Inspiring a Lifetime of Good Health and Well-being

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1 Inspiring a Lifetime of Good Health and Well-being

2 Helping you protect the health of your employees and your bottom line against rising health care costs is the foundation of our total population health and wellness approach we call it Tufts Health Plan Momentum. We all have moments when we enjoy the sense of well-being that comes with optimal health. Achieving well-being is different for everyone, but keeping a healthy momentum throughout our lifetime is something we all want and a priority for reducing preventable health care costs. With Tufts Health Plan Momentum, your employees receive the personalized support they need to help them stay healthy, get healthier and experience high-quality health care. Tufts Health Plan Delivers Proven Value Controlling your medical costs is serious business and we re working to help you do that. How? The concept is simple working to achieve positive outcomes through collaboration and coordination. } Empowering members through awareness, education and outreach } Rewarding providers for efficient, quality care } Supporting employers in worksite wellness Total Population Management Hospital Admission Trends* Admissions for asthma decreased 37% Admissions for CAD decreased 12% Admissions for CHF decreased 23% Admissions for COPD decreased 30% Admissions for Diabetes decreased 7% * Comparison based on Tufts Health Plan s commercial fully insured population admitted to an acute care facility with either a primary or secondary diagnosis of specific conditions listed. Past results do not guarantee future performance.

3 We Support Our Members in Sustaining Their Own Health Momentum Our comprehensive integrated health management approach promotes good health across the spectrum by targeting the right people, at the right time with the right level of care and support at home and in the workplace. Living Healthy Awareness, Prevention and Early Detection Healthy Outcomes Management, Guidance and Coordination Right Care. Right Time. Outreach, Analysis and Utilization Management Momentum+ Worksite Wellness Consultative Support, Engagement Programs, Incentive Administration Drive Total Population Engagement Accelerate Engagement Living Healthy Programs and support to help members prioritize wellness for themselves and their families at their own pace. Personalized Online Tools } The lifestyle behavior survey, Personal Health Assessment, educates employees on modifiable health risks and provides a personalized interactive wellness plan to help motivate behavior change. Employees we find to have high risk factors are invited to enroll in relevant health management programs. } Virtual Coaching Programs coach employees on adopting healthy lifestyle habits to lose weight, eat healthy, get active, quit tobacco and more. } Cost and quality tools } Personal health record } Multimedia library Lifestyle Management } Preventive care reminders } Nurse24 SM multilingual help line } Tufts Health Maternity Care } Nutritional counseling benefits } Alternative therapy discounts } Mobile decision-support tools } Wellness discounts } Eye care benefits and discounts Employees can find personalized wellness tools in the wellness section at mytuftshealthplan.com.

4 Healthy Outcomes Our interdisciplinary team of doctors, nurses and case managers works collaboratively with members, their health care providers and their families to ensure the delivery of high-quality health care aimed at optimizing health outcomes. Through outreach and individualized support, Momentum health and care management programs aim to help your population reach optimal well-being while helping strengthen your bottom line. Care Management Programs Tufts Health Priority Care Members we determine to need longer-term support for complex medical needs such as cancer, catastrophic injury, rare diseases and other serious conditions can choose to receive support, comfort and guidance from a dedicated nurse care manager to help them optimize well-being. Healthy Birthday An obstetrical nurse care manager supports moms at risk for preterm labor or with underlying complex medical conditions through pregnancy and delivery to help ensure a positive transition to home. Transition to Home With a focus on preventable readmissions, a dedicated nurse care manager provides recovery and stabilization support for selected members after hospital discharge. Tufts Health Priority Newborn Care A pediatric nurse care manager provides familycentered support for parents of new babies born with complex medical needs, across all care settings and at home. Basic Transitions Our Basic Transitions program provides non-clinical Transition Coordinator support for members who may benefit from assistance facilitating after care appointments and service needs following selected hospital stays. Clinical oversight supporting the Transition Coordinator, is provided by an RN Care Manager. Health Management Programs Behavioral Health Tufts Health Plan manages all behavioral health benefits in-house to help control administrative costs while promoting health care quality. Lifestyle Coaching** Personal lifestyle coaches focus on the whole person and empower members to change health behaviors that they are willing and ready to change to reduce the risk of preventable diseases. Condition Management Programs** Dedicated nurse care managers, in collaboration with physicians, help empower members with asthma, diabetes, coronary artery disease, heart failure, and kidney and lung disease to maximize their health and sense of well-being and reduce the future cost risk. Gaps in Care Targeted mailings help close gaps in care through increasing member self-responsibility and keeping physicians informed about treatment plan compliance that can result in better health outcomes. ** Available to all members of fully insured employers and self-funded employers who buy-in to this program.

