1. Chronic Care Solutions
Driving better management of chronic medical conditions

2. When members can’t get the right support to manage their disease,
everyone suffers.
Worsening health
Loss of productivity
Higher healthcare costs
The traditional models of engagement aren’t enough.

3. All companies face the challenge
Chronic medical diseases such as diabetes, cancer and heart disease, are the leading cause of disability and death in the US.
Surveys show:
50% of people have one or more chronic health conditions
1 in 4 had two or more chronic health conditions
5 times higher costs for those with one or more chronic conditions
$225.8 billion/year ($1,685 per employee) in productivity costs to employers
4-5 times higher productivity costs than direct medical costs

4. 91% of patients with chronic conditions say they need help managing their disease
59%
do not feel they are doing everything they can to manage their condition
are only somewhat confident that they know their current metrics (e.g. blood pressure, weight)
43%
70%
would like more resources or clarity about management
unsure of their target numbers for key health indicators (blood pressure, cholesterol and weight)
35%
rate their ability to manage their chronic condition as fair or poor
20%
Source: Strengthening Chronic Care: Patient Engagement Strategies for Better Management of Chronic Conditions, West Corporation

5. The traditional disease models have not been efficient
Lack of integration with other services
Narrow engagement
Lack of live nurse coaching at all risk levels
Patients are ready and waiting for the right help at the right time to better manage their condition to enjoy an improved quality of life.

6. Why Health Advocate Chronic Coaching Works

7. Integration of Advocacy, Wellness Coaching and Chronic Condition Management: The Value of Bundling Programs
Enhances coaching services to include management of chronic medical conditions to impact medical costs and outcomes.
Increase engagement in all programs through collaboration and cross referrals by >20%. In 2017, 61% of coaching cases were referred by internal Health Advocate programs.
Integrate biometric screening results to broaden early disease identification and enhance outreach.
Enhance and simplify your incentive strategy.
Wellness Coaching
Lack of Exercise
Poor Nutrition
Smoking
Intervention may avoid
Pre-diabetes
Hypertension
Cancer
Intervention may avoid
Heart Attacks
Amputation
Pneumonia
Avoidable ER & Inpatient Visits
Chronic Condition Coaching
Diabetes, Hypertension, Heart Disease
Chronic Kidney Disease, COPD, CHF, Asthma
Depression, Metabolic Syndrome

8. Integration with Advocacy a key differentiator
Working one-on-one with Personal Health Advocate – a trusted, unbiased professional
Integration referral
Member calls a Personal Health Advocate (PHA) to help them with a denied ER claim
The PHA sees dashboard spotlights that member has asthma and repeat ER visits
The PHA has a conversation about Chronic Care Nurse Coaching to help better manage asthma

9. Which chronic conditions are managed and why?
Diabetes
Asthma
Hypertension
Coronary Artery Disease
COPD
Depression
CHF
Chronic Kidney Disease
Metabolic Syndrome/Hyperlipidemia*
*requires access to biometric/lab data

10. Chronic Condition Coaching Goals
Through a dedicated nurse coach, provide evidence- based support for members with common chronic conditions designed to:
Improve health outcomes of members and educate them to better self-manage their conditions and lifestyles
Reduce gaps in care for recommended screenings, preventive care and medication management
Reduce utilization and costs associated with avoidable complications
Empower members to partner with their doctors to better manage their long-term health
Improve healthcare literacy

11. Data allows us to identify and risk stratify members with chronic medical conditions
Our data analytics use predictive modeling to identify members with one or more chronic medical conditions
In order to drive this process, we would need medical and pharmacy claims at a minimum. Biometric data can be integrated and used to drive earlier and broader identification.
When Health Advocate provides Wellness Coaching services, HRA results are also utilized.
The model considers the member’s condition status and co-morbidities to assign a predictive risk classification: Low, Medium or High risk
Predictive model is refreshed monthly when new claims data is provided

12. Chronic Condition Coaching Delivers
Dedicated Nurse Coaches provide condition-specific interventions
Coaching on evidence-based self-management and self-monitoring techniques
Full baseline health assessment to understand condition history and risks
Obtain, review and build adherence to provider’s treatment plan
Ensure engagement and provide coaching on partnering with their provider
Build knowledge about condition and ensure member is receiving recommended care
Medication management adherence issues
Identify and manage lifestyle/behavioral risks
Developing better healthcare consumerism skills such as shopping for medications, using pricing transparency tools, etc.

