Corporate wellness program tracking and management

www.advancecons.com

How Corporate Wellness Programs Achieve Outcomes Success and Lower Costs with Castlestone’s VisitEye

August, 2014

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Contents

• Management challenges with Corporate Wellness Programs • How VisitEye addresses many of the management challenges

– Captures wellness activities in real time– Provides up-to-the minute status for portals– Provides up-to-the minute, in context messaging to encourage action/next steps– Matches member activities to provider claims

• How to take advantage of Castlestone’s VisitEye in wellness program management

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Challenges in managing a Corporate Wellness Program

• These programs include a number of innovations, such as financial incentives for engaging in healthy behaviors and routine testing for life-threatening and high-cost conditions

• Claim information is used by program management to determine the compliance of its insured members

• Delays and errors in claim processing and filing create lags in the reporting of member activities

• Additionally, health benefits are often administered by third parties who have limited resources and little incentive to oversee claim activity and potential fraud and abuse

• The resulting lags lead to:– inaccurate status information on incentive programs, – resources being used to answer plan members’ concerns, and – potential impact on insureds’ insurance premiums.



The impact of being able to know, in real time, if a participant has been to the doctor/service provider when scheduled or needed

• Instead of waiting for claim data, reporting on medical and health activities in real time would allow members to check their program status within seconds after completing a medical encounter.

• This reduces the costs and overheads of servicing the membership to deliver information about their health status

• Also real-time information is more accurate, giving managers an additional tool to oversee billing contractors. Accurate and timely data on health care encounters and their costs enhances cost containment efforts

• Castlestone’s VisitEye contributes by:– Making status available in a portal with up-to-the-minute data for both program

participants and managers– Enable timely reminder messages to members, and – Provide a match to claim information when it is provided to the plan



Key elements of Castlestone’s VisitEye

• Real-time, non-financial transactions leverage Castlestone’s technology and operating status within the MasterCard network– we use their pipes and many of their transaction sets

• During set-up, codes are created for each office-visit-type in the corporate wellness program

• Service providers are given their own provider cards, with encoded mag stripes– Providers who do not see patients, such as pathologists and radiologists, do not

get wellness program cards• Individual employee/retiree participant cards with encoded mag stripes are

also created based on the employer/plan manager’s data• When these cards are swiped in provider offices or via swipe attachments to

smart phones, transactions are routed to Castlestone (see next)



Outpatient Provider Process:When the participant uses a wellness service

• Authorized provider & Location

• Service/procedure provided matches plan

• Time and date of service/procedure

We now have a record of:• A verified location

for each office visit• The time and date it

of the visit• Match of the

service/activity code to the program options

If there is no card, the provider office can register a new card for the patient on program portal

3) Castlestone compares swipe from pharmacy with prescription

1) Provider swipes recipient card

2) Provider enters Service/Activity Code

• Patient ID• Prescribing Physician

ID• Service Code• Service Location• Service Date



Real time status updates, member reminders, management portal data

• Castlestone can send members reminders of scheduled activities and/or inform the managers’ systems of upcoming events

• In the same way, Castlestone can tell members of missed activities and send messages to members indicating their status, YTD, as the plan year end draws nearer

• Typically, Castlestone provides real-time information on visits, procedures, and activities to a program for population in an existing wellness program portal– This saves employees/participants from having to visit a new and different portal– If no portal exists, Castlestone has a portal that can be used

• Program managers have access to transaction data either through Castlestone’s existing manager’s portal, or via real-time or batch transmission of transaction data to the client’s environment



Matching service provider claims with known member activity

• When wellness plan managers receive claims from providers, Castlestone matches the swipe data with the incoming claims to verify that the member actually received services on the time and date that the claims stipulate, e.g.:



Cost and Implementation Considerations

• Card Creation– Castlestone creates/activates/deactivates and manages cards based on guidelines. Plan

Sponsor existing card manufacturing contracts can be used if they are compatible• Hardware cost for plan & providers

– NONE. Uses existing credit card terminals • Network costs for plan & providers

– NONE. Uses the existing credit card networks from provider offices for transactions• Systems & programming costs

– S&P is very simple data exchange of new/change/delete clients or full real time integration• Cost Structure

– Design and programming & card cost– Hosting (data base & monthly hosting and management)– Monthly per-member transaction fees



Typical Results

• Set up completely implemented in 60-75 days, depending upon client resources

• All technical milestones (transaction capture, claim matching, file and interface implementation) exceed goals for speed and performance

• ROI for corporate wellness is based on:– Member participation enhancement due to messaging– Member participation enhancement due to confidence in real-time data accuracy– Program manager cost reduction by matching service claims with swipe data

• ROI for Castlestone when used in claims fraud prevention mode ranges from 125%-300% and can significantly exceed this



Options and Next Steps

• Contact us on how to use Castlestone’s VisitEye with your wellness program– Run a pilot (as little as 60 days to be operational)– Begin a full program


Doug BrockwayAdvance ConsultingCastlestone New England

(617) [email protected]

www.advancecons.com

CIO Advisory | Program Management | Business Development Jeffrey LestonPresident Castlestone Advisors LLC

(212) 874-4390 [email protected]

mailto:[email protected]

http://www.advancecons.com/


Appendix

Other presentations and reports you may find of interest include:

Title LinkFraud Prevention for Health Insurers http://slidesha.re/1pCGh98

Doctor Shopping and Prevention http://slidesha.re/1nNb9OL

CMS Pilot/Test of VisitEye http://slidesha.re/1vlGGeU

Management Tech. for Therapeutic Cannabis http://slidesha.re/1nQ5JkD

Corporate Wellness http://slidesha.re/1qQf6Fi

http://slidesha.re/1pCGh98

http://slidesha.re/1nNb9OL

http://slidesha.re/1vlGGeU

http://slidesha.re/1nQ5JkD

Healthcare

Corporate wellness program tracking and management