0. Medicare Advantage
Stars

1. Health Advocate Overview
Nation’s leader in healthcare advocacy and assistance
Distinguished roster of 10,000+ nationwide clients
Serving over 40 million eligible lives
Broad product spectrum
Outstanding, experienced management team
Expert staff of healthcare and insurance professionals
Powerful and proprietary infrastructure
Strong brand recognized as objective and well-respected
A subsidiary of West Corporation

2. The Context
Plans that achieve Star ratings of 4, 4.5, or 5 Stars can earn back bonus revenue
Ratings are based on 46 standard performance objectives from Medicare Advantage Stars measures
Star ratings are achieved by encouraging wellness and preventive services, boosting member satisfaction and customer service
Start improving ratings now for revenue opportunity
2015 activities determine ratings for 2017

3. At-a-Glance Health Advocate Approach
6-part, fully integrated program that helps plans meet quality-based objectives
Provides opportunity to win a 5-Star rating required to secure millions available in bonuses and the ability to market their plan year round
Multipronged, interrelated approach that fully engages members and supports the plan on multiple levels
Blends personalized, telephonic healthcare help, clinical coaching, Dashboard informational architecture and data-driven tailored communications
Ensures better compliance with quality-based measures to achieve the highest ratings and opportunity for increased revenue

4. Health Advocate Approach
6 Integrated Parts
Health Advocate Approach
Feature #1: Medicare Advantage Stars Advocacy Service. Personalized member support, problem resolution and coaching to meet quality-based measures supported by proprietary informational Dashboard tool.
Feature #2: Personalized Member Communications. Targeted communications to drive members to meet requirements.
Feature #3: Targeted Outbound Calls. An outreach program using “smart targeting” technology to increase compliance and address gaps in care.
Feature #4: Carrier Agent Dashboard. Provides the health plan with the proprietary Dashboard and training for staff in its use to engage members to meet measurements.

5. Health Advocate Approach
6 Integrated Parts
Health Advocate Approach
Feature #5: Personalized Member Online Dashboard. Custom tool highlighting the member’s Medicare Advantage Stars profile designed to encourage better compliance.
Feature #6: Comprehensive Monthly Reporting. Summarizes performance measures including participation and outcomes.
Improves Medicare Star ratings – Helps generate earn-back bonuses for health plan

6. Feature #1: Member Advantage Stars Health Advocacy Service
Personalized help to navigate range of healthcare and insurance-related issues
One-on-one relationship with Personal Health Advocates, typically registered nurses supported by medical directors and benefits and claims specialists
Assists with senior-related issues (e.g., finds living facilities, in-home care, locates durable medical equipment, cost-saving generic equivalents to brand-name drugs, etc.)
Clarifies Medicare Advantage benefits
Uses informational Dashboard with member’s profile for “teachable moments”
Guides members to preventive services and recommended care
Finds in-network doctors; schedules appointments
Advocacy service available 24/7; Personal Health Advocate remains with member

7. Health Advocacy Solution Close-up
Highly personalized
We do the work for the member
Helps members navigate healthcare and insurance-related issues
Experts who know the ins-and-outs of the healthcare system
Saves time and money

8. How We Help
Obtain unbiased health information about complex medical conditions to help make informed decisions
Answer questions about test results, treatments and medication prescribed by the physician
Assist in the transfer of medical records, X-rays and lab results
Locate and research the newest treatments for a medical condition
Explain benefits and help facilitate access to appropriate care
Find qualified doctors, dentists, hospitals, other healthcare providers anywhere in the country
Expedite appointments including those with hard-to-reach specialists; arrange for specialized treatments and tests
Help resolve insurance claims
Negotiate billing and payment arrangements
Assist with eldercare such as finding adult daycare, assisted living and other related issues facing parents, parents-in-law
Work with insurance companies to obtain appropriate approvals for needed services

10. Feature #2: Personalized Member Communications
All members receive personalized communications encouraging preventive services, tailored to their profile
Disease-specific communications for members identified with chronic conditions, tailored to the best management of their condition
Ongoing reminder communications during the year reinforce prevention actions
All communications are tailored to seniors (e.g., large print)

11. Feature #3: Targeted Outbound Calls
Uses “smart targeting” technology driven by member utilization
Personal Health Advocates reach out to members who meet criteria for specific screenings and other Medicare Star measures
Reminds and encourages Medicare Advantage members to follow through to meet measures
Call coordinated with physician appointments with confirmation that the appointments took place
Member data is updated to reflect improvement in success rates
Coordinated with health plans
Improves compliance and closes gaps in care

14. Feature #4: Carrier Agent Dashboard
Health Advocate provides proprietary information Dashboard to health plan
Enables health plan staff to leverage “teachable moments” when member calls plan directly
Key Medicare Advantage Stars measures highlighted
Spotlights focusing on required member actions
Integrated into ongoing customer service experience
Coordinated with appointment scheduling process by Personal Health Advocate
Increased Medicare Advantage Stars compliance
Training provided for health plan staff in the effective use of Dashboard
Helps increase Member Satisfaction measure

16. Feature #5: Personalized Member Online Dashboard
Online, secure member Web portal
Customized with member-specific Medicare Advantage Stars measures
Dashboard shows recommended tests and procedures, benefits information, physician contact, etc.
“Alerts” messaging when action is required or data updated
Access to health information and other member-centric information
Access anywhere internet connection is available

18. Feature #6: Comprehensive Monthly Reporting
Engagement – members contacted and coached
Preventive and chronic condition management
Topics discussed
Conditions addressed
Outcomes – physician appointments, exams scheduled, etc.
Member feedback

21. Benefits: How Health Advocate Helps Health Plans
Personalized, ongoing engagement on multiple levels to optimize compliance; help plans reach a 4, 4.5, or 5-Star rating
One-on-one support for increased member satisfaction
Highly knowledgeable about specific Medicare Advantage Stars measures
Tailored, targeted communications to help meet specific quality-based measures
Fully integrated—help for a spectrum of needs, including scheduling appointments; locating senior services
Low-cost solution
Significant ROI
Complete, turnkey solution