Healthy Back Management Program - · PDF file-Warm transfer or set appointment with ... (Up to 6 Weeks) Sub-Acute (6 to 12 Weeks) ... manager schedules time with Bob via messaging,

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Healthy Back Management Program

Healthy Back Program

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The High Cost of Low Back Pain

• People suffering from back pain consumer $90 billion annually inhealth care expenses*

• Approximately $26 billion of that amount is directly attributable to treating back pain, 2.5% of the national health care bill*

• Low back pain is one of the top 3 cost drivers in health care*

• PMPM costs hover around $10.00 for spine conditions, and is growing at 8-10% per year**

* Source: Duke University Study, published in Spine, January 2005.

** Source – UnitedHealthcare Patient by Condition Report 2005, AHRQ Category 205 (Spondylosis, intervertebral disc disorders, and other back problems)

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The High Impact of Low Back Pain

• More than 70 % of adults will experience low back pain at some point in their lives*

• The World Health Organization declared low back pain an official epidemic in 2001*

• "There are a lot of employers and plans struggling with huge outlays on low back pain, and the condition also is a major driver of lost productivity.”**

* The Battle over Your Aching Back, FORTUNE, September 4, 1006, 101-108.

** Greg Pawlson, M.D., NCQA EVP, quoted in Inside Disease Management, March 17, 2006

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The Opportunity To Make A Difference

• Targets low back pain, the largest musculoskeletal health care cost category

• Leverages the unique assets available across UnitedHealth Group and delivers an effective solution for managing back care costs and driving quality outcomes

• Delivers substantial savings by improving self-care and care-seeking patterns for individuals with recurring and chronic back conditions

• Is a single source for employees to obtain back-related information, support, and guidance in navigating the health care system while improving access to superior care and reducing out-of-pocket expenses

The cost and productivity impact of low back pain is significantto employers and prevention and intervention is key to reducing costs and keeping employees healthy and at work. The Healthy Back Program:

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• Premature and unnecessary visits to surgical specialists (e.g., orthopedists, neurologists)

• Overuse of high-cost pain interventions, treatments or therapies (e.g., injection therapy)

• Overuse of high-cost radiology and imaging

• Inappropriate use of high-cost surgery (with variable outcomes and high re-occurrence rates)

High-risk patients with sub-acute and chronic back conditions are not sufficiently coached or educated on treatment options resulting in:

Major Disconnects in Low Back Care

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Psychosocial

• Depression

• Anxiety

• Mental Stress

• Job Dissatisfaction

Psychosocial issue and Lifestyle risk factors are highly prevalent among individuals with chronic or persistent low back pain

Major Disconnects in Low Back Routine Care

Lifestyle Risk Factors

• Weight

• Heavy Physical Work

• Prolonged Static Posture

• Smoking

Addressing the needs of the whole person

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Range of Physician Practice Patterns % of patients with a Lumbar Laminectomy or Fusion

less than 30 Days from onset of illness1/1/2002-12/31/2003

21%25%

16%

29% 27%

13%

0%

10%

20%

30%

40%

50%

60%

70%

80%

DALLAS HOUSTON ATLANTA NEW YORKCITY

BOSTON LONG ISLAND% o

f Pat

ient

s w

ith a

Sur

gica

l Pro

cedu

re w

ithin

30

days

of o

nset

of

illn

ess

Market Mean

Variance in practice patterns resulting in varying treatment and outcomes

Diagram is intended to be illustrative in nature. Diagram source is UnitedHealth Network data analysis of spinal surgeries.

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Variance in practice patterns resulting in varying treatment and outcomes

Diagram is intended to be illustrative in nature. Diagram source is UnitedHealth Network data analysis of spinal surgeries.

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Healthy Back Management Program: The Solution

The Healthy Back Management Program is uniquely positionedto help deliver savings and improved outcomes:

• Educating individuals to support evidence-based care decisions

• Addressing psychosocial and lifestyle barriers to enhance self-care and self-management

• Encouraging use of high quality and efficient providers to improve outcomes

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What Makes This Program Different?

• Groundbreaking Approach to Low Back Care Management –Blend of intensive oversight using technology and human interaction to effectively support individuals with back pain

• A targeted Low Back Pain Predictive Model and Early Identification Approach – to find the right people

• A targeted Enrollment Call by non-clinical enrollment specialists, to encourage participation

• Full integration with the UnitedHealth Premium program, to refer to high quality and efficient providers

• Referral and integration with Treatment Decision Support* programs to ensure appropriate treatment decisions and promotesurgical avoidance

• Timely referrals to Case Management and Behavioral Health to ensure support for co-morbidity and psychosocial management

* This referral is available to customers who purchase Personal Health Support inclusive of Treatment Decision Support.

