Chronic Condition Management

Overview Facts

• Management of Conditions with the Highest Potential for Impact
  • Asthma
  • Diabetes – Type 1 and Type 2
  • Heart Health Conditions including; Coronary Artery Disease, Hypertension,
  • High Cholesterol, Stroke, Cerebral Vascular Disease and Congestive Heart Failure
  • Chronic Obstructive Pulmonary Disease
  • Focus on compliance with care standards as well as positive lifestyle changes

• Engagement of Every At-Risk Member
  • Customized outreach via phone and mail.
  • Standards of Care provided to each at-risk member for their specific condition

• A “Better Health” Management Track for Each At-Risk Member
  • Registered Nurse Health Coaching provides care assessment, custom compliance plan and member goal setting
  • Education and Awareness track stays in front of members not participating in coaching with quarterly better health information

• Real Time Integration with Utilization & Care Management
• Sophisticated Predictive Modeling of All Medical and Rx Claims
• Data Reports that Demonstrate Results

Program Impact

• Independent Cohort Study Shows ROI of $3.03 per $1.00 and…
• Claim Trend that is 42% Below Plans Without Care and Condition Management
• Diabetes Risk Level 1-4 Cost PMPM Lowered 47%
• Asthma Risk Level 1-4 Cost PMPM Lowered 40%