24/7 Nurseline and Future MomsPresenter: Amy Rising

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Agenda

Goal: Learn about 24/7 NurseLine and Future Moms including how to promote the programs in the workplace.

Frequently Asked Questions:24/7 NurseLine and Future Moms are included in your Anthem benefit offering at no additional cost. Promotional resources like posters, fliers, and promotional email templates are available at: http://group.anthem.com/360healthCA

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Comprehensive Wellness Benefits

– Fully Insured

Better Health = Financial Advantage

Care Management• 24/7 NurseLine• Future Moms• ComplexCare• ConditionCare• MyHealth AdvantageOnline Tools and Resources• MyHealth@Anthem

• MyHealth Assessment• MyHealth Record• Condition Centers• Online Community

• Specialoffers@Anthem• AudioHealth Library• Time Well Spent

Core Programs – Included in benefits • ConditionCare: Support

• ConditionCare: Kidney• MyHealth Coach• Worksite Wellness• EAP• Pharmacy Benefit Management• Staying Healthy Reminders• Healthy Lifestyles

*Speak to your Anthem account representative to determine pricing.

Also Available*

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24/7 NurseLine: Program Overview

Our 24/7 NurseLine provides access to a registered nurse over the phone 24/7, anytime, anywhere for assistance or just to hear a reassuring voice.

• Helps members understand their symptoms

• Increases understanding of medical condition or prescribed course of treatment

• Helps ensure members access the right care in the right setting

• Provides education for member self treatment in non-urgent conditions

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24/7 NurseLine: Goals

24/7 NurseLine seeks to:

• Promote self care via immediate access to health information and education

• Promote care and treatment by network providers• Provide immediate information on symptoms appropriately• Help lower health care costs by providing callers with

medical information to assist them in deciding which level of care to seek

• Provide seamless integration with our other care management programs

• Help increase participant satisfaction with their health care plan

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24/7 NurseLine: Key Features

The 24/7 NurseLine program features include:

• A skilled clinical team - RN license (BSN preferred)• Bilingual RNs, language line, and hearing impaired

services• Immediate physician support, as needed• Personal Health Counseling• Comprehensive Audio Health Library in English and

Spanish• Program promotional pieces available • Quality assurance

• Clinical record reviews• Satisfaction surveys

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24/7 NurseLine: Benefits

Both members and employers benefit from 24/7 NurseLine:

Members• Credible information that’s free, 24/7, 365 days a

year• Saves time• Proactive call backs• Health benefits integration

Employers • Cost Avoidance• Appropriate use of services• Employee satisfaction with health benefits

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24/7 NurseLine: Advantages & Differentiators

We started with NurseLine 20 years ago:

• Not affiliated with a hospital• Objective resource whom they can trust • Timely information independent from any particular institution

• All RNs • Nurse follow-up calls when a 911 call is placed. • Access to integrated system platform • Virtual environment – disaster resistant• Experienced staff – physician support• Medical Director is assigned to each call center• Extensive knowledgebase – more than 5,000 topics• 24/7 access incorporates AudioHealth Library’s extensive resources

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24/7 NurseLine: Advice & Information Program

Identifying the appropriate level of care

Acute/emergent procedures

HealthWise Knowledgebase• 125 complex medical problems• 135 symptom assessments• 500 health topics• 600 medical tests and procedures• 5,000 self-help support groups• 120 CancerNet topics• 5,000 drug treatments

24/7 NurseLine advice and information is based on:

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Poll #1

In 2009, the most frequent reason for calls to the nurse line was:

a. Cardiovascular reasonsb. Digestive issuesc. Pediatrics (Relating to child) d. Bone (Sprains/breaks/fractures)e. Dermatology (Rashes, etc)

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24/7 NurseLine: Call StatisticsIn 2009, the top five most frequent reasons for calls to the nurse line were:

• Pediatrics: 22%

• Digestive: 9%

• Bone: 9%

• Cardiovascular: 6%

• Dermatology: 5%

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24/7 NurseLine: 360° Health Integration24/7 NurseLine seamlessly integrates communication and coordination with other 360º Health programs via:

• Responding nurse may direct the caller to the primary physician

• ConditionCare primary nurse manager is automatically notified if a program participant calls 24/7 NurseLine and may initiate a follow-up phone call to the member

• Program and resource referrals for ongoing assistance

• Automatic tracking process

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24/7 NurseLine: StaffingExperienced nurses are trained to address common health care concerns such as medical information, education, access to health care, diet, social/family dynamics and mental health issues.

• 134 Registered Nurses; 20 Master’s prepared

• All calls are answered by a Registered Nurse

• Average nursing experience is over 19 years

• Wide variety of specialty areas

• Intensive, ongoing training

• Quality assurance – management oversight and review

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24/7 NurseLine: Member Outreach and Engagement

We see a higher participation rate with clients who incorporate more program promotion.

