1. Appendix:
Complementary Solutions

2. Engage Employees in Their Health and Well-Being

3. Health Advocacy
Personal Health Advocates help members navigate healthcare and insurance-related issues, quickly and efficiently
Personal Health Advocates are typically registered nurses, supported by medical directors, benefits and claims specialists
Single, ongoing contact available for, direct dial phone number and
Increases employee productivity, satisfaction and retention; maximizes benefits utilization
Available to members and their eligible family members including spouses/domestic partners, dependents, parents and parents-in-law.
Reduces grievances and appeals; improves administrative efficiencies; alleviates burden on HR staff
Reduces medical costs; improves health outcomes; saves everyone time and money

4. Wellness Program
Highly personalized program to help employees reach health goals
Unlimited health coaching by phone, or secure web messaging
Key focus areas include weight management, fitness/exercise, nutrition/diet, stress management, tobacco cessation, self care of chronic conditions
NCQA-certified Health Risk Assessment and personalized report
Robust online resources support coaching
Innovative engagement programs, campaigns, wellness competitions
Comprehensive, turnkey communications and educational materials
Individual and aggregate management reporting
Full suite of complementary add-on solutions
Seamless integration with Health Advocacy service and all other Health Advocate solutions

5. EAP + Work/Life
Licensed Professional Counselors provide confidential, short-term assistance with personal, family and work issues
Counseling focuses on coping strategies
In-person, telephonic and online video counseling available
Referrals to appropriate professionals for more long-term support
Work/Life specialists locate support services and local resources for help with childcare, eldercare, legal and financial counseling
Work/Life website, webinars and onsite seminars
Unlimited telephonic consultation for management and supervisors for help with critical incidents, employee conflicts and sensitive cases
Medical Bill Saver™ service features skilled negotiators for help lowering non-covered medical/dental bills
Personal Concierge service
Reduces need for more costly mental health services and ER utilization

6. EmpoweredHealth™
Strategic alliance of key programs and services into one seamless offering
Single, toll-free number, no matter what the issue
Delivered by a select team of interdisciplinary experts in one location
Advanced systems architecture analyzes health data from multiple sources; enables powerful targeting risk stratification and customized coaching
Integrated Dashboards provide consolidated view of benefits utilization, gaps in care, health/wellness measures and engagement opportunities
Promotes unprecedented level of collaboration around each individual
Targeted, multi-format communications
Robust management reporting
Improves health outcomes/productivity; decreases medical costs; maximizes benefits utilization

7. Chronic Care Solutions
Fully customizable to meet each client’s specific needs
Advanced data analysis identifies and stratifies employees by risk level (high, average, low) and co-morbidities
Ongoing, customized prevention and condition-specific communications increase compliance with recommended care
Unlimited access to a Registered Nurse for personalized coaching
Flexible communications including telephonic and
Reduces utilization and costs associated with avoidable complications
Improves health outcomes and quality of life; lowers medical costs
Fully integrated with Health Advocacy service and all other Health Advocate programs

8. Onsite Biometric Screenings
Customizable onsite health screenings available nationwide
Complete program management from start to finish
Wide selection of screening options and packages
Delivered by trained Health Advocate registered nurses, EMTs and health educators
Easy-to-use online scheduler
Immediate results
Turnkey educational and promotional materials
Seamless integration with Health Risk Assessment (HRA), wellness and incentive programs
Individual and aggregate year-over- year reporting

9. Health Cost Estimator+
Health Advocate’s proprietary pricing transparency solution
Supported by leading-edge technology and data analytics
Provides key information to help select the highest-value providers
Multiple data sources including client’s paid medical claims supplemented by our national database
Cost comparisons for hundreds of medical services by ZIP code
Real-time out-of-pocket estimates and user benefits status
Quality indicators, safety scores and patient reviews
Proactive employee awareness and engagement program
Empowers more cost-effective decision-making
Available on multiple platforms including mobile, tablet and PC
Employees can call a Personal Health for added pricing support

10. Personalized Health Communications
Personalized preventive and chronic care reminders focused on gaps in care
Data-driven using eligibility and claims data matched to evidence-based guidelines
Reaches 100 percent of members with preventive and chronic care services due
Promotes compliance with important tests, medications and other screenings
Addresses the most costly conditions such as heart disease, diabetes and asthma
Directs members to their personal physician, Personal Health Advocates and Nurse Coaches
Comprehensive management reports
Fully-integrated with all Health Advocate solutions

11. Incentive Management Participation-Based Outcome-Based
Engage with a Wellness Coach
Complete a workshop
Complete a PHP
Track activities + participation on Wellness website
Communications support
WPC/Consultation and planning
Added fees
Outcome-Based
Outcome-based associated with health-contingent program
Behavior change
Improve screening results
Quit tobacco
Eligibility file generation
Incentive tracking + reporting
WPC/Consultation and planning

