NC Health Smart : Promoting Optimal Health and Wellness for SHP Members

1. NC HealthSmart:Promoting Optimal Health and Wellness for SHP Members NC Medical Society Quality Subcommittee August 2009 Derek Prentice, MD, Consulting Medical Director Anne B. Rogers, RN, BSN, MPH, Director of IHM

2. 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

3. 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

4. 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).

5. 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

6. 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

8. NC HealthSmart Results • Program Participation • Clinical Impacts • Member Satisfaction • Provider Satisfaction

9. 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

10. 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

11. Member Satisfaction • 85% Satisfied with Health Coach • 93% Likely to Recommend Program

12. 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

13. 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

14. Opportunities • Disease and Case Management RFP • Discussions with various stakeholders • NCMS • CCNC/DMA • NCAFP • BCBSNC

18. Questions or Comments??