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Virginia Bankers Association. October 2008. Agenda. Introductions Overview of 360° Health Programs 24/7 NurseLine Future Moms ConditionCare Promotional Materials for VBA Wrap Up/Open Discussion. What is Anthem 360º Health?.

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Presentation Transcript
  • Introductions
  • Overview of 360° Health Programs
    • 24/7 NurseLine
    • Future Moms
    • ConditionCare
  • Promotional Materials for VBA
  • Wrap Up/Open Discussion
what is anthem 360 health
What is Anthem 360º Health?
  • Anthem 360º Health®is our approach to surrounding members with the tools, resources, guidance and support to help them make the right health decisions for themselves and their families.
24 7 nurseline program
24/7 NurseLine Program
  • 24/7 NurseLine provides members
  • toll-free access to trained
  • registered nurses any time of the
  • day or night.
  • Program goals:
  • Provide convenient, expert resource
  • Promote appropriate use of health

care resources

24 7 nurseline overview
24/7 NurseLine Overview
  • 24/7 NurseLine
    • Our information hotline provides access to a registered nurse over the phone 24/7, anytime, anywhere for assistance or just to hear a reassuring voice.
      • Helps members assess symptoms
      • Increases understanding of medical condition or prescribed course of treatment
      • RN’s have access to HRS; seamless care to members for all Care Management Programs

Members are directed to appropriate care settings, resulting in fewer emergency room visits and reduced costs.

24 7 nurseline resources
24/7 NurseLine Resources
  • Healthwise Knowledgebase - over 4,900 topics covering symptoms, medical tests, drugs, wellness and general health conditions
    • Robust and consumer focused
    • Covers common and uncommon conditions
    • Strong wellness and prevention content
    • Prepares callers for physician encounters
  • Audio library
    • Over 400 topics – English and Spanish
  • Utilize National Organizations for assistance for members:
    • American Self-Help Clearinghouse
    • Multum Information Services (drug reference)
    • Cancer Net (National Cancer Institute)
    • National Organization for Rare Disorders, Inc (NORD)
future moms program
Future Moms Program

Future Moms provides individualized support to expectant moms to achieve healthier pregnancies and deliveries.

Program goals:

  • Fewer pre-term births
  • Fewer low-birth-weight deliveries
  • Reduced pregnancy-related costs
future moms overview
Future Moms Overview
  • Future Moms
    • Helps expectant women establish a healthy lifestyle for a healthy pregnancy.
      • Follows progress from the first trimester through delivery
      • Offers early risk assessment and high risk management
      • Obstetrical nursing support for both high-risk and non-high-risk expectant mothers
      • Post-delivery follow-up, including postpartum depression assessment, education and referral.

VBA offers $100 WalMart gift card to expectant mothers that enroll in the Future Moms program in the first trimester.


Registration via:

800#, MD Referral, Health Plan Referral, Claims Data

Assessment by RNs via Phone

Assessment Results Shared with MD

High Intensity

Low Intensity

Prenatal Kit Mailed

  • 28 Week Educational Mailing
  • Birth Kit delivery
  • Postpartum Assessment
  • Satisfaction Survey
  • NICU Referral as needed

Future Moms Program Flow

  • Prenatal education
  • Telephonic assessment
  • Reassessment at 28 weeks to reevaluate risks
  • 24/7 RN Access
  • Proactive nurse counseling calls for patient mgt
    • Monitor compliance with physician visits and plan of treatment
    • Develop and manage intervention plan
    • Coordinate benefits as needed
    • Provide 24/7 RN Access
conditioncare program
ConditionCare Program
  • Our care management programs surround members with the help they need to live healthier lives.
  • ConditionCare helps members better manage the following prevalent, high-cost conditions:
    • Asthma
    • Diabetes
    • Chronic Obstructive Pulmonary Disease
    • Coronary Artery Disease
    • Heart Failure
    • Low Back Pain
    • Vascular at Risk
    • Musculoskeletal
conditioncare program overview
ConditionCare Program Overview
  • ConditionCare
  • Our programs provide personalized support tailored to the needs of each member to improve their health while reducing medical costs.
      • Multi-specialty team approach that includes registered dieticians, CSWs, pharmacists, and exercise physiologists
      • Dedicated care managers provide a wide variety of educational tools to help members manage their health.

Programs Include:

Asthma, adult and pediatric

Diabetes, adult and pediatric

Chronic Obstructive Pulmonary Disease

Heart Failure

Coronary Artery Disease

Low Back Pain


Vascular-At-Risk (Hypertension, Hyperlipidemia, Obesity, Metabolic Syndrome)

conditioncare identification process
ConditionCare – Identification Process

Screen Data from Medical/Pharmacy/Lab/HRA

Diagnosis Codes (ICD-9)

Procedure Codes (CPT)

Drug Codes (NDC)

Lab Data


  • Identified:
  • Asthma (Pediatric and Adult)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Coronary Artery Disease (CAD)
  • Diabetes (Pediatric and Adult; Types 1 and 2)
  • Heart Failure (HF)
  • Enhanced conditions (low back pain, musculoskeletal, and vascular at risk)


Members can always self refer into the program, as well as accept referrals from Anthem Case Management, UM, and MD

conditioncare intervention approach
ConditionCare – Intervention Approach

Targeted intervention focused on condition

stabilization / Intensive intervention for health &

cost optimization

High Risk

  • Dietary Counseling
  • Access to a nurse 24x7
  • Quarterly educational


  • Monthly re-stratifications
  • Primary Nurse Manager
  • Holistic assessment
  • Comprehensive care plan
  • Depression screening
  • Pharmacy counseling

Moderate Risk

Therapeutic Alerts

(Clinical & Pharmacy)

Moderate risk participants are managed on average

for 6 months, high risk participants for approx. 12-18 months.

Education, support & self-management tools

Low Risk

  • Access to a nurse 24x7
  • Quarterly educational newsletters
  • Monthly re-stratifications
promotional avenues for vba
Promotional Avenues for VBA

Customized flyers have been developed for VBA to promote the various Anthem 360 Health programs.