5 Right Care. Right Time. Through continuous data analysis we identify existing and potential health risks within your population that can impact your bottom line. Momentum gives you peace of mind that we re working to connect members with the right care at the right moment at the best cost. Our centralized data platform ensures a constant eye is kept on your population s health and monitors potential overutilization of covered services. Health care efficiency guidelines addressed before, during or after receiving covered benefits improve the quality, safety and efficiency of health care for you and your total population. On topics such as: } Prior authorization, including outpatient high-tech imaging* } Inpatient length of stay } Extended care } Post-discharge planning } Prescription management } Durable Medical Equipment (DME) } Assisted Reproductive Technology (ART) } Outpatient rehabilitation services Data-Driven Information } State-of-the-art technology platform integrates array of health data } Centralized information increases efficiency, tracking and resolution of problems } Data-driven information helps target intervention at the most critical time Eligibility Care Management Hospital Admissions PHA & Biometrics Medical Claims Behavioral Health Claims Pharmacy Claims Lifestyle Coaching Nurse24 SM * Available to all members of fully insured employers and self-funded employers who buy-in to this program. Our proprietary triage engine is built upon evidence-based clinical guidelines coupled with expert evaluation from leading physicians to ensure best practice and continual review of new protocols and the latest health information. Analytics Engine Metrics to Manage Program! Customized Messages Target Audiences Care Manager, Members, Providers Alerts and Interventions

6 Supporting your employees on their journey to better health We take every opportunity to inform your employees of their health and wellness benefits and make access to information and programs easy. } Health fairs } Employee onboarding } Open enrollment } Interactive member kits } Knowledgeable member services representatives } Mytuftshealthplan mobile } EmpowerMe Treatment Cost Estimator } Self-referral option for all health programs } Online enrollment for Tufts Health Plan Maternity Care and Priority Care Programs Our wellness discount program makes a healthy lifestyle more affordable for your employees. Fitness & Exercise } Appalachian Mountain Club } Boys & Girls Clubs } Curves Facilities } Fitness Club Rewards } Fitness Together Personal Training Health & Wellness } HealthyOptions money-saving coupons } Acupuncture & Massage Therapy } CVS Caremark ExtraCare Health Card } ChooseHealthy.com } Home Instead Senior Care } The Original Healing Threads } Brain Fitness } UMass Center for Mindfulness Nutrition & Weight Management } Jenny Craig } Nutrisystem } idiet And more! Online Health and Wellness Resource Center At tuftshealthplan.com/momentum you ll find valuable information, resources and tools to help you support a culture of health. The Worksite Wellness Toolkit provides do-it-yourself kits, worksheets, templates and innovative ideas to help you get started or expand and refresh your existing worksite wellness program. The Momentum Communication Resource Center includes a library of ready-made materials you can use to encourage healthy behaviors, increase demand for preventive health, and drive enrollment in Tufts Health Plan s health and care management programs.

7 Accelerating employee engagement to drive healthier lifestyles In building a worksite wellness program with Tufts Health Plan Momentum+ you can energize your workforce and reward employee engagement in wellness activities designed to drive healthy behavior change. Changes that over time could improve productivity, decrease absenteeism and strengthen your bottom line. Our best-practice wellness solutions are easy to implement to fit the needs of your company. Contact your account manager for more information about our worksite wellness incentive programs. } Activity-based reward program for employers with 51 or more subscribers } Premium-reduction program for qualified fully insured employers } Outcome-based program for qualified self-funded employers Legal considerations when delivering wellness programs include compliance with: Health Insurance Portability and Accountability Act (HIPAA), Americans with Disabilities Act (ADA), Patient Protection and Affordable Care Act (ACA), Genetic Information Non-Discrimination Act (GINA), Equal Employment Opportunity Commission (EEOC rules and regulations). General guidelines for wellness programs: Participation in wellness programs must be voluntary, Medical information obtained must be kept confidential, Should not be used for making employment decisions, Must be offered to all similarly situated individuals, Reasonable alternative standards must be available for certain program. It s always a good idea to consult with your legal counsel when designing wellness programs.

8 We care about our members just as you care about your employees and their families. As Health Care Reform continues to evolve, we re committed to staying on top of new developments as they unfold and collaborating with the organizations with which we work to improve health care for all and that makes everyone feel better. Tufts Health Plan is the first health plan in the Northeast to be awarded Wellness & Health Promotion Accreditation from the National Committee for Quality Assurance (NCQA), a designation that reinforces our commitment to providing outstanding wellness and health programs to you and your employees. tuftshealthplan.com/momentum MOMENTUM-BROCHURE-03/15