MYHEALTH ADVANTAGE PROGRAM OVERVIEW - ANTHEM
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MyHealth Advantage Program Overview
Better Health =
Comprehensive Wellness Benefits Financial Advantage
– Fully Insured
Core Programs – Included in your benefits
Care Management
• 24/7 NurseLine
Also Available
• Future Moms
• ConditionCare: Support
• ComplexCare
• ConditionCare: Kidney
• ConditionCare
• MyHealth Coach
• Healthy Lifestyles
• Worksite Wellness
• MyHealth Advantage
• EAP
Online Tools and Resources
• Pharmacy Benefit Management
• MyHealth@Anthem
• Staying Healthy Reminders
• MyHealth Assessment
• Incentives
• MyHealth Record
• Condition Centers
• Online Community
• Specialoffers@Anthem
• AudioHealth Library
• Time Well Spent
Healthy employees = healthy businesses.
2
MyHealth Advantage: Program Overview
MyHealth Advantage provides actionable and individualized
messaging to members and providers about potential
opportunities to:
Optimize their
Improve Avoid critical
health care
health health issues
spending
Healthy employees = healthy businesses.
3
MyHealth Advantage: Goals
The MyHealth Advantage program seeks to help:
Improve member health and safety
Improve compliance with evidence-based
guidelines
Increase early detection of health issues
Enable members and physicians to make
more informed care management decisions
Enhance results from synergistic
360o Health® programs
Reduce costs for both plan sponsors
and members
Healthy employees = healthy businesses.
4
MyHealth Advantage
The MyHealth Advantage program communicates to
members when gaps in care, safety issues and
opportunities for saving money are identified.
MyHealth Notes mailed to applicable members
(approximately 1 in 5 members)
Recommendations for members to help improve 89% of recipients
health and save money think the MyHealth
Listing of most recent medical, lab and pharmacy Note is easy to
claims understand and 72%
Links to educational information and resources perceive MyHealth
Specific ways they may be able to help save money Advantage as
on health care valuable.
Preventive reminders (if space allows) Q4 2009 Member Satisfaction Survey
Health Coaches field inbound calls
Monthly Provider letters for clinical issues
Healthy employees = healthy businesses.
5
MyHealth Advantage: Benefits
Both members and employers benefit from MyHealth Advantage:
Members
Early identification of potential health issues
Helps to improve health via targeted recommendations
Potential pharmacy and out of pocket cost savings
Helps to monitor and respond to dangerous drug issues
Employers
Helps to reduce costs
Helps to increase savings from generic equivalent drugs
Helps to improve productivity; reduced absenteeism and
‘presenteeism’
Helps to reduced incidence of more serious and costly complications
in the future
Healthy employees = healthy businesses.
6
MyHealth Advantage: Advantages
& Differentiators
Attention getting, easy to understand MyHealth Note
Lists recent claims
If benefit & formulary info is available, MyHealth Advantage can alert
members to actual dollar savings.
360o Health program integration – all information is included in the
members profiles so nurses can view
Pharmacy claims reviewed daily. Staff member calls with critical
issues
Educational information provided by the Harvard Medical School
Only program of this type to incorporate benefit information and
recommend money-saving changes
Program supports the total client population, not just those in disease
management programs
Proven increase in member compliance
Healthy employees = healthy businesses.
7
MyHealth Advantage: How it works
Healthy employees = healthy businesses.
8
MyHealth Advantage:
The Personal Health Picture™
The more health information available, the more comprehensive
the individual’s Personal Health Picture
Demographic Prescriptions
• Age 43 • Cholesterol Panel (May 26 2008)
• Female • Prilosec – 500 mg (May 25 2008)
• 1 Dependents • Accupril – 20 mg (Mar 28 2008)
• Prilosec – 500mg (Mar 23, 2008)
Biometrics • Accupril – 20 mg (Feb 18 2008)
• Height 5’6”” (May 23 2008) • Paxil – 20mg (Feb 12 2008)
• Weight 165 (May 23 2008) • Lipitor 20 mg (Feb 10 2008)
• BMI 26.63 (May 23 2008) • Lipitor 20 mg (Jan 15 2008)
• Abdominal Girth 31in (May 23 • Accupril 20 mg (Jan 12 2008)
2008) • Paxil – 20mg (Jan 10 2008)
• Blood Pressure 145 / 90 (May 23
2008) Lab Tests
• Cholesterol Panel (May 26 2008)
Medical History • Chest CT Scan (Feb 4 2008)
• ER Visit (March 28, 2008) • Complete Blood Count (Jan 15 2008)
• Office Visit Dr. Lynn (May 15
2008) Lab Test Results
• Office Visit Dr. Wilson (May 17 • Total Cholesterol 203 (Jan 15 2008)
2008) • LDL Cholesterol 152 (Jan 15 2008)
• Office Visit Dr. Jones (Apr 12 • HDL Cholesterol 42 (Jan 15 2008)
2008) • Triglycerides 193 (Jan 15 2008)
• Fasting Blood Sugar 123 (Jan 15 2008)
Healthy employees = healthy businesses.
