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NC HealthSmart:Promoting Optimal Health and Wellness for SHP Members
NC Medical Society Quality SubcommitteeAugust 2009
Derek Prentice, MD, Consulting Medical DirectorAnne B. Rogers, RN, BSN, MPH, Director of IHM
What is NC HealthSmart?
North Carolina HealthSmart is a population health initiative that aims to: Empower healthy members to stay healthy; Help those with chronic disease or disease
risk factors to better manage their health; Offer integrated, cutting-edge resources and
programs to members at work, at home, and through their health care provider
Guiding Principles of NC HealthSmart Reinforce and strengthen the patient-provider
relationship
Empower individuals to play active role in management of their health and health care
Improve health of members and their families
Improve quality of care
Engage employers in health care issues
Increase member satisfaction
Stabilize Plan and member health care costs
NC HealthSmart Eligible Members
Members eligible for NC HealthSmart services are members whose primary health insurance is through the NC State Health Plan (all except Medicare Primary).
HealthSmart Components
24/7 Health Coaching– Health Dialog
Disease Management – Health Dialog
Personal Health Assessment/Web Tools – Health Dialog
Physician Support/Clinical Gap Identification – Health Dialog
HealthSmart Components Intensive Case Management/High Risk
Maternity/NICU – SHPS
ESKD/CKD Care Management – KidneyTel (formerly Renaissance HC)
Health Promotion and Education SHP Staff/All Vendors/DHHS
Worksite Wellness SHP/DHHS/Division of Public Health
CADCHF
COPDAsthma
DiabetesOther Coachable Conditions
~545,000 Eligible Members (Not Medicare or COBRA):
RENAISSANCE HEALTHCARE:
ESRDCM
~100 Members
[<15 eGFR]
NC HealthSmart ContinuumHEALTH DIALOG:
7/31/08
CKDCM
~200 Members[<45-15 eGFR]
HEALTH PROMOTION/ WELLNESS/WORKSITE
INITIATIVES
Tobacco ProjectDHHS (NC Weigh)
STARHighway to Health (DOT)
Worksite Wellness Technical AssistanceOSP Policy Implementation
BCBSNC:Utilization Management
Prior AuthorizationDischarge Planning
SHPS:Intensive Case Management
~5% of PopulationMultiple Inpatient/ER Visits,
Trauma, High Risk Pregnancy,
Neonatal Intensive Care, Catastrophic Diseases, etc.
NC HealthSmart Results
Program Participation
Clinical Impacts
Member Satisfaction
Provider Satisfaction
Participation
Over 45,000 members (~ 9%) currently served by Disease and Case Management programs
Representing ~25% of SHP expenditures
Focusing on members with “coachable conditions” and members with the most need
2:1 ROI – Chronic Disease Trends report
Clinical Impacts
Member adherence to clinical guidelines (meds, tests, exams) 92.4% asthma controller meds 82.1% CAD - lipid meds 77.0% diabetes - microalbuminuria tests 47.4% diabetes - eye exam
Smart Registry and Provider Support Services
Member Satisfaction
85% Satisfied with Health Coach
93% Likely to Recommend Program
Provider Satisfaction[N = 234; ~3,000 surveys mailed]
77% are aware of NC HealthSmart
88% found the Provider Services Specialists helpful
79% found the SmartRegistry helpful
74% have a positive opinion of NC SHP as a result of NC HealthSmart
Worksite Wellness/Health Promotion
Preventive Services Worksite Wellness Infrastructure “STAR” and “Highway to Health” Comprehensive Wellness Initiative
(SL 2009-16) Tobacco Cessation Supports Weigh Less program expansion Benefit changes
Opportunities
Disease and Case Management RFP
Discussions with various stakeholders NCMS CCNC/DMA NCAFP BCBSNC
Questions or Comments??