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- Predictive Model- Referrals from other programs- NurseLine / Connect24- Existing and New Provider Notifications(Radiology, Injection Therapy)

- Health Risk Assessment- Self-Referral

- Predictive Model- Referrals from other programs- NurseLine / Connect24- Existing and New Provider Notifications(Radiology, Injection Therapy)

- Health Risk Assessment- Self-Referral

Finding the Right People

Identification

High-Risk Population Identification

Healthy Back ManagementHealthy Back Management

Enrollment Call

Non-Clinical Enrollment Specialist

Enrollment Call


Welcome Call and Assessment

(Clinician)

High Risk Population

Identification


Identification

High Intensity Outreach

Medium Intensity Outreach

Low Intensity Outreach

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Getting the Right People the Right Care

- Enrollment Specialists are Non-Clinical Marketing Experts

- Enrollment call focuses on the benefits of the Healthy Back Program and encourages participation

- Warm transfer or set appointment with Healthy Back Clinician

- Enrollment Specialists are Non-Clinical Marketing Experts

- Enrollment call focuses on the benefits of the Healthy Back Program and encourages participation

- Warm transfer or set appointment with Healthy Back Clinician

Enrollment Call

Consumer Engagement


Enrollment Call


Enrollment Call



(Clinician)


Identification


Identification




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Delivering Value

Empowered Individuals - Improved Outcomes

-Welcome Call and Nurse Assessment-Focus on

-Evidence-based treatment modalities -Assistance with addressing psychosocial and lifestyle barriers -The right services for treatment

-Pre- and Post-Outcome Measurement

-Welcome Call and Nurse Assessment-Focus on

-Evidence-based treatment modalities -Assistance with addressing psychosocial and lifestyle barriers -The right services for treatment

-Pre- and Post-Outcome Measurement

Healthy Back Management


Enrollment Call


Enrollment Call



(Clinician)


Identification


Identification




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High Intensity

Moderate Intensity

Low Intensity

Outreach• Addresses lifestyle adjustments and co-morbid challenges

• Clinician-determined intervention intensity is based on an individual’s readiness to change, identified barriers, and an individual’s commitment and progress towards goals

• Expected engagement is 6-12 weeks

Outreach• Addresses individual management of health

• Clinician-determined intervention intensity is based on readiness to change and progress with the Healthy Back Management Program

• Expected engagement is 4-6 weeks

Outreach• Addresses patient education • Low Intensity Interventions based on individual’s gaps in

learning about back pain management• Expected engagement is 2-4 weeksTools• Online Health Coach module / messaging• Exception-based telephonic outreach

Low Back Clinical Engagement Model

Welcome Call and

Assessment(Nurse)

Welcome Call and

Assessment(Nurse)

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Online Health Coach Module

Web-based behavior modification program• 5-level program that parallels the stages of change (Prochaska model)

• Content dynamically customizes to individual users

• Uses a “Learn, then Do” approach to successfully address adult learning

• Incentive for completing program• Established model currently delivering results for numerous conditions (e.g., Weight Loss, Exercise, Stress, Heart Disease, Diabetes, Asthma)

Built-in messaging ensures regular communications between individuals and clinical team

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Appendix

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Who are the Right People for this Program?

Acute (Up to 6 Weeks)

Sub-Acute (6 to 12 Weeks)

Chronic(More than 12

Weeks)

$$ per Member

Target population for Healthy Back

Target population for Healthy Back

80% of episodes

15% of episodes

5% of episodes

Cost Categories

Surgery

Radiology

Physician Visits

Absenteeism

Rx & Injection Therapy

The Right People are those individuals whose back pain becomes arecurring, or long term issue, impacting life / cost.

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Patient Experience #1 – Bob

The Healthy Back Management Program provides individuals with interactive tools and direct support to help care for their back

Bob experiences Low Back

Pain

Bob goes to primary care physician for

treatment

Primary Care Physician sends Bob home with

Acute Back Pain treatment plan

Bob receives call from Healthy Back

enrollment specialist, who explains the program and the

online components

Bob enrolls in online health coach

module of Healthy Back

Bob sends message to Healthy Back Care Manager via online

messaging requesting help with a back

exercise

Healthy Back care manager schedules time with Bob via messaging, calls Bob and discusses

exercise

Bob calls Nurseline

because his back pain seems

to be getting worse

Nurseline Nurse informs Bob that he will be receiving a call from a Healthy Back team member

Bob stretches and exercises his back as demonstrated

online

Bob completes online program and receives

gift card

Bob’s back pain has gone away. He

continues to stretch regularly

Nurseline referral triggers Healthy Back

Management Program

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Patient Experience #2 – Sarah

The Healthy Back Management Program helps individuals address lifestyle barriers that are preventing them from managing their own back pain

Sarah began to develop low

back pain in the last year. She

believes it stems from sitting most

of the day on the phone while working at her

new travel agency job.