12. Healthy Baby
Personalized program focused on education, support and helping members have healthy pregnancies and babies
Identifies risk factors (e.g., smoking) and supports members in reducing health risks
Ongoing, regular outreach throughout pregnancy and after delivery
During pregnancy: Ensures women get prenatal care, understand maternity benefits, and have a resource for any complications
After delivery: Ensures that the baby gets newborn care; screen mom for post-partum depression; offers benefits and claims support
Improves health outcomes and reduces medical costs

13. Outbound Calling, Text and Email
Employs a variety of communication methods to fully support your need
Product adoption, adherence and retention
Increased revenue and market share
Proven customer satisfaction & loyalty
CSAT Customer Satisfaction rate of 97%
Enhanced patient engagement
Improved health & wellness

14. Tobacco Cessation Program
Comprehensive solution helps employees successfully quit tobacco and stay tobacco-free
12-week, evidence-based program
Personalized, one-on-one coaching
Engages spouse in Coaching for additional support
Coordinates with employer or health plan-paid Nicotine Replacement Therapies
Integration with Wellness incentive program
Promotion and reinforcement materials

15. NurseLine 24/7 hotline staffed by experienced Registered Nurses
Supported by a state-of-the-art clinical information database
Addresses questions about symptoms, medications and treatments for acute health issues
Provides easy-to-understand self-care measures for non-urgent issues
Directs callers to appropriate care in emergency situations (urgent care, 911)
Ongoing communications support
Integrates seamlessly with Health Advocacy service

16. MedChoice Support™
Self-directed comparison tool guides employees through key health decisions about treatments, tests and medications
Combines authoritative medical information with practical personal assessments
150 decision-making topics cover costly and high-prevalence health choices such as surgery, diagnostic tests and medications
Downloadable summary to share with healthcare team
Helps employees choose appropriate care that may be less risky, complicated and costly

17. Cleveland Clinic MyConsult ® Online Second Opinion Program
Special arrangement with Cleveland Clinic for access to electronic second opinions through their MyConsult Online Medical Second Opinion program
Designed for employees with serious and life-threatening medical diagnosis
Provides access to the Cleveland Clinic’s expert specialty physicians
Eliminates time and expense of travel
Helps confirm diagnosis or a treatment plan or offers alternatives; provides recommendations
Convenient and secure; all personal health information is kept confidential
Maximizes employee engagement in their care
Improves health outcomes and reduces medical costs

18. Reduce Medical Costs – Save Money

19. Data Analytics
Comprehensive selection of analytics and reporting services
Flexible, customizable and scalable solutions available to self-insured groups of all sizes
Provides key insight into the cost and quality of health benefits programs
Helps monitor success of disease management and wellness programs
Measures the cost of absenteeism and lost productivity
Completely objective; no affiliation with specific carries or plans
Proven performance measurement methods to facilitate data acquisition/consolidation
Customized reporting with multiple end-user views

20. PreVent/Claim Overpayment Recovery
Complete post adjudication, pre-payment identification/validation solution supplements auto-adjudication and traditional pre-pay tools
Combines analytics with the human touch to identify areas of incorrect payment before the payment is made to the provider
Uses predictive, data-driven, integrated code edits and clinical aberrancy rules to identify potential mis-payments
Increases recoveries and reduces costs immediately

21. Cost Containment Solutions
State-of-the-art data analytics, combined with expert knowledge, to pinpoint claims payment errors and identify areas of waste
Highly-trained staff works to recover mis-paid claims and implement processes to protect future incorrect payments
Skilled recovery specialists provide complete case management
Supported by expert legal team and resources
Clients pay only if our services can save them money
Ongoing, comprehensive client reporting

22. HealthInsights Dashboards
Helps employee benefits organizations transform aggregate claims, pharmacy and enrollment data into a series of understandable web- based dashboards and reports
Predictive modeling based on evidence-based medicine cost and utilization history
Quickly identify and track spending
Track, measure and forecast enrollee health and wellness benefits costs
Select and manage insurers and health plans; monitor financial and clinical performance
Eliminate redundant costs and improve product offerings

23. Subrogation/Overpayment Recovery
Proprietary subrogation identification model and advanced analytics identify third-party liability and claims with the greatest likelihood of recovery
Applies specialty subrogation tools (property/casualty database searches, federal/state online records) to maximize identification and recovery
Validators manually calculate and verify that the claim is truly overpaid
Regular, detailed reporting of claims recovery status and results
You only pay us if we save you money

24. Third Party Liability
Proprietary software, combined with expert team, analyzes claims to identify when other sources for healthcare coverage may be liable for claim payments
Software uses ICD-9 trauma and E-series codes to identify and accumulate paid claims
Code library contains codes that most often represent accidents that result in settlement; library is updated annually
Minimizes member abrasion and use of client’s internal resources, and can be incorporated into any payer’s workflow

25. Survey Services
Coordination of Benefits (COB) Recovery. Experienced survey team collects, manages and reports other insurance coverage information for member populations; results uploaded to payers’ systems so claims can be processed accurately according to the primary sequence.
Employer Group Size Verification. Helps payers maintain compliance with Medicare Secondary Payer (MSP) requirements to ensure accurate claim payments and avoid fines/penalties.
Social Security Number Capture. Survey services ensure compliance with ACA mandate to capture Social Security numbers of members who carry minimal essential coverage.

