Risk Identification Disease Management

1
Risk Identification - Disease Management
Wellness
2

Its All About Health Better Health

• For Your Members
• For Your Benefit Plan
• For Your Bottom Line

Your Partnership with MCM Provides an Integrated
Solution to Achieving Better Health
3

MCM - Background for Maximizing Performance

• EXPERIENCE
• Care Management Pioneer - Founded in 1986
• Serving 500 Plans with over 450,000 Lives
• Management Team Averaging 20 Years of Industry
  Experience

• CREDENTIALS
• Independent Physician Directed
• URAC Accredited UM CM
• Licensed in All States

• CLINICAL MANAGEMENT MODEL
• Board Certified Medical Director
• Board Certified Onsite Associate Medical
  Directors
• Board Certified Physician Advisors
• Registered Nurse Care Managers
• Integrated Quality Improvement Program

4

Are You Managing What Matters?

• Key Factors Driving Costs
• Health Plans Focus on Illness
• Versus Risk Identification,
• Prevention and Wellness
• Chronic Disease Epidemic
• Lack of Appropriate Care

5

Illness Versus Prevention - Options

• Wait for a Sentinel Event to Take
• Place
• Hospitalization
• Surgery
• Emergency Room Visit
• Life Threatening Illness
• Then Manage the Care as Best as Possible
• OR
• Identify Member Health Risks
• Identify Gaps in Care
• Provide Members
• Education on Appropriate Care
• RN Health Coach to Promote Better
• Management and Positive Lifestyle
• Changes

6

Chronic Disease Facts

• Affects 1 in 10 People Nationwide
• MCM Data Shows a 24 Prevalence of
• Asthma
• Diabetes
• Coronary Heart Disease
• Chronic Obstructive Pulmonary Disease
• Chronic Disease Accounts for 70 of Health
• Dollars
• 50 of People with Chronic Disease are Not
• Receiving the Care Required to Stay Healthy

7

MCM Solutions for Better Health
Integrate Risk Identification and Maximize
Performance Results

MCMs fully integrated Optimal Health Solution
provides the tools to manage the health of all
members across the continuum of care
8

Stand Alone Health Risk Assessment Solution
Risk Identification

• Web based access
• Instant member feedback, risk identification
  
• Customized educational links targeted to
• identified risk
• Fully integrated with Care and Disease
• Management
• Encourages movement to better habits
• Group Report identifies preventable risk
• and helps plans focus interventions and
• educational programs

9

Onsite Biometric Testing
Risk Identification

• Available for All Members and Participants
• Simple Finger Stick
• Testing for Key Risk Areas
• Total Cholesterol
• HDL LDL
• Triglycerides
• Blood Sugar
• Body Mass Index Height Weight
• Blood Pressure
• Onsite Test Result Distribution
• and Comparison with Expected Values
• Immediate Participant Engagement and
• Education with MCMs Registered Nurse Health
• Coaches

10

Identify Risk MEDai Predictive Modeling Solution

• Incorporates Medical and Pharmacy Claim Data
• Initial Analysis of 2 Years of Data
• Monthly Data Updates
• Identifies Individuals
• With a Chronic Disease
• With Gaps in Chronic Care Guidelines
• Actual and Forecasted Health Risk
• Actual and Forecasted Health Costs
• Web Based Reports
• Summary of Health Plans Risk and Costs

Risk Identification

11

Optimal Health Disease Management

• Management of Disease Entities with
• Highest Potential for Impact
• Diabetes
• Asthma
• COPD
• Coronary Heart Disease
• CHF
• High Cholesterol
• High Blood Pressure
• Stroke and Cerebral Vascular Disease
• State of the Art Predictive Modeling
• Integration with Screening Data,
• UM, CM and HRAs
• Focused on Compliance with National Care
• Standards and Lifestyle Issues

12

Optimal Health Disease Management

• Program Announcement
• Incentives Maximize Program Participation.
• Positive Incentives Work Best!
• Its a New Benefit!!. Announce the Program to
• All Covered Members via Meetings or Flyers
• Custom Announcement Letters, Flyers and
• Welcome to Optimal Health brochures provided
  
• for each plan.
• Buy-in from Management Combined with Effective
• Announcement Produces Self-Referral!
• Continue Optimal Health Member Awareness
• with Newsletters, Posters and Benefit Fairs

