High-Tech - GPBCH · High-Tech Team uses the latest technology to close gaps in care Multiple ways to engage with us: phone, email, app, mail, text, chat Tailored content delivered

High-Tech

Team uses the latest

technology to close

gaps in care

Multiple ways to

engage with us:

phone, email, app,

mail, text, chat

Tailored content

delivered according

to preferences and

special health needs

Engagement

platform, healthcare

on-the-go

High-Touch

Talented,

experienced

healthcare staff

100% unbiased

and confidential

Responsive,

compassionate

approach

Go above and

beyond to engage

members

2 HealthAdvocate

Personal Health Advocate

Decision Support provided by RN’s

supported by Medical Directors and

claims and benefits experts

Care Locator ™

Nationwide service based

on Medis Analytic Engine,

network coordination,

Primary & Specialty Care,

DME, Dental Services

Advocates of Excellence ™

2nd Opinion service, EMO and

Centers of Excellence, complex care

coordination

Health Advocate CareCoach™

Medical information using the

HealthWise™ database, pricing

tools, evidence based care

Benefits Advantage™

Claims, Coverage

questions, Referrals,

Pre-certification,

Appeals, Grievances,

help with paperwork

Health Advocate CareQuest™

Additional outside services and

resources, Medicare Assistance,

Nursing home help

Core Advocacy Program

3

Benefits Gateway

and “HUB”

Health

Information

Dashboards

Wellness & Coaching EAP &

Work Life

Data Analytics

Predictive Modeling

Risk Scoring

Advocacy & Assistance

Multiple Engagement Points Integrate

Across the Model

Biometric Screening

Mobile Engagement

Platform

Personalized Health

Communications

Pricing

Transparency

Outreach

Engagement

Nurseline &

Telemedicine Remote Device

Integration Decision

Support

Chronic

Care

Solutions

Financial Fitness 4

2nd Opinions & EMO

Appeals Admin

Medical Bill

Saver

Benefits Gateway

and “HUB”

Health

Information

Dashboards

Wellness & Coaching EAP &

Work Life

Data Analytics

Predictive Modeling

Risk Scoring

Advocacy & Assistance

Multiple Engagement Points Integrate

Across the Model

Biometric Screening

Mobile Engagement

Platform

Personalized Health

Communications

Pricing

Transparency

Outreach

Engagement

Nurseline &

Telemedicine Remote Device

Integration Decision

Support

Chronic

Care

Solutions

Financial Fitness 5

2nd Opinions & EMO

Appeals Admin

Medical Bill

Saver

Empowered Health

Health Information Dashboards

Baseline & Annual Medical Claims Analysis

Pricing Transparency Tools Chronic Care

Solutions

Data Drives Empowered Health

Data Analytics and Predictive Modeling

Biometrics

Rx

Data

Engagement Platform

Benefits

6

Empowered Health is a holistic approach to individual health and

wellbeing, spanning multiple approaches and blending programs

together to create a single unified platform for patient engagement,

coaching and support

Typical Empowered Health utilization across services ranges from

20% to > 90%, driven largely by year-long multi-channel

communications and client incentives for participation

Using our blended approach, over the course of a year we are able to

consistently close approximately 50% of the gaps in care initially

identified in the population

Members with one or more chronic conditions and those with more

than one gap are more successful in closing gaps in care

Closing Gaps in Care

Empowered Health

7

Benefits Gateway

Single point of access for easy use

The ultimate integration tool

Triage / warm transfers to other vendors and programs

Low cost and cost-effective

Motivates actions at the point of engagement

Maximizes the value of all associated programs

Integrates with Gaps In Care Spotlights to reduce medical costs and improve clinical outcomes

© Copyright 2014, Health Advocate, Inc. 8

simplifying and connecting

it all together

Gaps

in Care Outreach

Pricing

Transparency

EAP + Work/Life

Biometrics

Chronic

Condition Coaching

Decision Support

Second Opinions

Benefits Gateway

Financial Wellness

Tele- medicine

Wellness

Health Advocacy

9 HealthAdvocate

Plus, the HR team can create custom alerts to notify employees about important events like health fairs!

