For fully insured groups of 100 or more eligible employees HealthyOutcomes wellness case management condition care maternity A fully-integrated health management solution that works for you
HealthyOutcomes wellness case management condition care maternity Innovative ways to make a positive difference in your employees health What it is Healthy Outcomes combines four great programs into one valuable package that helps you keep your employees healthy and your health care costs under control. 1 + Healthy Outcomes Wellness our range of structured, virtually turnkey wellness programs 1, 2 + Healthy Outcomes Case Management our personal outreach for high-risk individuals + Healthy Outcomes Condition Care our disease management program + Healthy Outcomes Maternity our program for expectant and new mothers 3 Healthy employees, healthy company Help your employees live healthier, more productive lives while keeping your health care costs down with Blue Cross and Blue Shield of North Carolina s (BCBSNC) Healthy Outcomes health management solution. The fact is that a healthier workforce can mean a healthier bottom line for your business. The direct and indirect costs of illness can really add up that s why BCBSNC provides solutions to help you curb these costs. How can Healthy Outcomes support your employee health strategy? BCBSNC understands that your employees and their families have different needs according to their health conditions. And because the 4% of the population with chronic or complex conditions is driving 50% of total health care costs, 4 being able to effectively target and focus health management efforts on the right individuals at the right time is important. Our sophisticated system identifies and targets: + Individuals with high-acuity needs, with intensive one-on-one interactions + Healthy individuals, with programs to maintain their current health. Identifying those who need care - so we can work with them to get well. For Every 100 Employees 5 25 8 34 11 have cardiovascular disease are asthmatic are excessively overweight are diabetic 31 33 21 15 use alcohol excessively have high blood pressure smoke have high cholesterol 20 33 44 don t wear seatbelts don t exercise suffer from stress PAGE 2 of 12
4% of your population is 4 driving 50% of costs Predictive Modeling + Care Gaps + Demographics + Utilization + Health Assessment + Impact predictive modeling rules Risk Stratification Participants re-stratified: + Monthly based on claims + Each time a Condition Care Coach has an interaction with the member Participant Acuity Level + Acuity level assigned by condition on a monthly basis Low Moderate High Risk Score & Profile Low Moderate High Member Engagement Moving toward wellness High Risk Specialty Care & Case Management High/Moderate Risk Condition Care & Utilization Management Moderate/Low Risk Lifestyle Risk Reduction Low Risk Wellness Programs & Services A constant eye on your employees health Through our risk stratification process, we re constantly monitoring your population to quickly identify individuals who may need attention. This helps to get people healthy and keep them healthy. And, it works to keep you and your employees health care costs down as well. PAGE 3 of 12
HealthyOutcomes wellness case management condition care maternity A new approach to health management: integrated, personalized, technology-enabled Improving health and wellness while keeping medical costs low The Healthy Outcomes programs work in concert with each other to help improve health and well-being. From innovative technology support for wellness programs, to disease management that covers five major chronic conditions, to comprehensive maternity management Healthy Outcomes is a smart, effective way to help you keep your employees healthy, productive, and happy. + Healthy Outcomes Wellness our range of structured, virtually turnkey wellness programs 1, 2 + Healthy Outcomes Case Management our personal outreach for high-risk individuals + Healthy Outcomes Condition Care our disease management program + Healthy Outcomes Maternity our program for expectant and new mothers 3 PAGE 4 of 12
The Healthy Outcomes Health Management Solution The Healthy Outcomes Health Management Solution is fully integrated, supported by technology that allows providers across programs to access a single record per member. Wellness Health Portal Health Assessment 6 Online Education Online Tracking Wellness Incentive Tracking Health Screenings 7 Member Services Health Line Blue SM Blue365 Discounts Support, centered around the member Case Management Complex Care Catastrophic Intensive Care Provider Integration Patient Care Summary Physician Reports Provider Engagement Care Reminders Condition Care Asthma Diabetes CAD Heart Failure COPD Maternity 3 Maternity Management (for healthy and high risk pregnancies) Postpartum Management Depression Screening 24/7 BabyLine PAGE 5 of 12