13

Optimal Health Disease Management

• Identification of Chronic Disease
• MCM Identifies Members with Chronic Disease
• Through Predictive Modeling, HRAs, Health
• Screenings, Case Management and UM.
• Health Screening Data can Increase Chronic
• Disease Identification up to 20
• The Identification and Assessment Process is
• Conducted by MCM each Month Using New Data
• Risk Navigator Predictive Modeling Data Analysis
  
• Helps Identifies Individuals with Gaps in
  Care
• MCM Registered Nurses s Conduct All Member
• Identification Assessments

14

Optimal Health Disease Management

• Member Engagement After Identification

• ALL MEMBERS Identified with a Chronic Disease
• are Included in the Engagement Process
• The Engagement Process Takes 30-40 Days. It
• Includes 3 Letters and 3 Phone Calls. Phone
• Numbers are Crucial for Success
• Engagement Starts with an Introduction Letter
• Distributed to All Members with Chronic
  Disease,
• Followed by a Phone Call in About 7 days
• Two Additional Mailings and Follow-Up Phone
  Calls
• are Conducted for Identified Members.
• The First Mailing Includes Educational Material
  
• Keyed to the Members Risk as well as the
• Standards of Care for their Chronic Disease

15

Optimal Health Disease Management
Health Coaching - Management Track

• RN Health Coach Assigned to Each Member
• Custom Compliance Plan Developed for Member and
  
• their Physician
• Calculate and Track Compliance Scores Based on
• Standards of Care for Disease Category
• Customized Education Material Keyed to Each
  Members
• Specific Needs
• Goal Setting for Positive Lifestyle Changes
  Regarding
• Diet, Nutrition, Smoking and Exercise
• Health Coach Follow-up Before and After Each
• Health Care Encounter

16

Optimal Health Disease Management
Educational - Management Track

• Educational Material Keyed to Member Risk and
  
• Compliance Level
• Promote use of Existing Member Assistance or
• Wellness Resource
• Web-based Educational Links
• RN Care Managers Offered to Members
• Quarterly Contact with All Members

17

Optimal Health Disease Management
Measuring Disease Management Plan Impacts

• Disease Management is a Marathon Not a
• Sprint. It Does Not Include Quick Fixes and
• Requires a Long Term Commitment from the Plan.
• Compliance and Dollar Impact in 18 24 Months
• Optimal Health Quarterly Reports
• Member Status Report
• Disease Management Activity by
• Disease State
• Member Status No PHI
• MEDai Risk Navigator Employer Profile
• Includes Data on Risk, Utilization, Care
  Compliance and Diagnoses Driving Costs.

18

Better Health and Wellness Solutions

• HealthInfoLine
• 24/7 Nurse Assistance
• MCM Better Health Portal
• Web Based
• Personal Health Portal
• Powered by Mayo Clinic
• Understand your Risks
• Make Behavior Changes
• Manage Current Conditions
• Reliable Health Information

19

HealthInfoLine - 24 x 7 Nurse Line

• Health and Wellness Solutions
• Did you know that
• 55 of Emergency Room visits are Not Necessary
• Education and Treatment Alternatives Could
• Replace 25 of Doctor and Clinic Visits
• One Simple Call can Provide Plan Members..
• Advice from Registered Nurses in Making
• Healthcare Decisions
• Education and Treatment Alternatives
• Information on Hundreds of Health and
• WellnessTopics

20

• Comprehensive personal health management portal
• Highly personalized for each user
• Medically reviewed, hosted and updated by Mayo
  Clinic

21

Mayo Clinic Health Assessment

• Exclusive state-of-the-artHealth Assessment
  designed to
• Raise health awareness
• Promote behavior change
• Serve as a health measurement
• tool for both individuals and
• organizations

22

Mayo Clinic Health Assessment 11 Risk Factors

• Alcohol use
• Blood pressure
• Blood sugar
• Cholesterol
• Emotionalhealth

• Exercise
• Nutrition
• Safety
• Tobacco
• Triglycerides
• Weight

23

Health Assessment Action Plan

• Available immediately upon
• completion of HRA
• Risk level
• Low (0-1)
• Moderate (2-4)
• High (5-7)
• Very High (8)

• Notes both Risks and Strengths
• Links to tailored messaging,
• MCM DM programs, plan resources
• and tools
• Results Assessed by MCM RNs

24


Health Assessment Drives Secure Messaging

• Secure messaging triggered by Health Assessment
  completion
• Action Plan Reminders
• Alerts at two weeks, one month, and six
• months after Health Assessment
• prompting participant to return to the
• application
• Chronic Condition Alerts
• Monthly messages for self-management of
• hypertension and diabetes
• Messages Appear in My Tools sidebar

25


Its Time! For Better Health