NASHO

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NASHO 5th Annual Leadership SummitAugust 1
2, 2007Four Seasons HotelWestlake Village,
CA
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National Association of Specialty Health
Organizations Leadership Summit Integration
Facilitated Opportunities
Douglas Metz, DC Chief Health Services
Officer American Specialty Health / Healthyroads
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Overview

• Who is ASH and Healthyroads?
• Brief company overview
• History of integration
• Demand for integration
• Integrated program design
• Program components
• Integrated processes
• Logistics of integration
• Outcomes from integrated processes

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ASH Corporate Structure

• American Specialty Health, Incorporated

Administrative services and networks
Disease management, wellness, and consumer
retailing
At-risk benefit programs
ASH Insurance
Healthyroads
ASH Networks
ASH Plans-CA
ASH Affinity
ASH ODS-NJ
ASH Clearinghouse
ASH IPA-NY
ASH Networks-SD
ASH Systems
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ASH Corporate Structure

• American Specialty Health, Incorporated

Administrative services and networks
Disease management, wellness, and consumer
retailing
At-risk benefit programs
ASH Insurance
Healthyroads
ASH Networks
ASH Plans-CA
ASH Affinity
ASH ODS-NJ
ASH Clearinghouse
ASH IPA-NY
ASH Networks-SD
ASH Systems
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Overview of Healthyroads Wellness and Disease
Management Programs
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Integrated Program Design
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Healthyroads Product Structure
Wellness Programs for weight management, tobacco
cessation, and healthy living Or Disease
Management for obesity, metabolic syndrome, and
other pre-chronic conditions
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Program Components
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Program Components Educational Text Resources
Weight management manual
Mind-body modules
Tobacco cessation manual
Supplemental guides
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Program Components Web Tools
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• FitnessCoach.com

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Integration Processes

• Integrating Strategies
• Integrated market philosophies, presentation, and
  messaging
• Integrated sales approach, training, and sales
  presentations
• Integrated training (Client ? ?Healthyroads?
  ?consultant)
• Integrated population assessment

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Integration Processes

• Integrating Health Outcomes
• Integrated health information messaging and
  referral
• Integrated event management
• Integrated case rounds and triage management
• Integrated multi-dimensional reporting
• Integrated data exchange and Web functionality

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Logistics
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Healthyroads Integration
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Healthyroads Integration
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Healthyroads Disease Management Model
Eligible Employees and Dependents
Access Points
Mental Health Vendor
Worksite Promotion (member inquiry to toll-free
phone line or Web site triage page)
Health Advocate or Disease Mgt. Vendor
HRA
Claims Data
Call List
Secured Fax, Secured e-mail, Online Messaging, or
Warm Transfer
Healthyroads Triage
Unmanaged medical condition
Untreated Psyche or Mood Disorder
BMI 30 and/or current smoker, Stable Psyche,
Stable Medical Condition
Healthyroads Weight Management and/or Tobacco
Cessation Program
Outcomes Reporting Participation Utilization Cli
nical Behavioral Satisfaction Projected ROI
No
Bariatric Surgery Candidate
Yes
Mental Health Vendor
Bariatric Psyche Management Required
Bariatric Surgery
Bariatric Medical Management Required
Post-bariatric Surgery Healthyroads Intervention
Health Advocate / DM Vendor
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Outcomes
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2006 Healthyroads Outcomes One-Year Follow Up
Percent of Participants in Telephone Coaching
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Return On Investment (ROI) Models Evaluated

• FitnessCoach.com General population
• Outreach Model Population qualified by personal
  health assessment
• Self-Referred Model Qualified self-referral
• Medical Referral Model Referred by disease
  management/PCP

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Integration Outcome Goals

• Client Satisfaction
• Easy to market to eligible members
• Integrated outcomes across vendors
• Participant Satisfaction
• Enhanced health improvement outcomes
• Seamless experience for participants

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Block Visions Role

• Vision and eye care benefits manager that
  partners with healthplans and employer groups for
  the delivery of high-quality eye care services
  and program management.
• Comprehensive eye care management, including
  wellness vision and medical-surgical eye care.
• Block Vision is not a service provider services
  are delivered through a network of eye care
  practitioners under an independent contractor
  relationship.
• Block Vision services all product lines witha
  niche in public-sponsored programs.

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Diabetes and Diabetic Retinopathy

• More than 14M Americans are diagnosedwith
  diabetes an additional 6M suffer from
  undiagnosed diabetes.1
• Diabetes is the leading cause of new casesof
  blindness among adults aged 20-74.1
• Diabetic retinopathy causes 12,000 24,000 new
  cases of blindness annually.1
• Early treatment of diabetic retinopathyis
  crucial because once damagehas occurred, the
  effects areusually permanent.2
• Detecting and treating diabetic eye disease can
  reduce the development of severe vision loss by
  an estimated 50-60.2

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The Goal and Benefits

• The Goal
• Help our healthplan partners increase the number
  of diabetic members receiving a dilated retinal
  exam (DRE).
• The Benefits
• Early detection and treatment yield
• improved health outcomes that maximize quality of
  life
• lower treatment cost
• Some of our healthplan partners are eligible to
  receive incentive compensation for achieving
  certain performance levels on quality
  initiatives.

