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Independence Blue Crossp
Health Management Programs
April 13, 2010
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Supporting members th tiacross the care continuum
At every stage of health programs and services are there to
D i iWellness Urgent Needs Complex Care Chronic and other T t d C diti
At every stage of health, programs and services are there to provide members with the support they need.
Decision Support
Wellness Support
Urgent Needs Support
Co p e Ca eSupportTargeted Condition
Management
24x7 Whole Person Health Coaching24x7 Whole Person Health Coaching
Evidence, Analytics, Risk Stratification
IBC Approach to Medical Management
State of the art predictive modeling to target right State of the art predictive modeling to target right member at right time with the right intervention
Whole person coaching that enables all of member’s p gneeds to be addressed by one health professional
Member profile and risk scores available for all members lt i f d d ti t h– result in focused, productive outreaches
Integration and co-management results in seamless member experiencemember experience
Proactive outreach to high-risk members
Comprehensive Member Identification and Stratification Process
100% of the population assessed monthlyClaims (medical, pharmacy) mined monthlyLab claims and results mined monthlyLab claims and results mined monthlyRadiology data mined monthlyReferrals to specialists mined monthlyAuthorization data mined dailyAuthorization data mined dailyPersonal Health Profiles included in monthly algorithm
f l f h h l h l Referrals from physicians, health plan case managers, self-referrals received daily
ConnectionsSM Health Management ProgramsConnections Health Management Programs
Disease ManagementgCongestive heart failureDiabetesCoronary artery diseaseAsthmaChronic obstructive pulmonary diseaseChronic obstructive pulmonary diseaseMigraineHypertensionGERD/PUD
16 complex, chronic conditions (i.e. Multiple Sclerosis Sickle Cell Rheumatoid Arthritis)Sclerosis, Sickle Cell, Rheumatoid Arthritis)
ConnectionsSM Health Management ProgramsComplex Chronic Conditions
Multiple Sclerosis
Seizure Disorders
P ki ' Di
ALS (Amyotrophic Lateral Sclerosis)
DermatomyositisParkinson's Disease
Rheumatoid Arthritis
Systemic Lupus
Dermatomyositis
Polymyositis
SclerodermaSystemic Lupus
Cystic Fibrosis
Hemophilia
CIDP (Chronic Inflammatory DemyelinatingPolyradiculoneuropathy)Hemophilia
Myasthenia Gravis
Sickle Cell Anemia
Polyradiculoneuropathy)
Gaucher Disease
Crohn’s Disease
Decision Support Topicspp pBack pain, back surgery
Hip replacement
Over 30 decision support
Knee replacement
Heart surgery
videos/DVDs are available
on these topics. Health
Weight loss surgery
Women’s health issuesHysterectomy Hormone replacement therapy
Coaches distribute videos/
DVDs to members when
Hormone replacement therapyMenopauseBreast cancer
Prostate problemsappropriate. Colon cancer screening
Depression
7
Member ExperienceGoals:
assist members with managing chronic conditionsprovide members with information regarding their condition, help them p g g , pprevent complications and better understand their conditionassist members with any co-morbid conditionprepare members for visits with their doctor
Components:24/7 telephone access to a health care professionalWeb-based informationWeb based informationTargeted mail and phone outreach
About the staff:Licensed experienced clinicians, mostly nurses with 10+ years experience; access to dietician, respiratory therapist, pharmacist and social workerProvide most current medical evidence-based information available
Member Experience
Outreach:Automated telephonic outreachAutomated telephonic outreach
Post-hospital discharge calls
Sophisticated algorithms for member identification
C i d h bCustomized outreach to membersMulti-culturalMulti-lingualFamily composition
Member Experience
Member diversity is taken into consideration in the development of materialsin the development of materials
Using claims information, census data and analytic models, members are segmented into community groups based on location lifestyle are segmented into community groups based on location, lifestyle, ethnicity, education, income, etc.
Outreach materials use a member centric approach to attend to diversity via tailored messaging such as targeted language, taglines diversity via tailored messaging such as targeted language, taglines and photos.
Member focus groups were conducted to gather recommendations on preferences within the communications. Groups looked at overall preferences within the communications. Groups looked at overall layout, photos, language, etc.
G l H l h I f iGeneral Health Information
Information about everyday health concerns from A to Z — rashes, bee stings, sprains and general nutrition
Rx information drug to drug interaction medication Rx information — drug to drug interaction, medication compliance, brand vs. generic
Web tools available through ibxpress.comg p
24/7 Health Coach 365 days/year available to all members
ConnectionsSM Health CoachesAccessible
1-800-ASK-BLUEPhone/Internet, 24x7x365
Dedicated personal coachesEstablish relationships Follow up with member and providerComprehensive and confidential
Specially trainedLicensed experienced clinicianspShared decision-makingBehavior modification and listeningTreatment options and proceduresCertified educators
Medical director oversight
Computer supportComputer support
Actual vs. expected costs for members with h i ditichronic conditions
Bend the trendExpected Year
Expected Year 4
Expected Year 2Expected Year
1
Expected Year 3
Year 2
Year 3savings
Year 4savings
Actual Year 1
Actual Year 2
Actual Year 3
Actual Year 4
Year 1savings
Year 2savings
Base Year 1 Year 2 Year 3 Year 4
Year 1
Utilization savings by service typeth t 4over the past 4 years
18%20%
% reduction from expected utilization
10%12%14%16%18%
11% 11% 10%
2%4%6%8%
%
0%
Inpatient days Outpatient professional visits Professional services
Member SatisfactionMember Satisfaction
95 percent of chronic members indicated that they 95 percent of chronic members indicated that they were able to follow their Health Coach’s guidance.
