NC HealthSmart:Promoting Optimal Health and Wellness for SHP Members

NC Medical Society Quality SubcommitteeAugust 2009

Derek Prentice, MD, Consulting Medical DirectorAnne B. Rogers, RN, BSN, MPH, Director of IHM

What is NC HealthSmart?

North Carolina HealthSmart is a population health initiative that aims to: Empower healthy members to stay healthy; Help those with chronic disease or disease

risk factors to better manage their health; Offer integrated, cutting-edge resources and

programs to members at work, at home, and through their health care provider

Guiding Principles of NC HealthSmart Reinforce and strengthen the patient-provider

relationship

Empower individuals to play active role in management of their health and health care

Improve health of members and their families

Improve quality of care

Engage employers in health care issues

Increase member satisfaction

Stabilize Plan and member health care costs

NC HealthSmart Eligible Members

Members eligible for NC HealthSmart services are members whose primary health insurance is through the NC State Health Plan (all except Medicare Primary).

HealthSmart Components

24/7 Health Coaching– Health Dialog

Disease Management – Health Dialog

Personal Health Assessment/Web Tools – Health Dialog

Physician Support/Clinical Gap Identification – Health Dialog

HealthSmart Components Intensive Case Management/High Risk

Maternity/NICU – SHPS

ESKD/CKD Care Management – KidneyTel (formerly Renaissance HC)

Health Promotion and Education SHP Staff/All Vendors/DHHS

Worksite Wellness SHP/DHHS/Division of Public Health

CADCHF

COPDAsthma

DiabetesOther Coachable Conditions

~545,000 Eligible Members (Not Medicare or COBRA):

RENAISSANCE HEALTHCARE:

ESRDCM

~100 Members

[<15 eGFR]

NC HealthSmart ContinuumHEALTH DIALOG:

7/31/08

CKDCM

~200 Members[<45-15 eGFR]

HEALTH PROMOTION/ WELLNESS/WORKSITE

INITIATIVES

Tobacco ProjectDHHS (NC Weigh)

STARHighway to Health (DOT)

Worksite Wellness Technical AssistanceOSP Policy Implementation

BCBSNC:Utilization Management

Prior AuthorizationDischarge Planning

SHPS:Intensive Case Management

~5% of PopulationMultiple Inpatient/ER Visits,

Trauma, High Risk Pregnancy,

Neonatal Intensive Care, Catastrophic Diseases, etc.

NC HealthSmart Results

Program Participation

Clinical Impacts

Member Satisfaction

Provider Satisfaction

Participation

Over 45,000 members (~ 9%) currently served by Disease and Case Management programs

Representing ~25% of SHP expenditures

Focusing on members with “coachable conditions” and members with the most need

2:1 ROI – Chronic Disease Trends report

Clinical Impacts

Member adherence to clinical guidelines (meds, tests, exams) 92.4% asthma controller meds 82.1% CAD - lipid meds 77.0% diabetes - microalbuminuria tests 47.4% diabetes - eye exam

Smart Registry and Provider Support Services

Member Satisfaction

85% Satisfied with Health Coach

93% Likely to Recommend Program

Provider Satisfaction[N = 234; ~3,000 surveys mailed]

77% are aware of NC HealthSmart

88% found the Provider Services Specialists helpful

79% found the SmartRegistry helpful

74% have a positive opinion of NC SHP as a result of NC HealthSmart

Worksite Wellness/Health Promotion

Preventive Services Worksite Wellness Infrastructure “STAR” and “Highway to Health” Comprehensive Wellness Initiative

(SL 2009-16) Tobacco Cessation Supports Weigh Less program expansion Benefit changes

Opportunities

Disease and Case Management RFP

Discussions with various stakeholders NCMS CCNC/DMA NCAFP BCBSNC

Questions or Comments??