9
MyHealth Advantage:
The Personal Health Scan™
The Personal Health Scan compares the member’s data with
medical best practices to find gaps in care and cost savings
opportunities:
Evidence-Based Care Rx Effectiveness
• Has Condition Needs Drug • Need Test to Optimize Drug Dose
• Has Condition Needs Test • Test Result - Monitor Drug Dose
• Need Test Follow-up • Started New Med - Need Doctor
• Need Event Follow-up Follow-up
• Need Preventive Test-Age
• Need Test to Optimize Drug Dose Rx Cost Savings
• Lab Result Need Doctor Follow-up • Brand Switch to Generic
• Lab Result Need Drug • Brand Switch to Formulary Preferred
• Formulary-Preferred Switch to Generic
Rx Adherence
• Non-Compliance Drug Regimen Health Risk
• Discontinued Drug • Has Condition Needs Drug
• Over-use of Drug • Need Drug to Prevent Condition
• Need Doctor Visit Follow-up ER
• Need Preventive Info Condition
• Need Info Warning Signs
Healthy employees = healthy businesses.
10MyHealth Advantage:
MyHealth Note Examples
Examples of Gaps identified through MyHealth Advantage
Healthy employees = healthy businesses.
11MyHealth Advantage:
Member Communication
MyHealth Note: Sample Communication
Member name, Front Back
mailing date and
notice of
confidentiality
Eye catching symbols
with bold headlines
linked to messages
inside
Healthy employees = healthy businesses.
12MyHealth Note: Member Communication
Member
name
Most recent
medical,
Targeted pharmacy,
suggestions and lab
regarding claims
care gaps or
cost savings
opportunities
Harvard
Medical
School
website
reference
Healthy employees = healthy businesses.
13MyHealth Note: Medication Graphic Insert
New Medication
Graphic provides
an innovative,
graphical
representation of
member
medication
compliance
Healthy employees = healthy businesses.
14MyHealth Advantage: Member Analysis
We monitored members with MyHealth Advantage for twelve
months to see what effect the MyHealth Note had on
increasing medical compliance.
12 groups were monitored for a total of 12 months (159,959
lives total).
40,176 people, or 25.1% of the total population received at least
one MyHealth Note due to an identified health opportunity.
Of the 25% that received a MyHealth Note, 61.4% of people
received more than one during the 12 month period.
Over 12 months, 184,121 issues were addressed, excluding
Daily Rx Safety Alert messages.
Healthy employees = healthy businesses.
15Results
The Member Analysis showed increases in compliance
associated with specific MyHealth Note messages:
46% showed increased compliance with clinical
recommendations1
69% refilled a high blood pressure Rx when reminded1
60% went for annual lipid check when reminded it was overdue1
38% scheduled a mammogram when reminded it was overdue1
23% switched to a lower cost generic medication when told
there was an alternative1
Healthy employees
Based on internal
1
= healthy
review of current participants; Membersbusinesses.
acted within twelve months of
receiving the initial MyHealth Note and may have been messaged more than once.
16MyHealth Note: Member Feedback
“I find the MyHealth Note very informative and helpful. It truly
does help me manage my health issues. Keep up the excellent
job.”
“I have found this service to be very helpful in continuing to
manage my several health problems.”
“The MyHealth Note had me write down questions to ask my
physician based on the meds I already take. It is very
informational and a great benefit to me.”
“Better than any other insurance program I have had.”
Healthy employees = healthy businesses.
Source: Quarterly MyHealth Advantage member surveys. 1,738 Member responses in 2009.
17MyHealth Advantage: Medical Guidelines
Evidence-based guidelines published by national medical
associations and societies:
The American Heart Association
The American Diabetes Association
Major studies and initiatives are used, including:
The Global Initiative for Asthma (GINA)
The United States Preventive Services Task Force (USPSTF)
The National Cholesterol Education Program (NCEP)
FDA information and drug package inserts from manufacturer
Healthy employees = healthy businesses.
18MyHealth Advantage: Provider Engagement
Member-specific messages sent to physicians increase
compliance with practice guidelines by 15% (5% absolute
increase).
Provider Care Alerts mailed monthly
Member non-adherence with tests,
exams and screenings, medication
therapy and drug safety issues
Healthy employees = healthy businesses.
19MyHealth Advantage: ROI
For every $1 invested in MyHealth
Advantage, employers can save
$1.63 in health care costs. This
translates into an annualized $1.63
savings of $1.63 per member. Saved
Based on a sample study of 34K members with clinical issues Actuarial
validation, 2010.
$1
Spent
Healthy employees = healthy businesses.
20MyHealth Advantage: Part of the pathway to
improved health
No matter which way it leads, we are here with personalized and
proactive solutions to help our members feel better and live better—
today and tomorrow.
Healthy employees = healthy businesses.
21If you have questions about this presentation or
your benefits, please contact your Anthem Blue Cross Blue Shield
representative.
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service,
Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of
Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area):
RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and
certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and
certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In New Hampshire:
Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia (excluding the City of Fairfax, the
Town of Vienna and the area east of State Route 123.): Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield
of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance
Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which
underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a
registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered
marks of the Blue Cross and Blue Shield Association.
Healthy employees = healthy businesses.
22Please join us for upcoming webinars
UPCOMING WEBINARS (All times 11:00 AM PST):
November 3: Complex Care /ConditionCare
December 9: Anthem.com and the member experience
Register at http://group.anthem.com/360healthWest
Healthy employees = healthy businesses.
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