26. Medical Bill Saver™
Negotiates non-covered, out-of-network, and/or exceeding the benefit maximum medical or dental bills over $400, regardless of benefit status
Highly experienced negotiating unit
Offers “safety net” for employees to reduce out-of-pocket expenses
Track record of achieving significant savings

27. Medicare Advantage Stars Program
Fully integrate 6-part program helps plans meet quality-based objectives
Provides opportunity to earn 5-star rating required to secure millions in bonuses and ability to market the plan year-round
Combines personalized, telephonic, healthcare help, clinical coaching, data- driven communications and Dashboard technology to increase compliance and improve outcomes

28. Telemedicine Licensed MeMD physicians available 24/7, 365
No waiting rooms, no closed offices, no waiting weeks for an appointment
Receive answers and treatment within minutes via phone or video
No limitations on use
Significantly less expensive than typical office, urgent care or ER visits
Saves on out-of-pocket expenses, i.e., deductibles, co-pays
Less time off from work for doctor appointments

29. Support Streamlined Administration

30. Benefits Gateway™
Benefits experts connect employees to all benefits through a single 800# (e.g., medical, dental, EAP, pharmacy)
Flexible design; client dictates which benefits/vendors to include
Health Advocate development team coordinates intra-vendor setup and processes
Supported by the latest information/telephonic technology
Turnkey communications program
Smooth transition to Health Advocacy service for help resolving healthcare and insurance-related issues

31. FMLA Support
Staffed by a team with experience working with providers, health benefits, medical issues and FMLA review
Reviews employees’ medical leave requests, including contacting the certifying physician when necessary
Helps determine whether the condition meets the FMLA definition of “serious medical condition”
Fully complies with HIPAA privacy regulations to protect health information

32. External Appeals Administration
Independent, turnkey solution to meet federal regulations for external appeals
Seasoned healthcare and insurance experts manage complete external appeals process
Contracts with qualified Independent Review Organizations for unbiased reviews
Develops required member notices, in accordance with NAIC model communications
Facilitates expedited reviews where member’s life or health is at risk
Coordinates relevant medical and benefits information
Tracks progress; provides required reports including certification of outcomes

33. Enrollment Advocate
Serves as primary resource for all benefit-related questions
Supports HR staff and strategic initiatives
Enhanced support to make presentation of benefits run smoothly
Supports all aspects of communication program
Employees can call any time; no limit on call duration and call-backs
Seamlessly integrates with Health Advocacy service

34. Independent Appeals Administration
Supports self-funded organizations who have fiduciary responsibility for the appeals process
Experienced appeals administration and review team performs objective analyses for accurate appeals decision
Researches appeals to ensure fair and consistent treatment and avoid costly mistakes
Manages the entire process; provides unbiased evaluations
Ensures compliance with state and federal regulations and timelines

35. Improve Quality of Care

36. Integrated Data Repository
Customizable services include patient outreach, administrative assistance and data analytics to help health organizations maximize revenue, optimize patient engagement and build brand loyalty
Personalized service from trained Personal Health Advocates
Administrative and clinical help for patients and staff; personal outreach to patients via telephone and mail
Advanced data analytics and reporting helps identify risk and pinpoint spending
Frees physician and administrative schedules
Maximizes performance on quality metrics and revenue retention
Fully integrated with all Health Advocate programs

37. Disease Stratification and Predictive Modeling
Identifies and risk stratifies patients with chronic diseases using proprietary clinical indicators adapted from nationally-recognized standards of care and evidence-based medical guidelines
Creates member-level risk scores, broken down by service category and 2,000+ clinical classifications
Actuarial forecasting uses industry- leading predictive models, customized to include multiple data sources
Comprehensive concurrent and prospective healthcare cost and utilization analysis

38. Provider Performance Analytics
Tailored approach to managing performance, quality and cost efficiency among provider populations
Flexibility—client decides how strict or loose the methodology
Analyzes episodes of care to rate providers on effectiveness and cost
Identifies unnecessary medical interventions
Analysis based on peer-reviewed preventive and recommended care metrics
Data is refreshed annually and presented in actionable formats to promote behavior change
Results can be used to develop preferred networks to control costs and improve outcomes
Detailed, easy-to-understand reporting package

39. Population Risk
Tailored approach to managing performance, quality and cost efficiency among provider populations
Flexibility—client decides how strict or loose the methodology
Analyzes episodes of care to rate providers on effectiveness and cost
Identifies unnecessary medical interventions
Analysis based on peer-reviewed preventive and recommended care metrics
Data is refreshed annually and presented in actionable formats to promote behavior change
Results can be used to develop preferred networks to control costs and improve outcomes
Detailed, easy-to-understand reporting package