Wellness: incentives drive behavior Research shows: + In 3-5 years, 86% of employers expect to have some kind of wellness incentive in place for employees. 8 + 46% of employees will participate in a biometric screening for a $25 gift card. 9 + 85% of employees will participate in biometric screening for $500 in premium reduction. 9 We consolidate your employees data for you, giving you what you need to reward and motivate your employees. Member completes activities and earns points toward their wellness plan goal Members check Portal to determine status 10 Activity Reporting + Health Coach or user-reported data + Completion of online programs and challenges using the portal + Claims data + Biometric screening 7 + Health Assessment 6 Health Assesment Data Engine Employer receives reporting to continually motivate employees Employer rewards employees + Gift cards (incentive fulfillment available) + Cash + Premium contribution + HRA contribution + HSA contribution + Paid Time Off + And more 11 PAGE 6 of 12
A wellness plan for every employer from basic to robust Healthy Outcomes Wellness is a suite of 11 structured, virtually turnkey options, designed with input from market research and built to grow with your company. Whatever your organization s size or industry, we ll help you choose the right option. Each plan features: + Defined employee wellness goals + Detailed, actionable reporting for employers so you can track employee progress Making the experience personal The employee wellness experience is highly personalized, all beginning with the Health Assessment. Not only does this information serve as a baseline for your organization it helps to customize the content delivered to an employee s portal. For example, if an employee indicates they have asthma, our Healthy Living Program for managing asthma will be prioritized in the queue within their portal. Actionable data to make decisions and drive behavior As part of Healthy Outcomes Wellness, you get detailed reporting that helps you reward employees the way you want and helps you motivate employees to achieve their wellness goals. Imagine having access to reports that can help you develop countless, creative ways to reward your employees. It s something you can really use to drive healthy behavior in your organization. + Integrated wellness tracking, with wellness goal data gathered from claims data, wellness portal activity completion data, health screening 7 data, Health Assessment 6 reporting data, and health coaching or employee reported data + A personalized Healthy Outcomes Portal, where employees can complete activities and track progress towards wellness goals you ve chosen for them. 10 The portal also features useful tools including fitness & meal planners, newsletters, a medical encyclopedia and much more + Rewards the way you want them: use your detailed reporting to reward employees or let BCBSNC handle incentive fulfillment for you 2 Wellness Plans Core Series Achiever Series Coach Series Ideal for organizations just beginning to establish a wellness program or looking to supplement and formalize an existing program. It s a way to introduce the Health Assessment to your employees and show them that their wellness is important to you. Adds more activities and builds on the Core Series. Achiever provides more complete programs that can really help create greater employee engagement and help build a company culture of health and wellness. Adds a layer of accountability and health coaching that creates a highly engaging wellness program. You can choose to use biometric measures to help drive and reward healthy behaviors among employees. PAGE 7 of 12
HealthyOutcomes wellness case management condition care maternity Case Management: Personalized attention, specialized services Healthy Outcomes Case Management With Healthy Outcomes Case Management, we identify employees who may need one-on-one attention for high-risk behaviors and conditions and offer specialized services that can help them better manage their health, avoid complications and additional expenses, and reach health goals faster. BCBSNC regularly analyzes member claims to identify those who might benefit from Case Management for example, if our data shows a member is taking multiple medications and seeing several doctors, or when we identify gaps in care for a high-risk individual, Case Management helps the member take control. Members with high-risk conditions such as heart disease, diabetes, cancer, or stroke can benefit from the support, navigation, and coordination our Case Managers provide. Here s how Case Management works: + Health conditions are measured by a 360-degree clinical view and risk score assigned to the member based on his or her data. + A case manager or engagement specialist (depending on the complexity of the health condition) makes the initial contact with the member. + Employees complete a Member Health Survey or other assessment, giving the case manager information to create a customized care plan. Impact of Case Management ER Visits per 1,000 by Claims End Month 11 Proactively identifying and helping employees who need one-on-one attention means fewer claims - and savings for you. Case Management makes a difference. Number of ER Visits 1000 900 800 700 600 Comparable 9/08 11/08 1/09 3/09 5/09 Months in Study Case Managed 7/09 9/09 11/09 1/10 3/10 5/10 7/10 $2.37 PMPM savings 13 Provider engagement Through provider engagement, BCBSNC makes sure that the member is receiving an optimal level of treatment and that the care process is seamless. Our integration with providers through Care Reminders and the Patient Care Summary help to ensure that members receive appropriate attention through various channels. Healthy Outcomes programs are also designed for full integration with providers and practices who are a part of a Patient-Centered Medical Home (PCMH). PAGE 8 of 12