Member Engagement Portal

A “People Like Me” approach

incorporating Machine Learning and

Predictive Modeling for targeted

personalized messages

Interact in real time with all Health

Advocate and 3rd party programs

View personalized to-do lists/alerts

Upload documents and forms and

view the status of a case

Compare costs for medical care and

prescription drugs

Access health and wellness

information

24/7 personal support is just a call

or click away

Choose the method of

communication; email, text, chat, call

10

Pricing Transparency

Health Cost Estimator+

Available on multiple platforms including smartphone, tablet and PC

Employees can call a Personal Health Advocate for added pricing support

Quality and cost information

Real time out of pocket deductible calculations

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Procedure Average

Savings

Pregnancy Care (C-section Delivery) $ 8,180

ACL or PCL Repair, Arthroscopic Approach $ 5,985

Arthroscopic Shoulder Surgery, Rotator Cuff Repair $ 5,846

Surgical Nasal/Sinus Endoscopy $ 4,465

Pregnancy Care (Normal Delivery) $ 4,335

Inguinal Hernia Repair, Open approach (age 5 and older) $ 3,736

Gallbladder Removal, Laparoscopic $ 3,653

Bunion Correction $ 3,270

Meniscal Repair, Arthroscopic Approach $ 2,637

Sleep Study, Attended by Technologist $ 2,303

CT scan, abdomen and pelvis (with contrast) $ 1,441

Colonoscopy with Biopsy $ 1,408

CT chest angiography $ 1,391

Cataract Surgery, simple $ 1,383

Tonsillectomy (age 12 or older) $ 1,382

Bone Marrow Biopsy $ 1,234

Colonoscopy, Diagnostic $ 1,090

CT Scan head/neck angiography (without and with contrast) $ 967

Colonoscopy Preventive Screening (Age 50-75) $ 948

Colonoscopy with Biopsy and Tumor, Polyp or Lesion Removal $ 907

MRI, spine (without and with contrast) $ 880

CT angiography, abdomen (without and with contrast) $ 792

Health Cost Estimator+ Results

What did you look at? What did you do? What did it cost? What did you save?

Physician Search and Care Concierge

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Intake to assess members’

needs and preferences

Check sanctions or licensing issues;

verify board certification

Assess experience

and contact providers

to confirm they

perform required care

Research and

identify leading

in-network

providers using

Medis™ Analytic

Engine

Contact members to

discuss provider and

treatment options

Follow

up

Schedule

appointments

and transfer

medical records

(if needed)

Facilitate any

necessary referrals or

authorizations

Confirm

network

status and

accepting

new patients

MEDIS Provider Performance

Analytic Engine MEDIS = Medical-Insights

A proprietary data driven tool that utilizes

clinical data (volume of cases, readmission

rates and lengths of stay) to rank providers

Developed by e2H exclusively for Health

Advocate’s Provider Locator program

Uses national performance information to

evaluate physician quality

Incorporated into all physician locator and

second opinion searches

Continuously updated as new data becomes

available

Includes information on more than 90% of

practicing US physicians in adult medicine

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Second Opinions and EMO

Intake to assess

members’ needs and

preferences

Research and identify top

experts and Centers of

Excellence nationwide

Arrange for the

transfer of

medical records,

test and lab

results; schedule

face-to-face

appointments or

facilitate chart

review

Coordinate services with physicians,

health plan case managers and

medical directors

Health

Advocate

assisted with

over 59,000

Second

Opinions and

EMO cases in

2016

15

BProBrokerExpo.com #BProBrokerExpo

Data at the Point of Contact

16


Personalized Member Dashboard

Your plan offers members a free home

visit to help you avoid slips and falls. Just

call us toll-free at

(800) xxx-xxxx and we can give you all

the details. It’s just that easy!

17

Client Reporting Dashboard

18

19

Client Gaps In Care Report

Client Reporting Dashboard Drill-Downs

20

Personalized Member Communications

Mail, email or text personalized communications encouraging preventive services, tailored to a member’s profile

Disease-specific communications for members identified with chronic conditions

Ongoing reminders reinforce preventive care, attention to chronic needs

Communications can be tailored to seniors (e.g., large print, topics) and other groups

Available in the Engagement Platform and Member Dashboard

21

Wellness Program

22

Member portal and mobile app

Available personal coaching

Wearable device integration

Online workshops

Client customizable competitions

Incentive tracking

Integrated reporting and outcomes


Online Biometric Scheduling Encourages

Participation, Links to Incentives and PHP

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Low Risk

Medium

Risk

High

Risk

Chronic

Care

Solutions

Chronic Care Coaching

(≈ 5% of overall chronic

population)

4 to 6 month intervention

Risk Assessment and Chronic Care

Solutions Intervention

Dashboards Gaps In Care

Short Term

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Risk Stratification

25

80%

23%

15%

26%

5%

50%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Members Total Costs

Member Breakdown and Percent Total Cost by Risk Level

Low Risk Medium Risk High Risk

Mean

Prospective Risk

Member

Engagement Rate

10.14 38.9%

2.56 46.9%

0.62 30.8%

High Risk members are 16 times more

likely than Low Risk members to have a

medical event in the coming year

The prospective risk score is an

estimate of future healthcare

utilization, including ER visits and

average inpatient costs

Severn Trent: 5% of Members Account for 50% of Total Medical Costs

Risk Stratification

26

Severn Trent: 10 Members Account for 23% of Total Medical Costs

90 High-Risk Members

Members

Medical Costs

50%

5% Current Year

Total Costs

Prospective

Risk Score

Clinical

Classification

Member A $566,708 27.36 Other Skin Conditions

Member B $558,810 36.12 Asthma/COPD

Member C $257,028 27.44 Cancer

Member D $250,145 12.93 Back Conditions

Member E $218,815 6.97 Pregnancy/Newborns

Member F $205,124 18.47 Back Conditions

Member G $203,286 36.03 Cancer

Member H $200,487 25.56 Cancer

Member I $179,888 32.47 Hypertension

Member J $146,306 18.38 Cancer

Top 10 High-Risk Members by Total Expenditures

$2,786,597 Total: (45 % of Total Costs in High-Risk Group)

