NC HealthSmart:
Promoting Optimal Health and
Wellness for SHP Members
NC Medical Society Quality Subcommittee
August 2009
Derek Prentice, MD, Consulting Medical Director
Anne B. Rogers, RN, BSN, MPH, Director of IHM
What is NC HealthSmart?
North Carolina HealthSmart is a population health
initiative that aims to:
 Empower healthy members to stay healthy;
 Help those with chronic disease or disease
risk factors to better manage their health;
 Offer integrated, cutting-edge resources and
programs to members at work, at home, and
through their health care provider
Guiding Principles of NC HealthSmart

Reinforce and strengthen the patient-provider
relationship

Empower individuals to play active role in
management of their health and health care

Improve health of members and their families

Improve quality of care

Engage employers in health care issues

Increase member satisfaction

Stabilize Plan and member health care costs
NC HealthSmart Eligible Members
Members eligible for NC HealthSmart services
are members whose primary health insurance
is through the NC State Health Plan (all
except Medicare Primary).
HealthSmart Components

24/7 Health Coaching– Health Dialog

Disease Management – Health Dialog

Personal Health Assessment/Web Tools –
Health Dialog

Physician Support/Clinical Gap Identification –
Health Dialog
HealthSmart Components

Intensive Case Management/High Risk
Maternity/NICU – SHPS

ESKD/CKD Care Management –
KidneyTel (formerly Renaissance HC)

Health Promotion and Education
SHP Staff/All Vendors/DHHS

Worksite Wellness
SHP/DHHS/Division of Public Health
NC HealthSmart Continuum
HEALTH DIALOG:
HEALTH PROMOTION/
WELLNESS/WORKSITE
INITIATIVES
CAD
CHF
COPD
Asthma
Diabetes
Other Coachable Conditions
Tobacco Project
DHHS (NC Weigh)
STAR
Highway to Health (DOT)
Worksite Wellness Technical Assistance
OSP Policy Implementation
~545,000 Eligible Members
(Not Medicare or COBRA):
BCBSNC:
Utilization Management
Prior Authorization
Discharge Planning
RENAISSANCE
HEALTH
CARE:
CKD
CM
~200
Members
[<45-15
eGFR]
SHPS:
Intensive Case Management
~5% of Population
Multiple Inpatient/ER Visits,
Trauma,
High Risk Pregnancy,
Neonatal Intensive Care,
Catastrophic Diseases, etc.
7/31/08
ESRD
CM
~100
Members
[<15 eGFR]
NC HealthSmart Results

Program Participation

Clinical Impacts

Member Satisfaction

Provider Satisfaction
Participation

Over 45,000 members (~ 9%) currently served
by Disease and Case Management programs

Representing ~25% of SHP expenditures

Focusing on members with “coachable
conditions” and members with the most need

2:1 ROI – Chronic Disease Trends report
Clinical Impacts


Member adherence to clinical guidelines
(meds, tests, exams)
 92.4% asthma controller meds
 82.1% CAD - lipid meds
 77.0% diabetes - microalbuminuria tests
 47.4% diabetes - eye exam
Smart Registry and Provider Support
Services
Member Satisfaction

85% Satisfied with Health Coach

93% Likely to Recommend Program
Provider Satisfaction
[N = 234; ~3,000 surveys mailed]

77% are aware of NC HealthSmart

88% found the Provider Services Specialists
helpful

79% found the SmartRegistry helpful

74% have a positive opinion of NC SHP as a
result of NC HealthSmart
Worksite Wellness/Health Promotion




Preventive Services
Worksite Wellness Infrastructure
“STAR” and “Highway to Health”
Comprehensive Wellness Initiative
(SL 2009-16)
 Tobacco Cessation Supports
 Weigh Less program expansion
 Benefit changes
Opportunities

Disease and Case Management RFP

Discussions with various stakeholders
 NCMS
 CCNC/DMA
 NCAFP
 BCBSNC

Questions or Comments??