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Risk Identification Disease Management


Powered by Mayo Clinic. Understand your Risks. Make Behavior Changes. Manage Current Conditions ... Mayo Clinic Health Assessment. 11 Risk Factors. Alcohol use ... – PowerPoint PPT presentation

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Title: Risk Identification Disease Management

Risk Identification - Disease Management

Its All About Health… Better Health
  • For Your Members
  • For Your Benefit Plan
  • For Your Bottom Line

Your Partnership with MCM Provides an Integrated
Solution to Achieving Better Health

MCM - Background for Maximizing Performance
  • Care Management Pioneer - Founded in 1986
  • Serving 500 Plans with over 450,000 Lives
  • Management Team Averaging 20 Years of Industry

  • Independent Physician Directed
  • URAC Accredited UM CM
  • Licensed in All States
  • Board Certified Medical Director
  • Board Certified Onsite Associate Medical
  • Board Certified Physician Advisors
  • Registered Nurse Care Managers
  • Integrated Quality Improvement Program


Are You Managing What Matters?
  • Key Factors Driving Costs
  • Health Plans Focus on Illness
  • Versus Risk Identification,
  • Prevention and Wellness
  • Chronic Disease Epidemic
  • Lack of Appropriate Care


Illness Versus Prevention - Options
  • Wait for a Sentinel Event to Take
  • Place…
  • Hospitalization
  • Surgery
  • Emergency Room Visit
  • Life Threatening Illness
  • Then Manage the Care as Best as Possible
  • OR
  • Identify Member Health Risks
  • Identify Gaps in Care
  • Provide Members…
  • Education on Appropriate Care
  • RN Health Coach to Promote Better
  • Management and Positive Lifestyle
  • Changes


Chronic Disease Facts
  • Affects 1 in 10 People Nationwide
  • MCM Data Shows a 24 Prevalence of
  • Asthma
  • Diabetes
  • Coronary Heart Disease
  • Chronic Obstructive Pulmonary Disease
  • Chronic Disease Accounts for 70 of Health
  • Dollars
  • 50 of People with Chronic Disease are Not
  • Receiving the Care Required to Stay Healthy


MCM Solutions for Better Health
Integrate Risk Identification and Maximize
Performance Results

MCMs fully integrated Optimal Health Solution
provides the tools to manage the health of all
members across the continuum of care

Stand Alone Health Risk Assessment Solution
Risk Identification
  • Web based access
  • Instant member feedback, risk identification
  • Customized educational links targeted to
  • identified risk
  • Fully integrated with Care and Disease
  • Management
  • Encourages movement to better habits
  • Group Report identifies preventable risk
  • and helps plans focus interventions and
  • educational programs


Onsite Biometric Testing
Risk Identification
  • Available for All Members and Participants
  • Simple Finger Stick
  • Testing for Key Risk Areas
  • Total Cholesterol
  • Triglycerides
  • Blood Sugar
  • Body Mass Index Height Weight
  • Blood Pressure
  • Onsite Test Result Distribution
  • and Comparison with Expected Values
  • Immediate Participant Engagement and
  • Education with MCMs Registered Nurse Health
  • Coaches


Identify Risk MEDai Predictive Modeling Solution
  • Incorporates Medical and Pharmacy Claim Data
  • Initial Analysis of 2 Years of Data
  • Monthly Data Updates
  • Identifies Individuals…
  • With a Chronic Disease
  • With Gaps in Chronic Care Guidelines
  • Actual and Forecasted Health Risk
  • Actual and Forecasted Health Costs
  • Web Based Reports
  • Summary of Health Plans Risk and Costs

Risk Identification


Optimal Health Disease Management
  • Management of Disease Entities with
  • Highest Potential for Impact
  • Diabetes
  • Asthma
  • COPD
  • Coronary Heart Disease
  • CHF
  • High Cholesterol
  • High Blood Pressure
  • Stroke and Cerebral Vascular Disease
  • State of the Art Predictive Modeling
  • Integration with Screening Data,
  • UM, CM and HRAs
  • Focused on Compliance with National Care
  • Standards and Lifestyle Issues


Optimal Health Disease Management
  • Program Announcement
  • Incentives Maximize Program Participation.
  • Positive Incentives Work Best!
  • Its a New Benefit!!. Announce the Program to
  • All Covered Members via Meetings or Flyers
  • Custom Announcement Letters, Flyers and
  • Welcome to Optimal Health brochures provided
  • for each plan.
  • Buy-in from Management Combined with Effective
  • Announcement Produces Self-Referral!
  • Continue Optimal Health Member Awareness
  • with Newsletters, Posters and Benefit Fairs