90% of respondents stated they would recommend p yConnections
88% of chronics were satisfied with their Health Coach
Member Satisfaction Survey2009 DMAA award!y
100% 2004
award!
60%
80%
94%90%87%
86%87% 88%
92% 96%88%
95%
2005
2006
40%
60% 2006
2007
2008
0%
20%
Chronic Non Chronic
2008
How satisfied were you with the assistance the Health Coach provided you? (Percent of respondents indicating “Very Satisfied” or “Satisfied” displayed)
88 percent of 2008 chronic and 95 percent of 2008 non chronic users indicated that they were
Chronic Non Chronic
88 percent of 2008 chronic and 95 percent of 2008 non-chronic users indicated that they were “very satisfied” or “satisfied” with the assistance provided to them by the Health Coach.
IBC - a leader in Disease Management: Independence Blue Cross won the Disease Management Association of America’s Outstanding Health Plan
award in December 2006 and the DM Leadership Award in 2009award in December 2006 and the DM Leadership Award in 2009.
17
Adventist Program LaunchAdventist members launched with the
Population Overview Count PercentCurrently Eligible 24,265 -
ConnectionsSM
Health Management Program on
No Chronic Condition 22,508 92.8%
Any Chronic Condition 1,757 7.2%
January 1, 2010.
As of February, 7.2 percent of the
Condition Prevalence Count Percent
Asthma 567 2.3%
population was identified with a chronic condition, which is within
Coronary Heart Disease 311 1.3%
Heart Failure 48 0.2%
Diabetes 960 4.0%
range of similar commercial groups.
Chronic Obstructive Pulmonary Disease
40 0.16%
Hypertension 1,710 7.1%
Migraine 380 1.6%
Program LaunchMail and telephonic outreach to educate and support members with chronic, preference-sensitive, and other conditions such as Migraine and CardiometabolicRisk began in February.
As of March, 84 members have called inbound to speak with a Health Coach, 25 members have been attempted in a post-hospital discharge call, and 483 members have been targeted in an outbound or AutoDialog® call campaign.
Outreach* Members TargetedAutoDialog® Calls
Chronic Welcome 120
P f S iti C diti W l 15Preference-Sensitive Condition Welcome 15
Back/Joint 22
Chronic Gaps in Care 154
Migraine 9
Cardiometabolic Risk Management 12
Health Coach Calls
Inbound Calls 84
O tb d C ll 151
*As of 03/29/2010
Outbound Calls 151
Post-Hospital Discharge Calls 25
Program LaunchAll households received a letter welcoming them to ConnectionsSM, as well as a magnet with the Program phone number encouraging members to call with health
Program Launch
g g p g gquestions 24 hours a day, 7 days a week.
In addition, members have received targeted mailings providing them with information on other conditions such as depression, weight loss surgery, and preference sensitive conditions such as back and joint pain preference-sensitive conditions such as back and joint pain.
Outreach* Members TargetedMail Mail
Non-Chronic Welcome Letter and Magnet 9,649
Variable Chronic Condition Letter and Magnet 1,560
Pediatric Asthma Welcome Letter 185
Pediatric Diabetes Welcome Letter 6
Preference-Sensitive Condition Letter 370
Depression Screening Letter 27
Weight Loss Surgery Letter 38*As of 03/29/2010
Weight Loss Surgery Letter 38
Healthy LifestylesSM Promotion Guidey y
Web based library of resources that employer groups can Web based library of resources that employer groups can use to design a worksite wellness campaign
12 monthly themed campaigns that groups can use or they can mix and match to create a customized campaign
Materials include posters, articles, flyers, and payroll stuffers that group can use to promote IBC programs
Includes disease-specific information, sample Health C h ti ti h lth i f tiCoach questions, preventive health information
Includes information on programs available to members to help them manage their health (e.g., Connections, Healthy Lifestyles, etc.).Healthy Lifestyles, etc.).
Enhanced capabilitiesFind a provider
Request an ID cardTreatment cost estimator
P l H lth R d Request an ID card
Change your PCPPersonal Health Record
Personal Health Profile
H i l/ id fi d Review open referrals
Print a temporary ID card
Hospital/Provider finder
View claims
Lifestyle Improvement ProgramsTrackers
Symptom checker View claims
View benefits informationHealth Management Center
Symptom checker
Health Management Center
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