Continuous, personalized support from a dedicated health advocate

Our health advocates help individuals manage many aspects of their personal health. This includes adherence to medications, understanding and managing risk factors, maintaining up-to-date screenings, participating in monitoring tests, treatment decision support, pre- and post-hospitalization outreach, lifestyle management coaching, and more.

Active one-to-one coaching and online coaching

We consider the severity of a person's condition and their willingness to change, and then work with the individual to create a plan that helps them reach their health goals. Our health coaching provides programs, tools and incentive opportunities so each customer can choose a path that is right for them.

Patient-provider relationship support

We educate patients about their health, support them in their relationship with their providers, and help them follow their health care provider treatment plans. We empower individuals to become active participants in their own health care by preparing them to have meaningful, educated interactions with their treating providers and other members of their health care team. In addition, your patient's may provide you with additional clinical information from their Personal Health Record (PHR). Patients have the option of sharing information found in the PHR electronically or in print.

Conditions we focus on

• Asthma (two years of age and older)
• Coronary artery disease (CAD)—angina, acute myocardial infarction, heart disease (18 years of age and older)
• Chronic obstructive pulmonary disease (COPD)—emphysema, chronic bronchitis (18 years of age and older)
• Depression—anxiety, bi-polar disorder (18 years of age and older)
• Diabetes mellitus Type 1 & Type 2 (two years of age and older)
• Heart failure (18 years of age and older)
• Low back pain (18 years of age and older)
• Metabolic syndrome (weight complications) (18 years of age and older)
• Osteoarthritis (18 years of age and older)
• Peripheral arterial disease (PAD) (18 years of age and older)

Participants enrollment and available programs

Our customer-centric predictive model takes each person's health data such as claims, laboratory data, health assessment results, and biometrics along with their communication preferences to align each person with appropriate tools and coaching options - online self-guided or coach-supported.

Coach-supported patients: Telephonic or face to face coaching sessions with a health coach based on their chronic condition risk.

Online Self-guided patients: Online coaching, supported by WebMD, offers online interactive modules to support positive behavior change and allow for a personalized experience.

Customers who have been directed to online programs can opt for live coaching support at any time.

Once a participant is identified for prioritization and segmentation, they are reprioritized for outreach every 90 days if no activity or engagement has been seen.

Participant notification and outreach

Once a customer is identified, they receive information from us on the benefits of the program and they may be invited to use a personalized online program or to connect with a coach by phone or in person.

Various methods of outreach occur to individuals and their family members who have been identified for participation in our health coaching programs. These may include automated personalized calls, letters, emails, or text messages. In addition, based on their preferences, we may use email and text messaging to remind individuals of the health actions they can and should take.

No administrative work for you

There is no administrative work for you or your office staff; our program is virtually work-free. However, we want you to have access to all the tools used to support your patients who participate in our program. These resources are outlined in the Practice Guidelines and Clinical Coaching Tools and Guidelines sections. Additionally, we will contact you if a potential opportunity for care or treatment barrier is identified.

We're always glad to accept your patient referrals for coaching and will address any issues or concerns you have. You can contact us by calling 855.246.1873 or by using the number on the patient's ID card.

Communications and Support

We use a variety of mechanisms to communicate with providers about our Chronic Condition Management Program.

To keep you informed, we provide you with clinical resources and program information in a variety of ways, such as the Reference Guide, Network News newsletter, the secure provider portal, our websites, and communications from our coaches, through letters, email, or secure fax. In addition, we will send notification to individuals and their provider when a potential identified opportunity for care is identified by the health coach and our gaps in care process.

Reference Guide

The Reference Guide (for contracted providers) contains the Administrative Guidelines, program requirements, policies, rules, and procedures pertaining to insured or administered plans. The guide is provided upon initial contract with the Plan and at least annually thereafter. The Reference Guide provides an overview of our Chronic Condition Management program and also provides the link to our Health Care Professionals website for additional program details.

The applicable web site address is provided to you through different modes of communication such as our introduction letter and Reference Guide, coach notification letter, gaps in care letters, or speaking with a coach. Our website contains:

• Sources of clinical guidelines (evidence-based decision support information)

• Detailed program information on our services and how we work with patients

• Samples of letters, text messages and emails

• Samples of customer educational material

• Practitioners' Rights Statement

• Opportunity for care outreach, including timelines

• Information about coaching staff, hours of operation, and how to report issues/concerns

The website content is reviewed annually and updated as needed, updates occur more often if significant changes are made to the program.

Letters

As a component of the program, providers with a patient who initiated coaching or who is identified with a potential gap in care may receive either or both of the letters described below along with directions on how to access resources/information about the program and the website address.

Here are several processes that will trigger outreach:

Preventative Gap Letters (Opportunities for care) provide notification of potential gaps to you and your patient within 5-15 business days from the identified evidence-based gap (identified from a variety of sources such as medical, behavioral, pharmacy and lab claims data). Patient identification is done monthly. We identify potential gaps, omissions, and errors in care, and we communicate these possible gaps to providers and participants in writing.

Coaching Notification Letters: Within 45 days of the initial coaching session with your patient, we will send you a coaching notification letter so you are aware that we are working with your patient along with directions on how to access resources/information about the program and the website address to the healthcare professional's website.

Telephone/Fax Communication

• Depression/Anxiety Screening: Coaches provide telephonic or fax outreach to providers on PHQ9 depression or GAD7 screening that score 15 or greater. Screening for depression and anxiety is a routine component of our chronic condition management program. The notification is completed by phone or fax within three to five business days or within one business day, if urgent
• Safety & Urgent Care: A medical or behavioral clinician triages all potentially urgent situations and telephonic communication will be done by our coach with in one business day, if our assessment determines a safety or urgent situation.
• Treatment Barriers Occasionally, barriers prevent customers from achieving their goals or communicating concerns to their provider. Provider notification occurs when identified barriers to treatment and abnormal biometrics are present. The coach may outreach to the provider one to three business days from their last contact with the patient, by telephone or secure fax, providing medical/behavioral information.

Quarterly newsletters are provided to keep you up-to-date on policy and procedure changes, program information, and much more.

We involve actively practicing practitioners in the development of clinical practice guidelines and decision-support content. Additionally, we seek your feedback through our annual physician satisfaction survey, through occasional focus groups, and when we become aware of your concerns or issues.

We're always glad to accept your patient referrals. You can refer a patient to us by calling 855.246.1873 or by using the number on the patient's ID card. We are committed to supporting your interactions with patients in making decisions about their health care.