Sarah’s back pain became

worse recently and she had to take 2 days

off work.

Sarah goes to a primary care

physician who tells her to stay active and take

over-the-counter pain killers.

Sarah is unhappy with this

recommendation.

Sarah receives a call from a Healthy Back enrollment specialist

who explains the program to Sarah. Sarah agrees to

participate, but doesn’t seem very excited.

Sarah receives a call from a

Healthy Back Nurse. During the

call, Sarah extensively

discusses all of the problems she is having at work

and in her personal life.

The Healthy Back Nurse talks to Sarah

again in one week and refers her to the

behavioral provider to identify some

therapists for Sarah to contact. The Healthy

Back Nurse tells Sarah that she will follow up.

Sarah returns to this

physician after a week and

requests stronger pain killers for her

back pain.

The doctor prescribes for

Sarah a series of prescription muscle

relaxants to take over a 3 week

period.

The Healthy Back Nurse suggests

to Sarah that she may want to

consider talking to a therapist or other behavioral health provider.

The Healthy Back Nurse contacts

Sarah and learns that Sarah is seeing

a therapist and is being treated for

depression.

One month later, The Healthy Back Nurse

contacts Sarah again. Sarah indicates that she is

feeling much better and that her back pain has

gone mostly away.

The Healthy Back Nurse recommends

some ergonomic adjustments and

stretching that Sarah can do at her job so she can manage her back pain if it flares

up again.

Predictive Model triggers notification to Healthy

Back Management Program

The Healthy Back nurse sends Sarah a

tip sheet for managing her back

pain.

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Patient Experience #3 – John

The Healthy Back Management Program provides individuals with information around the value of a Premium physician, and support for treatment decisions

John has had Low Back Painproblems for

over 10 years. His pain has

gotten worse in the last 3 months.

John goes to his

Chiropractor for an

adjustment: no relief.

John gets the name of an orthopedic

surgeon from a friend and goes

to see him.

The Healthy Back specialist discusses Premium Program

physicians and helps direct John based on quality

outcomes.

John receives a call from a

Healthy Back Nurse who works with John to set

goals and provideresources focused on improvement.

John’s pain remains and he now considers a surgical option.

The Orthopedic Surgeon orders

a Back MRI

One week later, John receives a

call from a Healthy Back enrollment

specialist.

John begins to follow the Healthy

Back plan.

On his next phone call with the Healthy Back Nurse, John

discusses his thoughts about a

surgical intervention.

John receives a call from a Treatment Decision

Support specialist, who provides evidence-based

literature on surgical methodologies, outcomes,

cost, and potential complications.

John decides against surgery, and continues to manage his pain on his own

following his Healthy Back care plan.

Provider Notification for MRI triggers Healthy Back Management

Program

The Healthy Back Nurse electronically transfers case to a Treatment Decision Support specialist.

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Integration Model

Provider Notifications

Back ManagementRN facilitated, one-on-one outreachPLUS web-based education and communications tool (for individuals with Online Access)

Enrollment Call(Non-Clinical

Enrollment Specialist)

Yes

No

Considering Surgery

UBH

ACN Clinical Support Program

Health Risk Assessment

Case Management

Disease Management

High-Risk Candidate for

Healthy Back?

Yes

Yes, and have TDS

Considering Surgery?

Wellness / Coaching for

Low RiskNo

Goals & Objectives Completed

No

Disability (Connection to

Unimerica)

Post TDS Referral

Behavioral Health Provider

Integration Points

Healthy Back Management Program


(Clinician)

Yes, and don’t have TDS

NurseLine / Connect 24

Case Management

(including ICA)Considering

Surgery?

Low Back Predictive Model

Treatment Decision Support

Integration in Development

Documents

Healthy Back Management Program - · PDF file-Warm transfer or set appointment with ... (Up to 6 Weeks) Sub-Acute (6 to 12 Weeks) ... manager schedules time with Bob via messaging,