Condition Care: Our disease management is different Healthy Outcomes Condition Care provides: + Integration across the spectrum of care + Enhanced reporting + Robust remote in-home monitoring + Communication Member Provider Condition Care Coach + Spanish program available + Customized program based on objective information and patient self-reported data + Robust disease management and maternity online portal 3 Disease management powered by data and technology Healthy Outcomes Condition Care is BCBSNC s disease management (DM) program 14. Condition Care helps individuals with chronic conditions live the lives they d like to live. Our sophisticated identification and segmentation engine draws from a wealth of sources of member data to segment and stratify inividuals for care which allows us to make sure they get into the program most appropriate for their unique needs. The program offers an innovative, integrated approach to DM, one that offers a dedicated Condition Care Coach to partner with the member and health care provider bringing needed help and peace of mind. Members can receive: + Support for managing their condition + Education and resources + Coordinated care from multiple providers Condition Care centers on a range of five chronic conditions: + Coronary Artery Disease (CAD) + Heart Failure + Chronic Obstructive Pulmonary Disease (COPD) + Asthma + Diabetes Condition Care Delivery Model Participant + Remote in-home monitoring, where appropriate + Lab & medication monitoring + Education & goal setting + Healthy Outcomes Portal + 24/7 nurse support Using technology to bring care home to the patient Condition Heart Failure COPD Diabetes Information < < < Condition Care Coach + RN Interaction + Teachable moments + Comprehensive clinical assessment + Individualized care plans + Care Gap closure + Participant education & empowerment through goal setting + Medication compliance & adherence monitoring + Monitoring by experienced RNs All supported by a safety-net of timely care gap identification and closure including HEDIS measures Technology DayLink Monitor Electronic Scale DayLink Monitor DayLink Monitor Glucometer < < < Biometric data Physician + Timely, actionable provider reporting + Care reminders + Calls from Condition Care Coach where appropriate In-home Monitoring PAGE 9 of 12
HealthyOutcomes wellness case management condition care maternity Maternity: Quality care, before 3 and after the big day Maternity management helps healthy mothers have healthy babies Did you know? Every year in the United States: + 875,000 woman experience one or more pregnancy complications 15 + 458,952 babies are born to mothers without adequate prenatal care 15 + 467,201 babies are born prematurely 15 + 307,030 babies are born with Low Birth Weight 15 Quality care for pregnant women and new mothers Quality health care during and after pregnancy is important. Healthy Outcomes Maternity 16 is a maternity management program for both healthy and high-risk pregnancies. The program offers a variety of assessments to make sure women are getting the right care during pregnancy. And, it offers tools to help women get the support they need, when they need it, to support maternal and child health. Features include: + Obstetric risk assessments + Postpartum depression screening + 24/7 BabyLine a dedicated maternity nurse line where pregnant women and new mothers can get their questions answered by specialized nurses anytime, day or night + Text4Baby SM a mobile information service, which provides pregnant women and new moms with information to help them care for their health and give their babies the best possible start in life. Women who sign up for the service receive free SMS text messages 17 each week, timed to their baby s due date. + We provide multiple touchpoints throughout pregnancy. about our program + A dedicated maternity nurse line is included, to provide specialized support to expectant mothers. + Highest risk members are referred to Healthy Outcomes Case Management for ongoing monitoring/management. + We accomodate both English and Spanish languages. PAGE 10 of 12
Answers to health concerns, 24/7 The benefits of Health Line Blue Health Line Blue is our 24/7 nurse line powered by technology that lets nurses quickly and easily access member information. + Single view of the member record providing a seamless experience All program nurses work off the same clinical system which houses a single, comprehensive record for each member Healthy Outcomes case managers also have access to Health Line Blue call details + More meaningful modes of interaction with members Via phone Chat + Communication with member s primary doctor + Guidance with finding the most cost-effective providers Answers to questions 24/7 with Health Line Blue Health Line Blue helps members get assistance fast whenever they have a health concern. Day or night, members can call Health Line Blue and speak to a specially trained nurse immediately offering peace of mind and convenient support. How Health Line Blue can help: + Tips on symptom relief at home + Guidance on finding immediate medical care in urgent situations + Answering questions about overall health The registered nurses at Health Line Blue can answer medical questions on almost any health care issue or treatment often helping your employees save time and money. And the Health Line Blue nurses offer support in either English or Spanish. Health Line Blue is your first line against rising health care costs. One call can help employees find the most appropriate, most cost-effective resolution to a health care issue. $$$$ $ $$ $$$ Retail Clinics Urgent Care ER Chart is for illustrative purposes only PAGE 11 of 12