(23 % of Total Medical Costs)

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Severn Trent Preventive Care Screening - Overall: 2/15/2016 - 2/14/2017

Empowered Health Outcomes

16%

92%

66%

62%

57%

36%

27%

96%

85%

68%

66%

51%

0% 20% 40% 60% 80% 100%

Bone Density Screening

Blood Glucose Screening

Cholesterol Screening

Breast Cancer Screening

Cervical Cancer Screening

Colorectal CancerScreening

Severn Trent Services e2H BOB*

28

Severn Trent Preventive Care Screening Engaged Group vs. Letter Only Group:

2/15/2016 - 2/14/2017

52%

45%

48%

30%

82%

87%

95%

70%

57%

50%

75%

38%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Breast Cancer Screening

Cervical Cancer Screening

Cholesterol Level Screening

Colorectal Cancer Screening

Letter Only Engaged Group Benchmark


29

79%

65%

82%

58%

81% 83% 81% 80% 77% 76%

87%

77%

66%

84% 82% 83% 82%

93%

87%

73%

64%

85% 85% 82%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Baseline Year Prior Year Current Year

Medication Adherence increased for 7 of the 8 conditions when comparing the Baseline Year and Current Year.

Severn Trent: Medication Adherence


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Severn Trent: Brand to Generic Switches

81% 83% 85%

7% 5% 3%

12% 12% 12%

0%

20%

40%

60%

80%

100%


Brand Prescriptions with Generic Equivalents

Generic Prescriptions

Brand Prescriptions without Generic

Equivalents

LEGEND


31

Severn Trent Hypertension Care: 2/15/2016 - 2/14/2017

82% 75%

95%

75%

91% 97%

0%

20%

40%

60%

80%

100%

Antihypertensives Cholesterol Level Screening Blood Glucose Screening

Compliance with Recommended Care

Letter Only Engaged Group

1,778 1,571

0

400

800

1,200

1,600

2,000


Inpatient Stays per 1,000 Members

$3,075

$1,868

$0

$400

$800

$1,200

$1,600

$2,000

$2,400

$2,800

$3,200

$3,600


ER Average Cost


32

Severn Trent Cost and Utilization: Engaged Group vs. Letter Only Group

2/15/2016 – 2/14/2017

27% 26% 21%

27%

17%

32%

23% 27%

0%

20%

40%

Hospital Outpatient Rx Physician/Professional

Letter Only Engaged

$18,948

$9,512

$ K

$2 K

$4 K

$6 K

$8 K

$10 K

$12 K

$14 K

$16 K

$18 K

$20 K

Letter Only Engaged

Tota

l M

edic

al C

ost (P

EP

Y)


33

Health Advocate has consistently demonstrated that our Empowered Health approach can “Bend the Medical Cost Curve” and return a positive ROI

While it is common to see costs increase in the first year of the program as individuals are

more motivated to seek care for their respective condition, costs typically are lower in the

second year as a result of that care.

The Year-Over-Year medical cost trend (PEPY) for members who had a gap in care, got a

reminder about the gap in care and interacted with Health Advocate (the Engaged Group)

flattened dramatically from the Prior Year to the Current Year (from 33% to 18%).

This 18 point difference saved Severn Trent approximately $708,000

33

$6,040

$8,027

$9,512

$5,000

$6,000

$7,000

$8,000

$9,000

$10,000

$11,000


Engaged Group

18 Point Lower Medical Cost Trend

for members who had a gap in

care, got a reminder and engaged

with Health Advocate

= $1,204 PEPY

=$1,204 x 588 ees

= $707,952 Savings

Trend

10,716


Savings Summary

Severn Trent's February 2017 census showed 1,455 employees

eligible for Health Advocate’s Empowered Health program

Severn Trent pays Health Advocate approximately $204,000 per

year for the Empowered Health, Biometric Screenings and flu shots

The reduction in medical cost trend from 33% to 18% for people

who had a gap in care, got a reminder and engaged with Health

Advocate represents a savings of $708,000 to Severn Trent

Compared to the cost of Health Advocate’s programs, Severn

Trent’s ROI is 3.47 to 1. That is, the Return On Investment (ROI)

was nearly 3½ times the cost of the Health Advocate

Empowered Health program.

34

Health Advocate has consistently demonstrated that our Empowered Health approach can “Bend the Medical Cost Curve” and return a positive ROI


35

Abbie Leibowitz, M.D., F.A.A.P. Chief Medical Officer, President Emeritus

and Co-founder

[email protected]

Documents

High-Tech - GPBCH · High-Tech Team uses the latest technology to close gaps in care Multiple ways to engage with us: phone, email, app, mail, text, chat Tailored content delivered