Advocate s Solutions Core Advocacy Wellness Advocate Prevention & Chronic Care Messaging 43

44 Personalized Communications A unique approach to motivating a member to take action Uses data to develop truly personalized messages Addresses preventive care and chronic care management Provides information on gaps in care to treating physician 2010

45 Personalized Messaging Overview Prevention Reminders Chronic Care Management Reminders

46 Personalized Messaging Targeted Tailored - Personalized Call to Action

47 Monthly Reminders Preventive Care Reminders Cancer screenings Cardiovascular screenings Immunizations Chronic Care Reminders Cardiovascular screenings Diabetes screenings Condition-based Rx reminders Pharmacy Reminders Cost-saving saving and convenience-gaining recommended Rx switches

48 Physician Notifications

49 Reporting Client Outcomes 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Total Breast Cancer Screening Cervical Cancer Screening Colorectal Cancer Screening Blood Pressure Screening Influenza Vaccination: Ages 0 18 Influenza Vaccination: Ages 50+ Influenza Vaccination: Ages Cholesterol Screening: Normal Cholesterol Screening: High Risk Osteoporosis Screening: Normal Osteoporosis Screening: High Risk % Compliance (Baseline) 51.9% 63.0% 67.6% 39.2% 87.0% 11.2% 17.5% 12.4% 60.8% 46.4% 25.0% 63.8% % Compliance (2/28/09) 55.8% 65.4% 69.8% 44.2% 88.6% 15.4% 27.5% 21.4% 62.8% 50.0% 33.3% 66.7% % Compliance (9/30/09) 59.3% 67.7% 7% 70.0% 0% 49.4% 4% 90.4% 17.0% 28.2% 2% 22.2% 2% 74.0% 57.8% 33.3% 3% 60.9% Difference (Points) (2.9) Difference (%) 14.3% 7.5% 3.6% 26.0% 4.0% 51.4% 60.8% 79.7% 21.8% 24.6% 33.3% 4.5%

50 Coaching to the Specific Need Core Advocacy Wellness Advocate Prevention & Chronic Care Messaging Benefits Gateway & Dashboards 50

51 Client Value Engage 100% of the population Well received, personalized program Increase use of in-network physicians and support the Medical Home Increase in number of high value medical procedures (i.e., colonoscopy) Increase in number of employees engaged thru Core Advocacy, Wellness, Prevention and Chronic Care Messaging, Benefits Gateway & Dashboards and other programs Generates cost savings and best possible medical outcomes through prevention, early detection and quality care

52 External Appeals Administration Tobacco Cessation

53 Thank You!