Reaching Out to Members to Address Health Disparities

ACAP CEO SummitJuly 15, 2009

Daniel J. Hilferty

President and CEO

The AmeriHealth Mercy Family of CompaniesWho We Are

We are a mission-driven Medicaid managed care organization with

over 23 years of experience in a variety of voluntary and mandatory

programs and both urban and rural settings Over 6.5 million covered lives in 14 states serving all categories of

aid: TANF, SSI, SCHIP and Medicare Advantage/ PDP including 3.9

million commercial, Medicaid, and SCHIP in behavioral health

programs Five distinct product lines:

- Full risk health plans

- Management and administrative service contracts

- PerformRx Pharmacy Management

- PerformCare Behavioral Health Care Services

- PerforMED High Cost Case/Disease Management

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The AmeriHealth Mercy Family of Companies

Addressing Health Disparities

• We are committed to overcoming barriers to care, such as:– Gaps in knowledge– Lack of trust in health care system– Socioeconomic pressures– Ethnic and language issues

• Our plans address disparities through:– Broad provider networks– Direct member outreach, education and care

management– Addressing cultural and socioeconomic barriers to care

The AmeriHealth Mercy Family of Companies

Addressing Health Disparities

• We have developed innovative member outreach programs that:– Educate and empower individuals– Takes into account cultural differences – Consider the “whole person” and involve the family– Build relationships between members and health care

providers– Leverage health and social resources within the

community

The AmeriHealth Mercy Family of Companies

We Are Honored…

..to have won the NCQA Recognizing Innovation in Multicultural Health Care twice:

• In 2006 for our Healthy Hoops Asthma Education Program

• In 2008 for our Health Ministry Program for Women’s 40-Day Journey

The AmeriHealth Mercy Family of Companies

Healthy Hoops®

• Healthy Hoops® is an award-winning, innovative health education and management program that uses basketball as a platform to teach children with asthma and other conditions how to manage their illness. The program uses a coalition of local health care providers and community organizations combined with full physical screenings, individualized health action plans and targeted health education. The result is improved health outcomes with decreased utilization and costs.

• Healthy Hoops programs have been held in PA, SC, KY and will start this year in IN

The AmeriHealth Mercy Family of Companies

Healthy Hoops Outcomes Among Participants

• Increase in use of controller medication

• Decrease in number of ER visits for asthma-related issues

• Decrease in hospitalizations

• Decrease in sleep disturbances

• Measurable improvements in Forced Vital Capacity (FVC) and Forced Expiratory Volume (FEV)

The AmeriHealth Mercy Family of Companies

Health Ministry Program for Women

Our plans in Pennsylvania and South Carolina partner with pharmaceutical firms and local faith-based communities on the Health Ministry Program for Women, a health and wellness program for women of color where they can learn about healthier lifestyles and illness prevention - and enjoy music and fellowship.

The Program has been awarded the prestigious "Recognizing Innovation in Multicultural Health Care Award" by NCQA in recognition of its success in reducing health disparities and helping African American women and their families receive appropriate services.

The AmeriHealth Mercy Family of Companies

40-Day Journey Outcomes Among Participants

• Drop in triglycerides

• Reduction in fasting blood sugar

• Weight reduction (average 5%)

• Reduction in resting heart rate

• Drop in blood pressure (average 6% systolic and 4% diastolic)

The AmeriHealth Mercy Family of Companies

What Our Experience Has Shown Us

• Community-based outreach programs must:– Reach out directly and personally– Be visible in the community and draw on community

partners to build trust– Educate members (and their families) about their illness

and about healthy lifestyles, and educate providers, too– Help members relate more effectively with health care

providers; e.g. to not be afraid to ask questions – Use incentives and “edutainment” to aid in learning and

keep participants’ attention (especially for children)