Solutions. Health Advocate Chronic Care Management Program

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1 Solutions Health Advocate Chronic Care Management Program

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3 Taking Control Immunizations, preventive screenings and managing chronic conditions are key to controlling costs. Yet physicians often have limited time and resources to reinforce these strategies and many employees are simply in the dark about how to be proactive in their own healthcare. Health Advocate s Chronic Care Management Program is a low-cost solution that uses personalized, data-driven preventive and chronic care communications, coupled with one-on-one clinical coaching, all tailored to the individual. The goal is to engage each covered employee in their own decision-making, drive them to the right preventive services at the right time and to give them the personal support they need for better compliance with recommended care. The unique integration with our Core Advocacy service ensures that employees get personalized assistance across multiple healthcare needs, leading to better health outcomes and greater savings. A low-cost, tailored engagement approach for better compliance and better health outcomes

4 Health Advocate Chronic Care Management Program Health Advocate: The nation s independent leader in healthcare advocacy and assistance Helping employees maintain good health Health Advocate s add-on Chronic Care Management Program provides a targeted, tailored and one-on-one approach, combining data-driven, personalized communications with clinical coaching. Our program helps guide employees to use cost-effective preventive services based on national care guidelines, and provides the right information and support to help them take charge of their health. Tailored solution to improve outcomes Our state-of-the-art data technology collects and analyzes employee utilization information, stratifies individuals and identifies those with chronic conditions. This enables us to create mailed, personalized messages that emphasize evidence-based recommended screenings, tests and disease-specific information, tailored to each covered member s needs. As a key feature of our program, employees have unlimited access to a trusted registered nurse for clinical coaching. The nurse actively engages the employee, and provides early intervention, understanding and support for follow-through with recommended strategies.

5 ...helping employees Take Control How it works Our technology collects and analyzes utilization data to stratify employees by age and gender, and to also identify individuals with chronic diseases, such as diabetes, heart disease and asthma. Based on the analysis, customized prevention communications are created and mailed to all employees with a personalized, call-to-action message. The message encourages the timely use of evidencebased screenings or immunizations, such as colonoscopies for individuals age 50 and older. Customized, disease-specific messages include relevant medical facts and medication issues, specific care alerts, health plan coverage information and emphasize the importance of regular check-ups, key tests and screenings. The confidentiality of clinical information and the opt-out process is clearly spelled out in all messaging. Parallel communications identifying the patient s needs and test history are sent to the treating physician to further support the utilization of services. Pairing patient messaging with physician notification enhances compliance by 20 percent. On an ongoing basis, employees also receive customized reminder messages that reinforce self-care strategies and help promote compliance. One-on-one clinical coaching At any time, the employee can call Health Advocate to talk to a trusted registered nurse who can further clarify and answer questions about diseases and symptoms. For instance, the nurse can inform the employee about side effects of a medication and address other issues. A key function of the nurse is to help the employee comply with recommended management strategies. As needed, referrals are made to care management and wellness programs, such as tobacco cessation to help increase participation in these programs. Help to navigate healthcare The communications remind employees that they can use Health Advocate s Core Advocacy service for personalized support for healthcare and insurance-related issues. These issues may or may not be directly associated with the Chronic Care Management Program. Delivering the right messages and the right support at the right time enables employees to make the right decisions about their healthcare and to lower costs.

6 Program Features Personalization for better outcomes The features of the Chronic Care Management Program include: Advanced technology systems Data on utilization information from vendor feeds is analyzed to stratify employees by age and gender, as well as by disease, sorted by diagnosis code. Prevention promotion messaging Utilizes established national screening guidelines to identify appropriate services for 100 percent of the population. Examples of services include: mammography, blood pressure checks, cholesterol screening, colonoscopy, diabetes screening, bone scans, immunizations and more. Customized, disease-specific communications Personalized messages are tailored to individuals with chronic conditions to help them better comply with best-management strategies. The messaging may include, for example, suggestions for cardiovascular and diabetes screenings, and specific medication compliance. Physician notification Parallel communications are sent to the treating physician to enhance compliance. Reminder messaging Periodic reminder messages reinforce self-care strategies, such as the use of asthma controller medication and comprehensive diabetes care, including HbA1C monitoring. Reminders also include information about brand-to-generic medication for cost savings. Clinical coaching Communications emphasize the availability of registered nurses to answer questions about diseases, symptoms, medications and tests. The nurse can also provide support for following recommended regimens, such as taking insulin and filling prescriptions. Periodic outreach Ongoing reminders are sent to the general population reinforcing preventive services, as well as lifestyle and health information. Mail-based outreach can be converted to -based outreach. Easy transition to Core Advocacy The employee has unlimited access to one-on-one help to navigate healthcare and insurance-related issues. A Personal Health Advocate (PHA), typically a registered nurse, supported by medical directors and benefits and claims specialists can help: locate in-network providers; facilitate appointments; find generic equivalents for medications; provide comparable cost estimates; clarify health plan coverage and address other issues. The employee, their spouse, dependent children, parents and parents-in-law are eligible to use the Core Advocacy service. Referral to wellness services Our program can suggest that the employee follow through with wellness programs, such as weight management, tobacco cessation and specific chronic care programs, to further support their needs.

7 Benefits to employees Clear, specific information helps adherence to sometimes complicated treatment regimens Employees know just what actions to take at the right time Personalized reminders about specific actions, such as scheduling screenings and filling prescriptions Coordinated communications with physician help reinforce actions One-on-one help from a trusted registered nurse is available for assistance in following recommendations Ready access to a PHA for assistance with a range of healthcare and insurance-related issues Benefits to employers Low-cost program; extremely cost-effective Ongoing intervention helps improve compliance; prevent or reduce development of costly complications Physician communications enhance compliance by 20 percent Get started today Maximize the value of your benefits with Health Advocate If you already offer Health Advocate, we would be happy to tell you more about adding our Chronic Care Management Program. Or, if you do not currently offer Health Advocate, we would welcome an opportunity to introduce you to both our Core Advocacy service and our add-on Chronic Care Management Program, plus our full spectrum of other solutions. Contact us at: Health Advocate , prompt #2 Or, send us an to: info@healthadvocate.com Can extend across multiple health plan platforms Effectively addresses gaps in care Helps employees take charge of their health Promotes better use of in-network providers and hospitals Generates cost savings and better medical care through prevention, early detection and quality care Seamlessly integrates with Core Advocacy service

8 The Total Solution Complementary Solutions EAP+Work/Life Wellness Advocate Chronic Care Management Core Advocacy Personal Health Advocates handle a range of clinical and healthcare insurance issues Interacts with providers and insurance Gets the right answers at the right time Benefits Gateway / Health Information Dashboard Medical Bill Saver Tobacco Cessation NurseLine MedChoice Support FMLA Support Independent Appeals Administration Enrollment Advocate External Appeals Administration About Health Advocate Health Advocate, Inc., the nation s leading independent healthcare advocacy and assistance company, serves more than 6,000 clients including the nation s leading companies providing more than 18 million Americans with expert, personalized help to resolve healthcare and insurance-related issues. The company offers a spectrum of add-on time- and money-saving solutions designed for both employers and employees Health Advocate, Inc. HA-B BRO info@healthadvocate.com HealthAdvocate.com