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Wellness and Care Management Solutions - Detroit Regional Chamber Best Practices Workshop

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Wellness and Care Management Solutions - Detroit Regional Chamber Best Practices Workshop: Tailoring a Solution using a Consultative Approach

Presentation given at Detroit Regional Chamber Best Practices Workshop, October 20, 2009

Michelle DeWyre, M.A. Senior Health Care Analyst, Wellness and Care Management Consulting

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Wellness and Care Management Solutions - Detroit Regional Chamber Best Practices Workshop

  1. 1. Tailoring a Solution using a Consultative Approach Wellness and Care Management Solutions DRC Best Practices Workshop October 20, 2009
  2. 2. BCBSM Consultative Tailoring Process LISTEN PROPOSE Consultant interacts with customer to tailor solution TAILOR Consultant proposes solution templates Flexible IT platform uses Business Process Management Workflow technology to deliver solution DELIVER Enhanced analytic capabilities enable measurement of activity and outcomes Consult with customer to review solution and provide recommendations for renewal MEASURE REPORT Consultant interacts with customer to understand goals
  3. 3. Goals for Today <ul><li>Creating a Culture of Wellness </li></ul><ul><li>Wellness Initiative Trends </li></ul><ul><li>Findings </li></ul>
  4. 4. Creating a culture of wellness “The Seven C’s” <ul><li>The Wellness Council of America (WELCOA) has identified the seven best practices for employers to follow when creating a comprehensive, effective worksite health promotion program. </li></ul><ul><ul><li>Capture senior-level support </li></ul></ul><ul><ul><li>Create a health promotion team </li></ul></ul><ul><ul><li>Collect data that will drive your health promotion initiatives </li></ul></ul><ul><ul><li>Craft an annual health promotion operating plan </li></ul></ul><ul><ul><li>Choose appropriate health promotion initiatives </li></ul></ul><ul><ul><li>Create a supportive environment </li></ul></ul><ul><ul><li>Consistently evaluate your health promotion outcomes </li></ul></ul>
  5. 5. Population Identification & Opportunity Assessment WELLNESS CARE MANAGEMENT CULTURE
  6. 6. Population Identification & Opportunity Assessment WELLNESS CULTURE CARE MANAGEMENT ASSESSMENT INTERVENTION Health Assessment Biometric Screening Claims Pharmacy Environmental Assessments Wellness Coaching Employer Campaigns Chronic Condition Mgmt Care Management Elective Surgery Counseling Employer Campaigns BCBSM Consulting Employer Policies Employer Campaigns
  7. 7. Wellness Initiative Trends
  8. 8. Types of Incentives <ul><li>Gift Incentives </li></ul><ul><li>Monetary Incentives </li></ul><ul><li>Benefit Design Incentives </li></ul><ul><li>Premium Surcharge Incentive </li></ul>
  9. 9. Incentives Impact HRA Participation Results for completion of Health Risk Assessments show a correlation between incentive value and participation Summary of market findings, Incentive, 2006.
  10. 10. BCBSM Customer Compliance Examples
  11. 11. Customer A Non-compliant members pay a higher premium share contribution starting 5/1/10 <ul><li>1/1/10 - 3/1/10 </li></ul><ul><li>Onsite Biometric Screening </li></ul><ul><li>(2/9/10 & 2/16/10) </li></ul><ul><li>Or </li></ul><ul><li>Physician Attestation Process </li></ul>Members identified as high-risk are targeted for Max Net Savings Telephonic Outreach Telephonic Outreach 35% of Identified on Chronic Condition 23% of Identified on Elective Back Surgery 1/1/10 – 12/31/10 3/1/10 – 3/31/10 2) Online Health Assessment
  12. 12. Customer B <ul><li>Member completes by 3/31/10 </li></ul><ul><li>Physician Annual Exam obtaining biometric results </li></ul><ul><li>Online Health Assessment using biometrics </li></ul><ul><li>One Online Digital Coaching Intervention </li></ul>Members identified as high-risk are targeted for Max Net Savings Telephonic Outreach Telephonic Outreach 40% of Identified on Chronic Condition 15% of Identified on Elective Back Surgery 1/1/10 – 12/31/10 Non-compliant members pay a higher premium share contribution starting 5/1/10
  13. 13. Customer C Step 1 Step 3 Step 2 Step 4 Members identified and targeted for Max Net Savings 35% Chronic Condition and 23% Pain Management Telephonic Outreach to Max Net Savings Target Non-compliant employee Premium Share Contribution Increase on 1/1/11 Employee completes Online Health Assessment by 3/1/10 (Member uses biometric results from fall 2009 onsite screening) Note: Wellness Only Option for non-blue members eligible for OHP and BS only. All employees complete (1) Online Digital Coaching Intervention 1/1/10 -12/31/10 Employee participates in Onsite Biometric Screening (9/1 – 9/15/10) Wellness Care Management At risk employees must complete (2) Telephonic Wellness Coaching Calls 1/1/10 - 5/31/10
  14. 14. Customer D All members begin in enhanced benefit level. Compliance Period 5/1/10 – 6/30/10 1/1/10 Member submits Attestation Form to BCBSM. Member schedules lab appointment & annual exam. Enhanced Benefit Level Employee stays in higher benefit level. Standard Benefit Level Employee is shifted into lower benefit level. Step 1 Member discusses biometric results & action plan during annual exam. Step 2 5/1/10 Step 3 Member calls Wellness Coaching Unit to discuss action plan w/ health coach. Compliance Period 1/1/10 – 3/31/10 7/1/10 Member completes HA using biometric results from annual exam. Enhanced Benefit Level Employee stays in higher benefit level. 4/1/10 Standard Benefit Level Employee is shifted into lower benefit level. Note: Members non-compliant in 2009 must comply with Steps 1& 2 to move to the enhanced plan 4/1/10.
  15. 15. Findings
  16. 16. Solution Process Flow Low-risk No intervention required Lower benefit level Employee is shifted into lower benefit level Paying higher co-pay and deductible Higher benefit level Employee stays in higher benefit level At-risk Wellness or Disease Management intervention required Noncompliant Employee did not complete HA Employee compliant Employee Noncompliant Compliant Employee completes HA Step 1 Step 3 Step 2 Step 4 Step 5 All employees begin in Enhanced Benefit Level BlueHealth Connection HA and Claims Data Risk Assessment Employee completes BCBSM online HA (within first 60 days)
  17. 17. Findings <ul><li>Overall Compliance – 77% </li></ul><ul><ul><li>Completion of HA – 81% </li></ul></ul><ul><ul><li>Completion of Wellness Coaching – 87% </li></ul></ul><ul><li>Stratification </li></ul><ul><ul><li>Low risk – 58% </li></ul></ul><ul><ul><li>Wellness Coaching – 42% </li></ul></ul>
  18. 18. Wellness Coaching Stage of Change Members’ Readiness to Change Progression (Initial and Final Wellness Coaching Calls) More Willing Readiness to Change Less Willing 27% 44% 15% 10% 4% Final Readiness to Change (final call) 4% 29% 36% 20% 11% Initial Readiness to Change (first call) Maintenance Action Preparation Contemplation Pre-contemplation Stage of Change
  19. 19. Chronic Condition Stage of Change Chronic Condition Members’ Readiness to Change More Willing Readiness to Change Less Willing 3% 74% 13% 9% 0% Final Readiness to Change (final call) 0% 1% 24% 73% 2% Initial Readiness to Change (first call) Maintenance Action Preparation Contemplation Pre-contemplation Stage of Change
  20. 20. Michelle DeWyre, M.A. Senior Health Care Analyst, Wellness and Care Management Consulting

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