HEALTHREACH INTRODUCTION PRESENTATION TEXT

“Thank you for taking the time today to attend this webinar in reference to the new services for Jefferson Health Plan effective on January 1st. My name is Dave Lauritzen with HealthCare Strategies, and I’m proud to introduce the new HealthReach program as it applies to Jefferson Health Plan.”

[Change Slide]

“HealthCare Strategies is a health management company that’s been in business for over 36 years. We’re based in Baltimore, Maryland. Um, our programs are two-fold. Number one, you know, obviously patient focused, making sure that we are engaging the members, helping them to stay healthy, compliant, and informed, but also helping Jefferson Health Plan control risk along with their member organizations to keep health care costs and the cost of their health plan as low as possible.

“So, going forward, we’re gonna be partnering with Jefferson Health Plan to provide the HealthReach program to everyone that had the Optum program before.”

[Slide Change]

“So, on January 1, HealthReach will be replacing the current Disease Management program that’s with Optum. All the current participants in the Optum program are being transferred over as we speak to HealthReach, and those communications are being sent out by HealthCare Strategies.

“Something new that we’re doing this year, uh, is HealthCare Strategies will be providing clinical and account management support onsite, uh, to promote the program and keep members informed. Um, this is going to be helpful for health fairs, um, any type of open enrollments. Any opportunity that we have to get out there and introduce the program and engage with the members is going to be key.”

[Slide Change]

“So, what is HealthReach?  HealthReach is a platform that takes in all the data; data that we collect from Jefferson Health Plan and all the different health plans within the organization. We stratify the population looking for those folks that are most at risk, so stratifying from highest to lowest. We’re also looking for gaps in care; so we’re looking for anyone in the population that has a medical care gap, something they’re not doing in reference to their medical care. Even if I’m the healthiest person in the group, if I forgot to get a physical exam, that’s considered a care gap. We have the ability to send out letters to everyone, not only reminders to them, but reminders to their primary care physician as well. We’re also looking at pharmacy. We’re looking at any drug interactions, duplicate medication, compliance issues that are out there or within the population.

“So, the program is two-fold. Number one, we’re concentrating on those folks that are most at risk, and we’re assigning them to a Registered Nurse, but then we’re also managing the entire population, looking for gaps in care and any pharmacy issues that might be there.”

[Slide Change]

“So here’s a screenshot of our data platform, and, as you can see, you know, we’ve taken in all the Jefferson Health Plan data. We can easily identify those folks that are most at risk. We can also identify the folks that are moderately at risk and low risk as well in the population.”

[Slide Change]

“We can also identify the conditions that are prevalent in the condi--, in the, uh, population. We can break this down, um, by member organization, um, within Jefferson Health Plan, or we can do it as an aggregate, but we can see exactly what conditions are out there and are prevalent in that particular population. So as you can see here, you know, musculoskeletal conditions, obesity, high blood pressure, high cholesterol are all prevalent in this particular population. This is very useful, and like I said before, we’re gonna have an onsite nurse that’s going to be out there educating members and keeping members informed about what the program is. Um, this is key when you’re working with a particular member organization because if you put out a newsletter or a communicating, uh, important information to the members, we can do it based on fact. We know exactly what the conditions are, so you know, we can put out useful information in reference to high blood pressures or high cholesterol, um, knowing that that’s a prevalent condition within our population.”

[Slide Change]

“So, effective on January 1^st, the nurses are going to be reaching out to those folks that are most at risk. Like I said before, we stratify the population based on the data. We identify the folks regardless of cost and regardless of condition that have the most risk factors, so when that nurse is reaching out to that member, they’re reaching out with facts, and they can see on their screen, as you can see here, exactly what conditions that person has and if they’re being compliant with that condition. As you can see here, this person has been to the doctor and has got their preventive screenings, but they’re not doing what they’re supposed to be doing in reference to their diabetes. Uh, it looks like they’ve got their high blood pressure under control; it looks like they’ve got their high cholesterol, but again it looks like they have a kidney disease and they’re not doing everything that they should be doing. This nurse is going to help them. Um, three very important factors: number one, help the member close any of these gaps in care that they have, get them to their primary care physician, making sure that they’re doing what they’re supposed to be doing, and then any medications they are taking, make sure that we keep them in compliance – make sure that there are no drug interactions, that they’re filling their prescriptions timely, and that they’re taking their medications appropriately.”