Optimal Health Disease Management
  • Identification of Chronic Disease
  • MCM Identifies Members with Chronic Disease
  • Through Predictive Modeling, HRAs, Health
  • Screenings, Case Management and UM.
  • Health Screening Data can Increase Chronic
  • Disease Identification up to 20
  • The Identification and Assessment Process is
  • Conducted by MCM each Month Using New Data
  • Risk Navigator Predictive Modeling Data Analysis
  • Helps Identifies Individuals with Gaps in
  • MCM Registered Nurses s Conduct All Member
  • Identification Assessments


Optimal Health Disease Management
  • Member Engagement After Identification
  • ALL MEMBERS Identified with a Chronic Disease
  • are Included in the Engagement Process
  • The Engagement Process Takes 30-40 Days. It
  • Includes 3 Letters and 3 Phone Calls. Phone
  • Numbers are Crucial for Success
  • Engagement Starts with an Introduction Letter
  • Distributed to All Members with Chronic
  • Followed by a Phone Call in About 7 days
  • Two Additional Mailings and Follow-Up Phone
  • are Conducted for Identified Members.
  • The First Mailing Includes Educational Material
  • Keyed to the Members Risk as well as the
  • Standards of Care for their Chronic Disease


Optimal Health Disease Management
Health Coaching - Management Track
  • RN Health Coach Assigned to Each Member
  • Custom Compliance Plan Developed for Member and
  • their Physician
  • Calculate and Track Compliance Scores Based on
  • Standards of Care for Disease Category
  • Customized Education Material Keyed to Each
  • Specific Needs
  • Goal Setting for Positive Lifestyle Changes
  • Diet, Nutrition, Smoking and Exercise
  • Health Coach Follow-up Before and After Each
  • Health Care Encounter


Optimal Health Disease Management
Educational - Management Track
  • Educational Material Keyed to Member Risk and
  • Compliance Level
  • Promote use of Existing Member Assistance or
  • Wellness Resource
  • Web-based Educational Links
  • RN Care Managers Offered to Members
  • Quarterly Contact with All Members


Optimal Health Disease Management
Measuring Disease Management Plan Impacts
  • Disease Management is a Marathon Not a
  • Sprint. It Does Not Include Quick Fixes and
  • Requires a Long Term Commitment from the Plan.
  • Compliance and Dollar Impact in 18 24 Months
  • Optimal Health Quarterly Reports
  • Member Status Report
  • Disease Management Activity by
  • Disease State
  • Member Status No PHI
  • MEDai Risk Navigator Employer Profile
  • Includes Data on Risk, Utilization, Care
    Compliance and Diagnoses Driving Costs.


Better Health and Wellness Solutions
  • HealthInfoLine
  • 24/7 Nurse Assistance
  • MCM Better Health Portal
  • Web Based
  • Personal Health Portal
  • Powered by Mayo Clinic
  • Understand your Risks
  • Make Behavior Changes
  • Manage Current Conditions
  • Reliable Health Information


HealthInfoLine - 24 x 7 Nurse Line
  • Health and Wellness Solutions
  • Did you know that…
  • 55 of Emergency Room visits are Not Necessary
  • Education and Treatment Alternatives Could
  • Replace 25 of Doctor and Clinic Visits
  • One Simple Call can Provide Plan Members..
  • Advice from Registered Nurses in Making
  • Healthcare Decisions
  • Education and Treatment Alternatives
  • Information on Hundreds of Health and
  • WellnessTopics


  • Comprehensive personal health management portal
  • Highly personalized for each user
  • Medically reviewed, hosted and updated by Mayo


Mayo Clinic Health Assessment
  • Exclusive state-of-the-art Health Assessment
    designed to
  • Raise health awareness
  • Promote behavior change
  • Serve as a health measurement
  • tool for both individuals and
  • organizations


Mayo Clinic Health Assessment 11 Risk Factors
  • Alcohol use
  • Blood pressure
  • Blood sugar
  • Cholesterol
  • Emotional health
  • Exercise
  • Nutrition
  • Safety
  • Tobacco
  • Triglycerides
  • Weight


Health Assessment Action Plan
  • Available immediately upon
  • completion of HRA
  • Risk level
  • Low (0-1)
  • Moderate (2-4)
  • High (5-7)
  • Very High (8)

  • Notes both Risks and Strengths
  • Links to tailored messaging,
  • MCM DM programs, plan resources
  • and tools
  • Results Assessed by MCM RNs


Health Assessment Drives Secure Messaging
  • Secure messaging triggered by Health Assessment
  • Action Plan Reminders
  • Alerts at two weeks, one month, and six
  • months after Health Assessment
  • prompting participant to return to the
  • application
  • Chronic Condition Alerts
  • Monthly messages for self-management of
  • hypertension and diabetes
  • Messages Appear in My Tools sidebar


Its Time! For Better Health
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