Wellness and Disease Management Program
Sales Staff Presentations
September 2014
May 23 , 2013
1
PROPRIETARY AND CONFIDENTIAL
Agenda
1. Current State Wellness and Disease Management
2. Definitions and CareFirst Policy
3. Integrated Wellness and Disease Management Model Program
4. Effective 1/1/15
5. Enhanced Wellness Program Features
6. Next Steps
2
PROPRIETARY AND CONFIDENTIAL
Current State Wellness and DM
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Vendor Partners
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CareFirst has offered multiple options of program packages for both Wellness and DM
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23 Wellness only
61 DM only
11 DM and Wellness
83 Neither
Pricing for Risk Accounts
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Wellness is included
DM is NOT included
Programs for ASO Accounts – there is a mix as of Q1 2014
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3 different Wellness packages
3 different DM packages
Programs for Risk Accounts
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HealthFitness delivers Wellness (Health Assessments, Lifestyle Coaching, Workplace Wellness Events)
Healthways delivers Disease Management (Chronic Condition Coaching)
Wellness (Health Assessments, Lifestyle Coaching) is included as part of premium
Pricing for ASO Accounts
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Wellness and DM pricing is broken out separate from the Admin
3
PROPRIETARY AND CONFIDENTIAL
Current State Wellness and DM
Book of Business Program Offerings
Wellness
Disease Management
Assessment
Coaching
Workplace
Coaching
Fully Insured 2-199
Wellness Package 3
Wellness Package 3
N/A
N/A
Fully Insured 200+
Wellness Package 3
Wellness Package 3
$
N/A
$
$
$
$
Self Insured
Wellness Package 3 includes Health Assessment, Telephonic Health Advising, Online and Telephonic Health Coaching
Self Insured Purchase Options
Wellness
Package
Description
Disease
Management
Description
Option 1
Health Assessment, Online Health Coaching
Package A
5 core chronic conditions
Option 2
Health Assessment, Telephonic Health Advising,
Online Health Coaching
Package B
Package A + Impact Conditions (11)
Option 3
Health Assessment, Telephonic Health Advising,
Online Health Coaching, Telephonic Health
Coaching
Package C
Package B + Conditions (4)
4
PROPRIETARY AND CONFIDENTIAL
Definitions and CareFirst Policy
Definitions
Wellness – Assessments are important to identification of where members fall on the
continuum of care and what targeted services they should receive. Lifestyle Coaching is
targeted to those members with high risk for unhealthy behaviors and have not yet been
diagnosed with a condition.
Disease Management – Targeted chronic condition coaching (where we are identifying cases
to outreach based on our predictive modeling) of members with full expression of a disease
and who need outreach to be impactful.
CareFirst Policy
Healthways and HealthFitness will offer both Wellness and DM as opposed to having different
vendors for one account. Healthways will manage all ASO and HealthFitness will manage all
Risk.
5
PROPRIETARY AND CONFIDENTIAL
Integrated Wellness and DM Model Program
Ideal State Effective January 2015 for Self Insured Business Only
Vendor Partner: Healthways
Assessment Process
• Well-Being Assessment
• Biometric Screening/Physician Form
Incenting Member Participation
• Plan Design (HealthyBlue/Blue Rewards)
Health Condition Tracks
• Early identification that a member may be headed towards developing a condition
Coaching Interventions
• Lifestyle Management Coaching
• Disease Management Coaching (10 conditions)
Workplace Wellness Services
• Supports a Culture of Wellness
• Available for an additional fee; may be deducted from wellness credits
6
PROPRIETARY AND CONFIDENTIAL
Effective 1/1/15
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Risk Accounts
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ASO Accounts
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No change for 2015 – looking to incorporate DM for 2016
Price Wellness ($1) and DM ($3) into every opportunity upon medical renewal
The cost of these programs will be included and not broken out into the Admin fee
Messaging (depending on the mix outlined above)
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Account members will receive targeted DM programs for 10 chronic conditions which includes:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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Asthma
Diabetes
Coronary Artery Disease
Chronic Obstructive Pulmonary Disease
Congestive Heart Failure
Chronic Low Back Pain
Osteoarthritis
Atrial Fibrillation
Irritable Bowel Syndrome
Fibromyalgia
Wellness Assessments and Lifestyle Coaching which are critical to identification and management are now
included as core so that we can appropriately risk stratify and support the Account’s population
This is part of our transition to a health care delivery manager so that we are meeting member where they are
on the continuum of health
7
PROPRIETARY AND CONFIDENTIAL
Enhanced Wellness Program Features
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Shorter, more engaging Health Assessment
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Social experience throughout, including Groups, Challenges, Forums, etc.
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Personalized Messaging
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Wireless device integration (i.e., FitBit, Withing, etc.)
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Text messaging capabilities
8
PROPRIETARY AND CONFIDENTIAL
Next Steps
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Account Transition
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Effective 2015 for eligible accounts upon their medical renewal date
Including in all RFPs – pricing, written description and executive summaries
Currently identifying most appropriate accounts for 1/1 on a case-by-case basis
Collaboration between Sales, Wellness and Underwriting to determine best approach
Marketing Materials
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New Print and PDF Brochure
Individual Sell Sheets and Program Descriptions
New Pricing Guide
Member facing materials (in development)
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For all groups moving to this program, Sales to please complete new H+W Request form
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Additional Questions: Please contact the Wellness Team for any questions
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Scott Smith: 200+ Commercial, Health & Education Accounts
Jenna Schiffelbein: 200+ Municipal and Labor Accounts
Carla Savage: General Wellness
9
PROPRIETARY AND CONFIDENTIAL