[Slide Change]

“So here you can see graduates versus non-graduates. This program is starting now, January 1^st. Going forward, as we get some graduates under our belt, you know, after 6 months, after 8 months, after a year, we’re gonna be able to compare graduates to non-graduates and the progress and the impact that the program is having on that population. As you can see with the non-graduates, over on the right-hand side, their risk is very high. Um, these are folks that, um, have been reached out to by the nurse, but for one reason or another, they’re not participating. Uh, they’ve got a lot of risk factors, not necessarily one particular disease, but several conditions, and they’re not doing what they’re supposed to be doing with those conditions.

“As you can see over on the left, these are the folks that have been through the program, so they are working with the Registered Nurse one-on-one. And you can see that their high risk is reducing, and they’re also starting to develop green, so they’re getting a, um, a portion of healthy folks within this population, which is key. We’re also seeing the yellow increase, which is good because now we know that folks that were in the red are now in the yellow, and they still have the condition, but they’re maintaining; they’re doing what they’re supposed to be doing, and they’re keeping their medications under control.”

[Slide Change]

“Here’s another way of looking at it. So, as you can see here, risk over time for the graduates, the risk is actually reducing, and that’s what we want to see. So as we reach out to members, as members engage, uh, what we’re doing is we’re reducing the risk factors that these folks have and we’re getting them out of harm’s way in the red and moving them in to the yellow and, obviously, into the green as well.”

[Slide Change]

“Now, for those folks that don’t participate, the ones that say ‘no’ to the nurse, just the opposite. As you can see here, their risk is growing. These are folks that are coming into the office every day, but for, and they have risk factors, and they could be our future claims of tomorrow. Um, you know, one thing that we do very well in this program is identify emerging risk or pre-claim, folks that have the risk factors, but they haven’t been in the hospital yet. Here’s a perfect example of folks that are coming in to work every day, they have the risk factors, and as you can see, their risk is growing in the red. Uh, very little yellow, and obviously, the uh, the healthy or the green is disappearing.”

[Slide Change]

“These are the folks that we really wanna concentrate on. This is what we are gonna, in the Account Management Department at HealthCare Strategies, we’re really gonna be working closely with Jefferson Health Plan to control this as much as possible, so if we see that there are people that are saying ‘no’ to the nurse, how can we better engage those folks to get as much engagement in this program as possible? And here just cost after identification, you know, what we’re saying here is that participants have lower health care costs than those that don’t. And like I said, we can, after a period of time, after we have data under our belt, we’re gonna be able to show the members that graduated from the program where they were 12 months before the program and where they are 12 months after. And our book of business shows that we have a reduction of $3900 per participant for those folks that have successfully completed the program. So what that means is that claim costs have come down for those folks. These were folks that had risk factors that could be a future claim, and now they’re not as much of a risk to the health plan, which is good. So not only can we show this to Jefferson Health Plan from a participant standpoint, but we’re also gonna be able to show the results from an aggregate standpoint as well. Like I said before, these are folks that are pre-claim or emerging risk. These are folks that have not been in the hospital yet, but they have the risk factors that could put them there in the future. So folks that participate in the program have lower health care costs than those that don’t and are not going into the hospital for an admission or a readmission. Here you can see the participants in the orange and then, obviously, the non-participants in the purple. And, uh, they have much higher rates of admissions and readmissions than those that have graduated from the program.”

[Slide Change]

“Same thing with compliance. In this particular case, the preventive care – so the physicals, the mammograms, the PAP tests – the compliance rates of those folks that have participated in the program are much higher than the rest of the population and those that chose not to participate.”

[Slide Change]

“Same thing with chronic disease. So when we’re dealing with high blood pressure, high cholesterol, diabetes, the compliance rates of those folks that have worked with the nurse are much higher than other folks within the population.”

[Slide Change]

“So as I said in the very beginning, we’re building a data warehouse for Jefferson Health Plan. Um, we can show data on an aggregate standpoint. We can also show it by member organization. When we have members that work with the Registered Nurse, with the Care Manager, we’re building a data warehouse for them as well. So they’re gonna have a playbook that they can use when they’re working with the nurse that’s going to give them all their data, all their information. They can see exactly where they’re at risk. They can see anything that is an action item, things that they need to do including maybe a biometric screening or a mammogram based on data that we get in. If we have biometric data, we can see all the data out there. We can see what their results are. We can see if there are opportunities to save money or if there is any, uh, screenings that are coming up that are gonna be due. So again, a very useful tool to keep the member compliant, to keep the member informed, and a great opportunity to work very closely with the Registered Nurse Care Manager.”