A dedicated team working hard for you Client Management + Responsible for overall account management + Financial and health improvement goals + Renewal activity + Utilization and clinical reporting Client Engagement + Certified Corporate Wellness Coaches + Strategy and execution of health care programs + Administrative resources and service reporting BCBSNC offers Healthy Outcomes programs as a convenience to aid members in improving their health; results are not guaranteed. BCBSNC contracts with Alere Health Improvement Company, an independent third party vendor, for the provision of certain aspects of Healthy Outcomes programs and is not liable in any way for goods or services received from Alere. BCBSNC reserves the right to discontinue or change Healthy Outcomes programs at any time. The programs are educational in nature, and are intended to help members make informed decisions about their health, and to help members comply with their doctor s plan of care. Decisions regarding care should be made with the advice of a doctor. 1) Healthy Outcomes Wellness is available for members who elect BCBSNC coverage from groups with 51 or more eligible employees. Dependent eligibility in the wellness program is determined by the employer. 2) Employer remains responsible for designing the rewards component and funding the incentive fulfillment. 3) Healthy Outcomes Maternity program is separate and apart from any maternity benefits. Members should consult their benefit booklet with regard to any medical benefits relating to maternity. 4) BCBSNC Internal Data, claims incurred from 3/2011-2/2012 for 100+ commercial group. 5) Department of Health and Human Services, 2011. 6) The Health Assessment is provided by Blue Cross and Blue Shield of North Carolina (BCBSNC) through an association with Alere. The purpose of this Health Assessment is to provide members with information to assist in maintaining and improving their health. Participation in this survey and any follow-up contacts based on individual results is completely voluntary. In filling out this survey, members will be disclosing Protected Health Information (PHI) that is protected by Federal and State law and will be protected as described in the Notice of Privacy Practices provided at enrollment or in their benefit booklet. Survey results will be shared with Alere and BCBSNC to provide additional health plan services and programs for members. Individual survey results will not be used to establish insurance coverage rates, eligibility for coverage, or employment decisions. Information will only be shared with employers for wellness program administration, incentive tracking and clinic administration purposes, upon employer request. 7) In order for the biometric screening component to be integrated, Group must contract directly with a BCBSNC preferred vendor who will bill Employer directly. 8) Aon Hewitt 2011 Health Care Survey. 9) PricewaterhouseCoopers Health Research Institute: What employers want from health insurers in 2010: Better information, more value. 10) Not all wellness plans feature online tracking for employees. 11) Please consult with your tax advisor and attorney to ensure that your rewards program complies with all applicable laws and regulations. 12) BCBSNC Internal Data. Case Management report comparing 2008 through 2010 engagement rates, December 2010. 13) BCBSNC Internal Date. Employer Dashboard Reporting. January 2011. 14) All programs, except Asthma, are for those 18 years or older. 15) http://www.americanpregnancy. org/main/statistics.html, accessed June 7, 2012. 16) Females aged 18 and older who are currently pregnant are eligible to enroll in the program. 17) Individual data plan charges from your wireless carrier may apply. The cross, the shield and Blue365 are registered marks of the Blue Cross and Blue Shield Association. SM Service Mark of the Blue Cross and Blue Shield Association. All other marks are the property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. U8187, 7/12 find out more Health Care Management Member Support + Data analysis and recommendations + Health and wellness strategy development & monitoring + Overall health policy and management + Benefits and claims customer service + Health Line Blue 24/7 Nurse Line + Member Services online or via mobile Healthy Outcomes can help you improve your employees health and wellness while helping keep your health care costs low. Call your authorized agent or BCBSNC representative to see all the benefits that Healthy Outcomes can offer you, your employees, and your company. PAGE 12 of 12