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American Health Care s Disease Wellness Management Program:

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American Health Care s Disease Wellness Management Program:

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    1. American Health Care’s Disease & Wellness Management Program:

    2. OVERVIEW Introductions/roles/responsibilities Differentiating AHC from competitors Experience supporting similar programs AHC’S HEALTHNAVIGATOR PROGRAM HOW AHC IDENTIFIES, ENROLLS, ENGAGES AHC’S PATIENT MANAGEMENT & CUSTOMER SERVICE AHC’S OUTCOMES REPORTING

    3. Grover C. Lee, Pharm.D., BCMCM – CEO Christine Lee, Pharm.D., BCPS, CLS – Chief Clinical Officer Dan Garrett, RPh, MS – VP of Health Care Programs Barry Bunting, Pharm.D., DSNAP – VP of Clinical Programs Grant Knowles, Pharm.D. – Senior Clinical DM Manager

    4.

    5. OVERVIEW American Health Care Differentiators

    6. SENIOR LEVEL STAFF EXPERIENCE Dan Garrett, VP of Health Care Programs One of the originators of the Asheville Project® Replicated Asheville as a member of the APhA Foundation Barry Bunting, VP of Clinical Services Asheville program director Principle publisher of the Asheville program Facilitated program implementation nationally and internationally Grover Lee, CEO of American Health Care Replicated Asheville across the country Founder of the Hickory Project Published outcomes on the “Hickory Project” AHC IS THE PBM FOR THE MAJOR ASHEVILLE PROJECT ® EMPLOYER AHC became the PBM for Mission Hospital (11,000 covered lives) in 2002. AHC contributed data analysis & clinical support for the Asheville Project® publications and assists care managers in the care of over 1,000 enrollees.

    8. California – Sacramento, Moreno Valley, Costa Mesa, Irvine, Rocklin Florida – Orlando Hawaii – 4 islands of Oahu (Honolulu), Maui, Kauai, and Hawaii Illinois – Effingham Louisiana – Shreveport Nevada – Carson City New Hampshire – Hudson New York – Wappinger Falls

    9. I don’t think the last 2 column heading are the same font size as the rest, they look smaller.-BEI don’t think the last 2 column heading are the same font size as the rest, they look smaller.-BE

    11. Care management using pharmacist and other care managers, on-site or in community locations; additional option of telephone meetings Focus on collaboration and prevention Control of healthcare costs/improve individuals’ health Removal of care-access barriers Cutting-edge clinical documentation tools Superior, documented outcomes results

    12. Announcement letter sent to all eligible employees Kickoff employee information/enrollment meetings provided on-site Identification invitation of member eligible for the program Follow-up calls to eligible individuals, if warranted Individuals complete enrollment forms (on-line or paper) Contacted by care manager/coach to begin sessions Identification, Enrollment & Engagement

    13. Incentive options Care manager sessions at no charge to enrollees (Recommended) Reduced medication copayments (Recommended) Labs without copayments (Recommended) Premium reductions (Optional) Enrollee responsibility – must keep appointments or lose incentives

    14. Meetings with care manager every 1-3 months depending on patient need Medication review, education, goals setting, physician contact and recommendations; individual outcome is tracked Care management (on-site, in community locations, or by telephone) Healthcare activity integrated into DOCS to enhance collaborative care

    15. Primary member services, administrative, and technical staff in Rocklin CA Primary clinical support staff in Asheville NC First line of issue resolution is the care manager

    16. Local care managers recruited by AHC in conjunction with client to meet client needs Contacts with local pharmacy leaders to select the best care managers available Care managers trained on latest clinical guidelines Centralized monitoring and supervision of care managers through the DOCS

    17. Outcome goals determined by national medical care organizations (JNC, NCEP, NAEPP, ADA, etc.) Financial goals are net savings to the health plan Humanistic goal tracking through HRA

    18. Net decrease in total healthcare costs avg. >$2,000/pt/yr for diabetes group (ROI of 4:1) Diabetes: missed work hours decreased by 50% Net decrease in total healthcare costs of $725/pt/yr for asthma program (ROI of 4:1) Asthma: missed work decreased from 10.8 days/yr to 2.6 days/yr Avg. 18 fewer asthma ED/hospital events/100 patients/yr Cardiovascular event cost decreased from $1,344,953 to $496,625 (-63%) 50% reduction in heart attacks and strokes

    20. Secured and password-protected web-based communication portal acts as a medical documentation record – accessible anywhere Identifies members with deficiencies in their medical care Ensures a level of consistent care with all of the medical professionals Allows for real-time communication between all providers of care

    21. Designed in a user-friendly format Patent-pending simplicity (manila file folder with fasteners—familiar patient chart look) Point-and-click platform Medical chart layout Easy delineated tabs Internet-based

    27. The Hickory Project

    28. The Hickory Project

    29. The Hickory Project

    30. The Hickory Project (Goal = A1c of 7 or less)

    31. The Hickory Project

    32. The Hickory Project

    33. The Hickory Project

    34. The Hickory Project

    35. The Hickory Project

    36. Comprehensive health management programs using evidence-based clinical care produce verifiable and significant results. Data should drive decisions and judgments for success. Integrate your medical, Rx, lab, HRA, and encounter data and use technology (DOCS) to improve clinical outcomes. No need to reinvent the wheel—follow a model that works.

    37. Recruit, train, and administer care manager network DOCS – enhancement of collaborative care Predictive modeling to identify at-risk members Comprehensive outcomes reporting

    38. Assist in program promotion to plan members Assist in identifying at-risk individuals Provide program incentives Assist in care manager network identification Consider expanding disease management program to other disease states based on results

    39. Dan Garrett, RPh, MS Vice President Health Care Programs dangarrett@americanhealthcare.com Contact Us

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