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The Challenges

• For wellness-only clients, need to regularly
  integrate data with clienthealthplans as DREs
  may be delivered either through Block Visions
  wellness program or healthplans medical care
  delivery system.
• Changed contact informationfor members,
  especially withMedicaid programs.
• Overlap with healthplans own diabetic outreach
  initiatives.

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Addressing the Challenges Data Integration

• Need to ensure that outreach is performed only to
  those eligible members who have not yet received
  a DRE, accounting for

• newly-diagnosed members
• newly eligible members/terminated members
• recent utilization

• Frequent data exchange with client
  healthplans typically done on
• a monthly or quarterly basis.
• Requires commitment by both business owners
  and IT staff.
• Refreshed data must be culled to identify
  members eligible for
• outreach based upon the above criteria.

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Addressing the Challenges Changed Contact
Information

• Is the hardest of the challenges to overcome,
  especiallywith a Medicaid population.
• Is somewhat addressed by the frequent data
  exchange with clients.
• On average, successfully reach approx. 50 of
  members targeted for outreach.

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Addressing the Challenges Overlap With
Healthplan Initiatives

• Customize outreach plan for each participating
  healthplan in order to complement, rather than
  duplicate,plans own outreach initiatives.
• Member mailing(s)
• Member telephone call(s)
• PCP mailings identifying members who have not
  received DRE highest DRE scores achieved when
  outreach plan includes PCP.

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Demonstrated Outcome Improvement Medicare Plan
Results
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Demonstrated Outcome Improvement Medicaid Plan
Results
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Summary

• Success measured not only by HEDIS results, but
  also by growing popularity of the program. When
  first introduced, just three clients elected to
  participate. In 2007, 13 client healthplans
  are participating.
• Continue to expand the reach of the program and
  to try additional outreach methods to maximize
  effectiveness and help our healthplan partners
  achieve improved outcomes.

1 American Diabetes Association website
www.diabetes.org 2 American Optometric
Association website www.aoa.org/diabetic-retinopa
thy.xml 3 The State of Health Care Quality 2006
HEDIS Measures of Care. National Committee for
Quality Assurance.
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Integrated Strategies to Meet Patient and Payer
Need

• Ian A. Shaffer MD, MMM
• Chief Medical Officer, MHN

NASHO August 2007
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Integrated Care

• Many types of integration
• Coordinated Care
• (Medical/Behavioral Integration)
• Health Care Coach
• (Wellness/Illness Integration)
• Ombudsman Approach
• (Multiple Aspects of Life Integration, e.g.
  medical, behavioral, disability, work/life,
  financial, etc.)

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Coordinated Care

• Significant number of people have both medical
  and behavioral issues
• Providers do not always communicate, especially
  non-physician therapists
• One approach to ensure coordinated care is
  through a co-management process to bring both
  medical and behavioral resources together

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What is Needed to Develop a Co-management Program?

• Medical and behavioral champions
• Committee to develop methodology
• Process of data sharing
• Opportunity for regular communication
• Method to recall cases previously in
  co-management
• Ongoing review of process, cases and impact

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Co-management Program

• Co-management committee formed between medical
  and behavioral clinical health plan managers
• Links established between medical and behavioral
  care managers
• Case information and tracking system developed
• Outcomes monitored to identify opportunities for
  improvement

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Data Collection Tools

• Referral process put in place with standardized
  form and data elements
• Tracking log developed to capture and track data
  elements and outcomes

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Data Analysis

• Validation of the log and types of cases referred
  to identify common problems
• Track how cases get resolved and success in
  engaging patients
• Improve the process based on data

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Data Analysis

• Validation of the log to capture data
• 67 patients were discharged from medical unit and
  admitted to psych unit the same day
• 40 cases (60) were on the log
• Types of cases referred to the log
• Most cases (31 of 40) were on a med unit and
  transferred to a psych unit
• Nine cases on the log for other reasons (psych
  transfer to med, discharge planning, EDO on med
  unit)

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Data Analysis

• Of cases referred to the co-management process,
  how many engage in treatment?
• 40 eventually got engaged in outpatient
  treatment
• Of those who did not
• 58 (14) refused services despite repeated
  efforts
• 8 (2) died from medical illness
• 17 (4) transferred to SNF or other placements
• 17 (4) other reasons

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Data Analysis

• Improve the Process (Projects for this Year)
• Project to have direct contact with medical
  social workers who do discharge planning on the
  medical unit to address cases where patients
  leave a medical service with no behavioral plan
  in place
• Effort to identify high-risk medical patients
  with behavioral issues to try to improve access
  and engagement with behavioral resources

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NASHO 5th Annual Leadership SummitAugust 1
2, 2007Four Seasons HotelWestlake Village,
CA