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Wellness Coalition America Fully Integrated Solution April 2014
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Today’s objective © Wellness Coalition America Inc. Our view of the world Clinic fundamentals (CSF) System needs to manage clinic Total population management process Identifying and stratifying risk Scope of care Our view of wellness Staffing model and staging clinic growth Behavioral health advantages Clinic management Patient management and member empowerment tools Reporting and keys to success Differentiators to look for
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Challenges employees face Healthcare is expensive Access to care Over or duplicate utilization Lower health literacy Tend to defer preventative care Unidentified and/or unmanaged conditions Unhealthy lifestyle habits Limited support to manage conditions and lifestyle Need help navigating the health system Income challenges can alter diet choices Our view of the world © Wellness Coalition America Inc.
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License to Spend …and employees are given © Wellness Coalition America Inc.
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Managing Expenses Providing Benefits Employers left to make a decision © Wellness Coalition America Inc.
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Two Approach's Health Benefits Plan Design: Cost shifting Deductibles Co-insurance HDHP Surcharges HSA Incentives & compliance Clinical Solutions: On-site and near-site clinics Health coaching Direct access to primary care Screenings and health assessments Results based programs Super size impact
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Clinical solutions based on the unique needs of the client Integration of plan design with clinical solutions Scope of care, state regulations and requirements Participation criteria Member engagement strategies Member incentives, compliance requirements and tracking Government regulations Program launch and clinic communication process Risk stratification and identification process Data findings and clinic initiatives Process and system utilization to track and measure success Cultural and philosophical alignment Clinic Fundamentals © Wellness Coalition America Inc.
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Clinic management system
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Data Gathering and Analysis Identification and Risk Stratification Program Recommendations and Rollout Enrollment and Outreach Strategies Measurement of Activity Measurement of Condition Specific and Utilization Compliance Measurement of Clinical, Behavioral, and Financial Outcomes The integration of our Care Management System is the backbone of our business model and supports our Total Population Management Process, aimed at improving the health of your population and decreasing costs. © Wellness Coalition America Inc. Total population management process
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Managing risk © Wellness Coalition America Inc. 3.4% 50% Membership Plan Cost
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The MI2 report stratifies members from highest risk to lowest risk based on all available data input sources, displaying: Member identification and risk stratification process Clinical Diagnoses Co-morbidities Rx adherence Labs BMI Utilization ER visits Hospitalization Gaps in care Medical cost PCP Bonding © Wellness Coalition America Inc.
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Nurse Practitioner: Disease Management Assess, triage, diagnose, treatment Condition education Medication education Preventative education Compliance management Acute Care Assess, triage, diagnose, treatment Occupational health First responder workers comp Patient advocacy – steerage Medical Office Assistant: Scheduling and administrative NP medical support Patient advocacy – steerage Establishing clinic focus © Wellness Coalition America Inc.
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Optimal wellness model © Wellness Coalition America Inc.
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Staffing model © Wellness Coalition America Inc. Leveraging competency for optimal success WCA Clinic Staff Nurse Practitioner Nurse Coach Medical Office Assistant Company Wellness Coordinator Clinic point person Human Resources Company Executive Buy-in HR Team Engagement Strategic Direction Plan Design and Incentives Tactical Involvement - MOA Clinic Staff DM Focus Acute Care Ancillary Health Advocacy Provider Steerage WCA Clinic Operations Medical and Clinic Staff Oversight Strategic and Tactical Recommendations Account Management
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Staging clinic growth © Wellness Coalition America Inc. MOA Nurse Practitioner Health Coach MOA Nurse Practitioner/ MD Health Coach MOA Nurse Practitioner Vendor flexibility to accelerate and expand services has needed. Clinic LaunchSix Months Eighteen Months
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Clinic management - strategic vision and tactical direction © Wellness Coalition America Inc. Clinic focus Plan design Clinic access and visitation policy Incentive plan Compliance requirements Scope of care DM, PM, Acute Care, ancillary Staffing model Recruitment Training – initial and ongoing Clinic set-up and timeline Clinic launch Communication tools Clinic initiatives Measures of success Engagement strategy New hire policy Quarterly meetings to review progress
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Behavioral Focused: Core competency Individual goal setting Overcoming barriers Health education Condition specific education Medication education Preventative education Compliance management Patient advocacy - steerage Integration of behavioral health © Wellness Coalition America Inc.
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Clinical management system and tools Clinical Health History Conditions - compliance Screenings - compliance Rx - compliance Labs and vitals Stage of change Session activity Utilization and Financial Referrals Type of services rendered Location of services rendered Cost of services rendered Electronic Medical Record:
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© Wellness Coalition America Inc. Member empowerment tools Personal Health Record: Health history Personalized action plan Screenings – compliance Health alerts Labs and vitals Articles and videos Exercise log
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© Wellness Coalition America Inc. Health seminars Walking programs Group challenges Weight Watchers Member empowerment tools
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Reporting and data © Wellness Coalition America Inc. Standard reporting package document
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© Wellness Coalition America Inc. Keys to success Adhering to optimal clinic model High clinic utilization Proper balance of disease management, prevention management, acute care and ancillary services Movement from uncontrolled to controlled: Medication adherence Condition specific compliance Gaps in care Primary care Labs and values Behavior Culture of health and wellness Intangibles: morale, productivity, employee satisfaction
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© Wellness Coalition America Inc. On-site Savings Report On-site Clinic Savings Report: Calculates ROI for the clinic based on savings associated with all clinic activity and other proprietary factors. ROI drivers are: Direct office service savings Referral avoidance Service utilization Productivity savings Reduced absenteeism Screenings
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© Wellness Coalition America Inc. Differentiators Single vendor solution = easy of delivery Depth of services = quality control Proprietary software = platform flexibility Independent = control, mobility and continuity Passion and philosophy = aligned interest Fully integrated services allow better quality control and greater flexibility to meet your unique needs.
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© Wellness Coalition America Inc. Questions Any questions?
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Wellness Coalition America Terrie Reeves, President and Founder Terrie.reeves@wellnesscoalition.com Wellnesscoalition.com 1-877-903-4726 Contact information © Wellness Coalition America Inc.
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