• On average, 2-4% of members will call the NurseLine in a given year• Spanish speaking nurses available• Network Services Language line available• Satisfaction Survey cover letter• Branded promotional materials available

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24/7 NurseLine Satisfaction Surveys

90

100

50

60

70

80

90% felt more positive about their health plan due to

the availability of Nurse

Advice Line

94% were comfortable

speaking to a nurse by phone

92% followed the nurses

recommendationFelt more positive about their health plan due to the availability of 24/7 NurseLine

Were comfortable speaking to a nurse by phone

Followed the nurses recommendation

**Based on 2007 responses for all business 21,411 Surveys

%

90%94%

92%

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24/7 NurseLine: Reporting Metrics24/7 NurseLine reports are provided quarterly and include the following data*:

Total number of contacts

Total contact reasons

Unique member contacts

Number of calls requiring clinical evaluation

Most frequent nurse recommendation

Contact category distribution: administrative, clinical evaluation, or other

Top 5 symptoms

Caller precall intent & nurse recommendation: call 911, seek emergency care, seek urgent care, unsure, call healthcare professional, seek healthcare professional, self care

*Availability varies based on size, please see Anthem representative for more details

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Future Moms: Program Overview

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

• Follows progress from the first trimester through delivery

• Offers early-risk assessment along with both standard support 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 to BH & ESP

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Poll #2

On average, employers pay how much more for preterm babies?

a. 3 times moreb. 10 times morec. 15 times mored. 25 times more

Sources: Estimates come from Thomson Reuters research findings as contracted by March of Dimes; and Preterm Birth: Causes, Consequences, and Prevention, a report published by the Institute of Medicine (2006): http://www.marchofdimes.com/prematurity/21198_15349.asp

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The Case for Future Moms

•Average cost of a preterm baby in the U.S. = $64,713 •Average first-year medical costs:

• $49,033 = preterm infants• $4,551 = full-term births• Direct healthcare costs to employers:

• $41,610 for every premature baby• $2,830 for every full-term baby

• Employers pay 15 times more for preterm babies• Productivity/synergy loss= $2,766

High-risk pregnancies, premature births and infant mortality can have a significant impact on health care costs:

Sources: Estimates come from Thomson Reuters research findings as contracted by March of Dimes; and Preterm Birth: Causes, Consequences, and Prevention, a report published by the Institute of Medicine (2006): http://www.marchofdimes.com/prematurity/21198_15349.asp

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Future Moms: Goals

Future Moms, is designed to help expectant mothers focus on early prenatal interventions, risk assessments, and education in order to help:

Promote healthy pregnancies and healthy babies

Recognize signs and symptoms of complications related to pregnancies

Reduce low birth-weight births

Reduce pregnancy-related medical costs

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Future Moms: Key FeaturesA key component of Future Moms is a comprehensive, systematic and personalized management approach for the participants.

Key features include:•A thorough assessment and risk stratification for each participant

•An assigned primary registered nurse with OB experience

•24/7 toll free telephonic access to registered nurses

•Education on pregnancy care and topics

•Lifestyle management and behavioral change counseling

•Pharmacy and nutritional counseling

•Coordination of services and referrals

•Screening for pre-delivery and postpartum depression

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Future Moms: BenefitsBoth, members and employers, benefit greatly from the Future Moms program as the program helps to:

Members• Promote healthier behaviors• Improve birth outcomes• Provide proactive intervention and support• Educational materials- on proper self-care and pregnancy management goals • Increase understanding and control of health risks/conditions• Increase understanding of appropriate health care utilization• Reduce preventable conditions & related medical costs

Employers• Improve employee productivity • Reduce absenteeism• Increase employee satisfaction

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Future Moms: Advantages and Differentiators

Other key differentiators include:•First maternity management program

•NCQA full accreditation

•Experienced nurses in obstetrics and/or perinatology

•Lactation consultants and nurses certified in smoking cessation

•24/7 access to our nurses

•Personalized approach

•Successful management of high-risk participants

•The program integrates effectively with other 360º Health programs

Since 1989, Future Moms has helped welcome more than 200,000 babies into the world.