[Slide Change]

“So, again, I get this question quite a bit about, hey, what makes your program different, what makes your nurses different, um, than a health coach or a wellness coach, or even someone that was in a disease management program? Our nurses are all Registered Nurses. They’re all nurses that have backgrounds in working with patients, and they’re all employees of HealthCare Strategies. They’re also all trained in motivational interviewing. This is to us what makes them different is that this is the way they work with the member one-on-one. Instead of telling somebody what to do, they’re asking questions. They’re asking structured questions to help the patient recognize their own issues, set their own goals, and decide what change they want to make in their life. By doing this, we’ve seen better outcomes than just by simply telling somebody what to do. Um, and this is what these nurses do every day when they’re working with the patient. And like I said, we do three simple things, and that is help the member stay informed by helping them close any care gaps that they may have, get them to their primary care physician so that person can help them, and then get their medications under control.”

[Slide Change]

“And here’s a case study that we have of a uh, this is a client that we currently have. A 56-year-old male, uh, that is part of this client. Um, I know this person personally. Uh, this is a truck driver that is a manager in one of our, uh, client locations. As you can see, uh, he is morbidly obese. Um, he wasn’t exercising, he wasn’t doing what he was supposed to be doing. I think his favorite diet was McDonalds or Burger King. Um, he has been treated with diabetes, for diabetes, hypertension, and high cholesterol. Um, he was identified in the program, he opted to work with the nurse one-on-one. That nurse was able to apply the motivational interviewing that we just talked about, um, is working with him to make sure that we get those care gaps for his diabetes and his high blood pressure under control. He was taking several medications that we were able to, uh, make sure that he will filling timely, and some of the results is, you know, after a period of time, you know, he graduated from the program, he lost 48 pounds, his A1C for his diabetes is under control. He’s doing everything that he should be doing, and, again, this is all based on that intervention that the nurse was able to provide.”

[Slide Change]

“So the hard work is in front of us, and the hard work is getting people engaged, making sure that the members within Jefferson Health Plan, um, especially those that are at risk are aware of the program. And one way that we do that, that we’ve been very successful in doing is by providing the engagement letter that you see here. It’s a letter that goes out to all the members that says, ‘Hey, this is a new program with Jefferson Health Plan, effective on January 1^st. It replaces the program that we had before, and this is what it’s all about. It’s HIPAA compliant, it’s there to help you.’ And by doing this, we’re gonna be educating the folks when the nurses call, because when the nurses reach out to these folks, when the nurses send letters out to those that are most at risk, we want these fo--, we want these people, to, uh, participate and work with the nurse.”

[Slide Change]

“So, again, communication pieces to help people understand; this is one of them that’s going to be new for Jefferson Health Plan, you know, talking about the new program for 2019, talking about what the program is, and if you do get a call from a nurse, please, by all means, take the call. Speak with that Care Manager, and, you know, they’re gonna be able to help you, uh, stay informed, you know, and be, and live a healthier life.

“Also, Q and A, questions and answers about the program. Why was I identified? Why is this program important? Why did Jefferson Health Plan put this program in place? This, uh, brochure is going to be able to help those members answer those questions.”

[Slide Change]

“So, we also have an advocate program. This program is in place to take advantage of a lot of the campaigns that we have in society, such as the American Cancer Association or the American Diabetes Association. So, there’s different months out there like National Diabetes Month or maybe the Great American Smoke Out. But we’re able to go through the data that we receive and identify those folks that are appropriate for that particular monthly campaign, and then we can send out targeted postcards to help people. So diabetics or smokers or whatever the case may be, there’s different, um, advocate programs out there to make sure that we’re targeting the right people and getting the message out there about not only our program, but about that particular condition.”

[Slide Change]

“So we talked a lot about, you know, the program going forward. Um, this is a case study for a particular group that saw great success with, um, with HealthCare Strategies and with the HealthReach program. You know, we were able to take a client that was having issues, they were seeing double-digit increases, they were seeing a lot of rising health care costs in their plan. We were able to put a program in place that engaged the members, got the members informed, uh, got ‘em healthier, but at the same time, it gives the, um, the group an opportunity to reduce costs and to put the plan back on track. Um, this is the case study. If you want a copy of it, by all means let me know, and I can send you one. I also have my contact here, information here if you have any questions in reference to anything we talked about.

“Again, this program is HealthReach. It’s effective on January 1^st. It replaces the current Optum program that’s out there right now. Anyone or any member that was, uh, participating in Optum is gonna be rolled over to the new program with HealthReach.  So they’re gonna be working one-on-one with their own Care Manager. We’re also taking in data now to identify the new risk within the group going forward, and the, uh, members that we’re gonna be reaching out to.

“Like I said, if you have any questions at all, please reach out to me. I can be reached at, uh, at the phone number here. Also my email. Um, I’m also available to talk with members, talk with member organizations, about the new program going forward.

“Thank you very much, and have a great day. Happy New Year.”