Chronic Care Management. WPS Chronic Care Management Next Generation Disease Management

Transcription

1 Chronic Care Management WPS Chronic Care Management Next Generation Disease Management

2 Taking on Chronic Illness and Winning. People with chronic illnesses make up only 20 percent of your employee population, but they account for as much as 80 percent of total health care costs: 76 percent of hospital admissions, 72 percent of physician visits, 88 percent of prescriptions filled.* In addition, productivity losses related to chronic illnesses often total four times more than the cost of treatment.** Clearly, it pays to tackle chronic illness head-on to improve employee health and rein in spiraling health care costs. That s where WPS Chronic Care Management can help change the game. WPS Chronic Care Management reaches out to members at the first sign of a chronic illness. Our program focuses on providing health education and member support designed to improve adherence to clinical practice guidelines, lower the incidence of hospitalization, and increase the adoption of healthy behaviors. This strategy helps ensure more appropriate, cost-effective care, resulting in reduced health plan costs over time. Breakthrough Strategy Drives Early Identification, Lower Costs. Our comprehensive, integrated chronic care management program advances traditional disease management practice by leveraging the unique advantages of real-time patient-specific pharmacy data and frequent member touch points to enhance identification and engagement. This approach takes advantage of more complete and timely information, with streamlined collaboration between nurses and pharmacists to swiftly identify and address the needs of members at risk, achieving better outcomes and faster, more significant savings. WPS partners with Medco and Healthways, to bring you Optimal Health, this innovative, first-of-its kind, chronic care management program. Optimal Health is a collaborative effort uniting the leading capabilities of Medco Health Solutions, Inc. the world s most advanced pharmacy, and Healthways, the industry leader in total Health and Care Support SM solutions. * World Economic Forum, **National Governors Association Center for Best Practices, 02/2003.

3 Improving Management of Chronic Conditions, One Member at a Time. WPS Chronic Care Management is the next-generation in disease management. We combine the most important elements of traditional disease management, including health education, prevention, and personalized coaching, with the most innovative techniques for identifying and engaging members at risk. Our program is also designed to optimize transparency in reporting, with clearly-defined ways to measure outcomes and return on investment. Faster Identification, When it Matters Most. The first 30 days after diagnosis are critical. This is when members are most open to taking action to improve their health. We take advantage of access to real-time pharmacy data to reach out to members as early as 72 hours of their filling a prescription up to 90 days sooner than most traditional disease management programs. Integrating pharmacy data with medical claims, health risk appraisals, physician-reported data, and a variety of other sources, we employ sophisticated predictive modeling to stratify members into one of four risk levels, from stable to high risk. Based on the member s risk level and other factors, a tailored care plan is created to empower the member to set and achieve health goals that support their physician s care plan. We share this plan with the member s physician so that, together, we can collaborate to identify opportunities to enhance care. Maximizing Care Opportunities through Early Engagement. Real-time pharmacy data allows us to identify and engage members up to three times faster than a traditional disease management program, permitting more effective interactions that lead to sustained behavior change.

4 Tailored Outreach at the Point of Need. Within days of being identified for intervention, members receive a phone call from a registered nurse and a welcome mailing including condition-specific educational materials. After that, we tailor the frequency and intensity of outreach depending on each member s level of risk and the severity of his or her condition. These outreach services include: Personalized educational mailings, self care goals, and coaching. Scheduled care calls. 24/7 access to a dedicated care team. Depression screenings. Good health reminder calls and mailings. Counseling from a specialist pharmacist. Hospital discharge calls. Quarterly newsletter. Free in-home monitoring (for heart failure patients). Members not interested in participating in chronic care management counseling may choose to just receive program mailings, or may choose to opt-out of our program at any time. Targeting the Most Costly Chronic Conditions. The WPS Chronic Care Management team works with members physicians and pharmacists to create and take advantage of teachable moments that promote the adoption of healthier behaviors. We specialize in working with members with conditions and treatment needs, such as: Chronic kidney disease Chronic back pain Chronic obstructive pulmonary disease (COPD) Coronary heart disease Diabetes Heart Failure High-risk asthma We also actively engage physicians to enhance patientdoctor communication, helping to drive greater health improvement and savings. Physicians receive regular calls, faxes, and mailed alerts on member-specific safety risks, including Care Link reports providing evidence-based recommendations to help them identify opportunities for care. We also provide access to a hotline physicians can call to consult with our clinical team or with Medco specialist pharmacists. Precise Measurement that Demonstrates Value. We continuously track and provide program performance reporting so you can evaluate levels of employee engagement and overall results. Our standard reporting includes: Monthly Early Activity and Engagement Report (first 90 days). Quarterly Engagement Report. Semi-Annual Clinical and Utilization Outcomes Report Our transparent reporting methods utilize clearly-defined performance metrics for each chronic condition. We calculate everything from emergency room utilization rates to diabetes care testing compliance. We ll even show you actual levels of employee participation, including engaged and nonengaged employees.

5 Better. Faster. Stronger. Early Member Identification Equals Better Outcomes and Savings. The Patient: A member was diagnosed with diabetes and filled a prescription for metformin. She did not start taking the medication and was not monitoring her blood glucose. Intervention: Using pharmacy claims data, Medco immediately identified the member as a new diabetes patient. A nurse called her two days later and began coaching her on medication compliance and self-care. Result: The member began taking her medication and set a self-care goal to obtain a glucometer. This early identification and engagement provided needed education and prevented long-term, unnecessary, and costly complications down the road. The earlier we identify and engage someone with a chronic disease, the Better their care, the Faster their turn-around from crisis to stability, the Stronger their commitment to beneficial behavior change. WPS Chronic Care Management interventions often result in: Improved compliance with medication regimens and treatment plans. Fewer hospital admissions and emergency claims. Lower utilization of medical services. More appropriate care. Adoption of healthier behaviors. In the long run, you ll have healthier, more productive employees, and lower overall health care costs. The Right Chronic Care Management Program. Right Here for You. Since 1946, WPS mission has been to provide affordable, comprehensive health coverage for our friends and neighbors right here in Wisconsin. In today s health insurance marketplace, WPS Chronic Care Management delivers needed solutions to help employees reduce their health risks while lowering costs for employers. Contact your local agent to learn more about WPS Chronic Care Management. Or, call WPS at

6 1717 W. Broadway P.O. Box 8190 Madison, WI Wisconsin Physicians Service Insurance Corporation. All rights reserved Optimal Health and World s Most Advanced Pharmacy are registered trademarks of Medco Health Solutions, Inc. Health and Care Support is a registered trademark of Healthways, Inc. Self-funded groups using a pharmacy benefit manager other than Medco may experience different results. Ask your agent or WPS representative for details.