13. Health Advocate Nurse Coaches Multiple Pathways to Engagement
Inbound Identification
via Health Advocacy
Biometrics
Integration
Wellness Coaching Integration
Targeted Home Mailings
Text Push Messages
Health Advocate
Nurse Coaches
Multiple Pathways to Engagement
Targeted Phone Calls
Third Party Referrals
Onsite Clinic Integration
Incentive Management

14. Member Engagement Portal – Push Notifications
Chronic Care Management Opportunities
Members who download the app will be prompted authorized notifications
Notifications can alert members to eligibility for chronic care coaching
Alerts members to gaps in recommended chronic condition treatment and preventive care
Member will receive one push notification alert once a week

15. Chronic Condition Advice
Based on members identified with claims who have a chronic disease risk for a condition AND haven’t joined a program
If multiple care gaps exist, member will receive one prioritized message per week
If eligible for coaching, member is directed to log into secure site for detail
Diabetes Advice Examples for Gaps in Care

16. Gaps in Care Home Mailers
Reaches 100% of members who are overdue for recommended chronic condition care
Directs employees to their personal physician and Health Advocate
Drives utilization of chronic condition management programs
Encourages completion of important tests such HbA1c and cholesterol monitoring
Provides guidance to evidence-based care
Promotes wellness/lifestyle changes and medication compliance

17. Case Study Problem: Solution:
Mike was having difficulty managing his weight and diabetes, as well as unrecognized symptoms of hypoglycemia. He was using 50 units of insulin and taking 4 mg of medication daily to control his blood sugar.
Solution:
Working with his Nurse Coach, Mike:
Learned how to control his diabetes and self-monitor more frequently
Identified hypoglycemia symptoms and how to
handle them
Learned to better understand and adhere to his doctor’s medication plan, and keep his doctor informed of symptoms
Worked out an exercise plan and received automatic daily reminders to keep on track

18. Results:
After coaching, following his doctors’ plan, eating properly and exercising, Mike:
Lost 22 pounds
Stabilized his blood sugar levels
Reduced additional health problems
Most significantly, Mike’s doctor allowed him to come off insulin completely and reduce his glucose control medication dosage from 4 mg to 2 mg daily.
After my doctor told me that I could go off insulin completely, I was shouting for joy in her office. The education and guidance you provided helped me reach my goal…Now on to more weight loss goals! “ ”

19. Case Study Problem: Solution:
Following a hospital admission for breathing difficulties, Carolyn needed help to manage her uncontrolled asthma, stay compliant with her medication and find affordable medications. She entered coaching based on receiving a call from Health Advocate.
Solution:
Working with her Nurse Coach, Carolyn:
Learned about the numbers on the asthma control test (ACT) and, scoring <18, required discussing her asthma symptoms with her doctor
Discovered how to manage the underlying issues including cost and frequency that prevented her from taking medicine
Followed recommendation by her provider to switch to a more effective, less-costly medication
Received guidance to improve lifestyle issues around diet and exercise

20. Results:
After coaching, Carolyn:
Became more compliant in taking the recommended medication
Improved her ACT score from a 9 to 23
Enrolled in a water aerobics class
I’m feeling a lot better and you have really helped me a lot. “ ”

21. Chronic Condition Management Activity Reporting
Provided monthly, quarterly or bi-annually:
Breakdown of disease prevalence and risk within the population
Unique members by disease state
Members with multiple conditions
Member engagement and enrollment
Gaps in care mailings
Care gaps coached on
Case collaboration activity
Compliance with recommended care

22. Chronic Condition Management Annual Outcomes Reporting
Provided annually, this report demonstrates the impact that our services have had upon:
Impact on prospective risk scores
Adherence to recommended treatment
Utilization of medical services
Claims trend differential between engaged vs. non-engaged members to establish ROI
Changes to PMPY treatment costs
Changes to biometric levels
Most client’s experience an ROI of 2:1 to 4:1

23. Thank you Chris Weale Director, Specialty Sales Chronic Care Solutions