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Future Moms: Identification of MembersMembers are identified using a variety of “opt-in” methods:

Physician and/or self referrals

Case management referrals

Customer service inquiry reports

Physician & health clinic interaction

Promotion- via newsletters, benefit information, and workplace distribution

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Future Moms: Member Outreach and Engagement

• Outbound contact to members meeting program criteria

• Get In Touch letter- to introduce the program and encourage enrollment

• Mailings to all identified participants

• Healthy Returns System (HRS)- houses all clinical and demographic information

• Outreach at a “teachable moment- leverage the opportunity to reach willing participants

• Implement appropriate interventions- to achieve health goals based on assessment

The Future Moms program utilizes an industry-leading, technology- enhanced, personal touch approach:

Materials are available in English and Spanish

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Future Moms: Ongoing Management

•Periodic assessments-monitoring and providing educational information

•Contact High-risk participants-monthly or as frequently as daily

•Program interventions and communications- via phone and mail

•Pharmacist or Dietician telephone contact

•Coordinate services and referrals

•Progress updates- inform associate case managers of progress

•Maintain contact- maternity care provider and health services vendor(s)

•Post partum follow up- (2-4) weeks after delivery

•Birth kit-mail to new mom’s home

•Satisfaction survey

Individual intervention goals are established based on participant’s medical status, maternity risk factors, and provider’s plan of care.

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Future Moms: Member Education Materials

Communication includes:•Prenatal Kit•Your Pregnancy Week by Week pregnancy book

•Maternity Care Guide•Eating for Two brochure•Delivery Option brochure•Postpartum brochure•Birth Kit•Keeping Yourself Healthy @ Home pamphlet

•Online information

Future Moms maintains ongoing contact with participants throughout the pregnancy and after the delivery.

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Future Moms: 360° Health Integration

Future Moms, seamlessly integrates communication and coordination with other 360º programs, including:

• Wellness initiatives• Preventive care programs • Integrated care and condition management• Catastrophic case management• Behavioral health• Pharmacy • Dental• Employee assistance program (EAP)• Care coordination & utilization management

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Future Moms: IncentivesConsider incentives to increase member participation in the Future Moms program

• Monetary gifts• Gift cards • Baby supplies: car seats, new baby baskets• Extra days off

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Program Results

Future Moms participants incur fewer NICU costs than those that do not participate; NICU admits per 1,000 were 50 – 60% lower for members than for non members.1

93% of Future Moms members rate the program as excellent or very good.2

99% of Future Moms members say they would recommend the program to others.2

93% of Future Moms members agree they had an excellent experience in speaking with a staff member. And 90% feel the staff member provided the member with valuable information.3

1Source: 2006-2007 data for large national client with 130,000 members 2Source: 2008 member satisfaction study3Source: Q4 2009 member satisfaction study

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Future Moms: Provider EngagementFuture Moms encourages physician feedback and collaboration to improve program outcomes. Our multi-level approach to collaborating with physicians includes:

• Self-help resources for members

• Maternity nurse telephone access 24/7

• Conservation of valuable office staff time

• Spanish-speaking consultants- help facilitate communication

• Coordination of authorizations and arrangements-for home health services

• Update the provider on member performance

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Future Moms: Reporting MetricsProgram Activity:

• Registration numbers• Participation rate • Participant demographics• Risk assessment rate• Clinical risk factors • Program completion• Program satisfaction

Program Outcomes:• Participant delivery outcomes• Low birth weight rate• Gestational age at birth• IP facility maternity expense per member • IP facility maternity expense related to pre-term complications • IP facility infant prematurity expense • Postpartum assessment • Customized ad hoc reports available

*Availability varies based on size, please see Anthem representative for more details

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Promotional Resources at Your Fingertips

Make sure your employees know the 360° Health programs available to them.Go tohttp://group.anthem.com/360healthca

Here you will find: Program posters with phone numbersProgram fliers with phone numbersEmail templates that promote programsTime Well Spent 2010 Promotional Calendar

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Promotional IdeasHang posters or fliers in common areas like the

cafeteria, break room, stairwells or elevatorsPost the 24/7 NurseLine phone number where HR

resources are housed (bulletin board or intranet).Use the email templates to send quarterly or monthly

emails highlighting one health program or a wellness article from Time Well Spent

Provide fliers at Open Enrollment meetings, in your HR office, or on your company intranet site

Post the Future Moms flier wherever you house short term disability or maternity leave information.

Highlight health programs in your company employee newsletter

Add healthy bytes from Time Well Spent to emails from company executives

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Questions

We will now answer questions that were sent during the presentation. If you’d like to ask a question, please use the Q&A feature located at the right hand side of your screen and address to ALL PANELISTS.

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Thank you for your time today!

If you have questions about this presentation or your benefits, please contact your Anthem Blue Cross representative.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM and 360° Health are registered trademarks of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association.

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Please join us for upcoming webinars

UPCOMING WEBINARS (All times 11:00 AM PST):

August 18: MyHealth AdvantageSeptember 22: How to Promote Wellness in the WorkplaceOctober 20: Complex Care /ConditionCareNovember 17: Anthem.com and the member experience

Register at http://group.anthem.com/360healthca