HealthReach Predictive Care Management

The Jefferson Health Plan Introduction Meeting December 19, 2018

www.hcare.net

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Who is Healthcare Strategies?

• Providing health management services nationally for more than three decades

• Patient focused programs and services

• Tools to help clients control risk and keep members healthy, compliant, and informed

• Aligned with the client’s healthcare plan and their broker or consultant

• Partnering with JHP to provide the HealthReach program.

Jefferson Health Plan and HCS

• HealthReach will replace the current Disease Management program with Optum effective January 1, 2019

• Current participants in the Optum program will be transferred over to HealthReach

• Communications introducing the program will be sent out by HCS

• Onsite HCS support will be provided throughout year to promote program.

What is the HealthReach Program?

• Uses data to identify risk regardless of cost and the focus is on “emerging risk” within the population

• HCS focuses on the entire population, with Registered Nurses reaching out to those with the highest risk for complications/crises

• Physician notification for Rx issues for HealthReach participants (communication to all prescribing providers)

– Drug / Drug Interactions – Duplicate therapy
– Compliance (filling Rx timely)

• Care Gap notices to Primary Care Physician for all members

• HealthReach addresses ALL levels of risk

5	Managing the Population

The backbone of our HealthReach risk management program is HealthConnect, our state of the art integrated data warehouse and connectivity platform, providing HIPAA compliant health information capture and exchange.

Data housed within HealthConnect is analyzed by to identify:

– At risk members, stratified from highest to lowest – Medical gaps in care
– Pharmacy alerts (drug interactions, duplicate therapy, dosage, compliance)

Identify Actionable Risk

High Risk

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Risk by Condition

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Medical Care Gaps

Risk

Graduates

Compared

Non-graduates

Risk Over Time: Graduates

Risk Over Time: Non-graduates

Average Monthly Claims $ -12 mn Rolling
Cost After Identification

4500

4000 	Because of Notifications regarding Care Gaps & Rx Issues for ALL 

3500	Members there is a reduction in both sectors

Average Cost Reduction after the HealthReach 3000	program is $3929 per participant

2500

2000

1500

1000

500

0

1	3	5	7	9	11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59

Months from Identification

Non-Participants	Participants

Inpatient Days After Identification

140	Members identified as High Risk but NOT participating in HealthReach have more Hospital Days
120

100

Days / 1000
80

60

40

20

0

1	3	5	7	9	11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59

Months from Identification

Non-Participants	Participants

Compliance with Preventive Care Gaps

70%	67%	62%

60%	52% 50%                                                     44%

40%

30%

20%

10%

0%

Mammogram		Colon	Physical	Pap* 2011	2014        Oct. 2016	HR Grad

Compliance with

Chronic Disease Care Gaps

80%	74%

69% 70%

62%	62%

72%

60%

50%	47%

40%

30%

20%

10%

0%

Asthma	Diabetes		Hyperlipidemia	Hypertension	Obesity	CAD 2011	2014	Oct. 2016	HR Grad

Health Navigator Patient Edition

Motivational Interviewing

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All HCS Care Managers are Registered Nurses, who receive ongoing training in Motivational Interviewing.

Motivational Interviewing is a specialized evidence-based form of coaching using collaborative conversation.

It is aimed at positive behavioral change.
	Instead of simply telling a
		
member what to do, Motivational Interviewing asks carefully structured
	
questions to help patients to recognize their own lifestyle issues,
		
discover their own interest in change, and identify solutions that will
		
work for them.
	The principle behind this is to drive change from within.

By carefully guiding patients to recognize and overcome their own

resistance to change, our nurses
	can achieve better outcomes than
		
they would by simply telling a member what they need or have to do.

Member Case Study

Background:

•	This 56 year old male has been treated for diabetes, hypertension, and hyperlipidemia. He was also morbidly obese with BMI 45. He was not exercising and had not been following a healthy diet.

Interventions:

•	Motivational Intervention was conducted, and he was encouraged to make time for healthier eating. His nurse helped member explore opportunities to improve his food choices and increase his exercise levels. Positive changes were reinforced.

Results:

•	He identified and put into place realistic dietary changes. The member began following a healthier diet and lost 48 pounds. His A1C remains within normal limits at 6.3. He is firmly committed to continuing to eat well and exercise in order to improve his overall health.

Member Endorsement Letter

Communication Pieces

HCS Advocacy

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Case Study

23	For Follow-up and Additional Questions

David Lauritzen Healthcare Strategies
COO, and Senior Consultant 410-423-9400 ext. 3209 dave.lauritzen@hcare.net