WPS Integrated Care Management Improving health, one member at a time

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1 WPS Integrated Care Management Improving health, one member at a time

2 Integrated Care Management supports and promotes member health Looking for more from your group health insurance for your employees? You re in the right place. WPS understands you want value and more bang for your buck than just comprehensive health care coverage. You want your employees to receive high-quality, appropriate care; you want the best care, better outcomes, and reduced costs for your employees. That s where we come in. Integrated Care Management offers a holistic view of your employees health and wellness You re probably familiar with the initial aspects of Integrated Care Management (ICM): case and disease. Other companies promise to coordinate case services and empower members to manage their conditions and prevent complications through these services. We do those things too! But we start coordinating our services and resources several steps before, begining with our unique, comprehensive analytic tools; and we carry on afterward, with our targeted approach and specialized ICM care team.

3 Getting started Using your group s claims history and pharmacy benefits information and data gathered during care transition, WPS runs the data for each employee through a special algorithm, tailored and adjusted specifically for WPS groups, based on certain criteria and industry standards. This algorithm highlights high-risk or at-risk members with gaps in care, high claims submissions, and more. Some examples of criteria in our algorithm include: More than 10 inpatient days in the past three months Two or more hospital admissions in the past six months Chronic condition and no history of a physician visit in the last calendar year Member with a new cancer diagnosis Member with a cardiac event (heart attack, etc.) in the past month Once we identify members that meet the criteria, our Integrated Care Management team reviews the information and hands it off to a local WPS nurse. The nurse will reach out to each member to motivate him/her to participate in case help. The nurse will act as the main point of contact and coordinator of care for the member. Together, the nurse and the member will assess the current status of the member s health, develop a plan, refer for more specialized care, and work with the member s physician to get back to a healthier lifestyle. Maximize results with our Clinical Pharmacy Programs Three Clinical Pharmacy Programs support ICM and the care plan developed between you and your provider(s). ScreenRx SM helps members overcome barriers that prevent them from consistently taking their medicines. RationalMed helps members get care when a gap has been identified and prevents wasteful medication use, drug therapy conflicts, and unnecessary costs. You also have access to specially trained pharmacists with expertise in most common conditions (e.g., cancer, women s health, asthma, diabetes, and more) to answer your questions and oversee your care through our Therapeutic Resource Center program. ScreenRx, RationalMed, and the Therapeutic Resource Center are all integrated into the overall ICM program. Impact: Personalized experience Real-time pharmacy data and results Optimized health outcomes

4 Learn more about the Integrated Care Management member resource wheel Our program goes beyond the usual case or disease that has been offered; we provide a spectrum of resources to ensure your employees have access to the best care. Based on the analyzed data, the nurse will work with high-risk or at-risk members to determine which area(s) he or she needs support from. Not only do we offer shared decision-making tools, which allow members to understand their health choices and provide additional guidance for discussions to have with their doctor, we also offer expertise in the areas below. Health care informatics (HCI) Behavioral health Wellness Member Disease (DM) Medical utilization (UM) Pharmacy programs Case (CM) The ones you know: Case : Coordination of services on behalf of members. Disease : System of coordinated health care interventions and communications that empowers members to manage their conditions and prevent complications. The ones that go above and beyond: Behavioral health : Mental and substance abuse evaluations guide members to appropriate care. Medical utilization : Evaluation of the appropriateness and medical need of services, according to evidence-based criteria and guidelines. Pharmacy programs: Ensure access to the medications members need while keeping costs down and adhering to doctor recommendations. Health care informatics: Links data and reporting to improve the quality and safety of patient care. Population Health Management: Our Integrated Care Management program, plus close collaboration with providers, helps manage the health of your entire employee group. It s not hard to see our ICM program gives you more. Depending on your employees needs, our team will assess each area outlined above and offer personalized services and tools to give them the support and help they need.

5 Integrated Care Management works for you Sickest Care Continuum Healthiest Catastrophic Chronic Unstable Chronic Stable Acute Illness Major Acute Illness Minor Asymptomatic Illness/ Disease Healthy with Risk Factors Healthy ICM doesn t focus on diseases it centers on each member s overall health. The WPS ICM team seeks to meet members wherever they fall on the care continuum, from healthy to catastrophic. Members move toward the healthy end of the spectrum using the expertise of our care team. Members learn the best ways to manage their health, with support from the ICM team. And that s why it works! Care and health and wellness are integral parts of everyday life, not just one-and-done solutions. Healthy members have a better quality of life and are empowered to self-manage their health conditions for the rest of their lives through our tools and resources. Sickest Care Management Healthiest Facilitate access to health care Coordinate health care provider visits Create care plan Educate on disease, medications Maintain or coach

6 Pharmacy Services Nurses Physicians Member Health Coaches Data Analysts Learn more about our ICM team Our ICM team is our greatest asset. All team members are committed to making a difference in the lives of each member they care for, which impacts your company and our communities. They re continually focused on innovative solutions and holistic care that gets your employees back to work and living a healthy lifestyle sooner. Data Analysts: Provide reporting and analysis that promote better, data-driven decision making. Pharmacy Services: Identify issues that directly impact patient care and safety regarding prescription drug adherence and use. Nurses and health coaches: Educate members about health conditions and assist with benefit issues; focus on member wellness and encourage healthy lifestyles; and assist members through complex episodes of care. Physicians: Ensure members get the most clinically effective, cost-effective care as well as the help they need to understand their care options.

7 The results of Integrated Care Management speak for themselves You know that employees who are not in good health indirectly increase costs for your business. Sick days, disability, and reduced productivity all contribute to those costs. Why wait when the solution is clear? Greater claims cost savings The potential benefits of ICM are numerous: Costs are controlled for your group and employees Inappropriate procedures are avoided Length of inpatient and hospital stay is reviewed and managed Health care is guided to the best sites of service Services are reviewed according to evidence-based guidelines to ensure quality Costly future health events are avoided Members are met where they fall on the care continuum and led back to better health with our holistic approach Consideration for the whole member and all of his or her clinical needs is taken into account The members quality of life is enhanced Members are educated about their health conditions and empowered to self-manage Increased member satisfaction Greater treatment engagement Better adherence to treatment plans Better quality decision making

8 Find out more today! Contact your local agent or call WPS directly at Get more information about health insurance and healthy lifestyles read our blog online at blog.wpsic.com! 2015 Wisconsin Physicians Service Insurance Corporation. All rights reserved