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.”
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“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.”
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“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.”
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“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.”
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“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.”
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“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.”
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“So,
effective on January 1st, 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.”
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“So
here you can see graduates versus non-graduates. This program is starting now, January 1st. 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.”
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“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.”
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“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.”
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“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.”
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“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.”
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“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.”
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“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.”
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“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.”
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“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.”
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“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 1st. 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.”
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“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.”
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“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.”
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“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 1st. 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.”