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					Virginia Bankers Association

October 2008

 • Introductions
 • Overview of 360° Health Programs
    • 24/7 NurseLine
    • Future Moms
    • ConditionCare
 • Promotional Materials for VBA
 • Wrap Up/Open Discussion

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What is Anthem 360º Health?

 Anthem 360º Health® is
 our approach to
 surrounding members with
 the tools, resources,
 guidance and support to
 help them make the right
 health decisions for
 themselves and their

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24/7 NurseLine Program

                         24/7 NurseLine provides members
                         toll-free access to trained
                         registered nurses any time of the
                         day or night.

                         Program goals:

                          Provide convenient, expert resource
                          Promote appropriate use of health
                          care resources

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24/7 NurseLine Overview

  24/7 NurseLine
  Our information hotline provides
  access to a registered nurse over
  the phone 24/7, anytime,
  anywhere for assistance or just to
  hear a reassuring voice.
      Helps members assess
      Increases understanding of
       medical condition or
       prescribed course of
      RN’s have access to HRS;
       seamless care to members for     Members are directed to appropriate care
                                       settings, resulting in fewer emergency room
       all Care Management
                                                  visits and reduced costs.

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24/7 NurseLine Resources

  • Healthwise Knowledgebase - over 4,900 topics covering symptoms,
    medical tests, drugs, wellness and general health conditions
     •   Robust and consumer focused
     •   Covers common and uncommon conditions
     •   Strong wellness and prevention content
     •   Prepares callers for physician encounters
  • Audio library
     • Over 400 topics – English and Spanish
  • Utilize National Organizations for assistance for members:
     •American Self-Help Clearinghouse
     •Multum Information Services (drug reference)
     •Cancer Net (National Cancer Institute)
     •National Organization for Rare Disorders, Inc (NORD)

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Future Moms Program

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

                       Fewer pre-term births

                       Fewer low-birth-weight deliveries

                       Reduced pregnancy-related costs

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Future Moms Overview

   Future Moms
   Helps expectant women
   establish a healthy lifestyle
   for a healthy pregnancy.
       Follows progress from the
        first trimester through
       Offers early risk assessment
        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,            VBA offers $100 WalMart gift card to
        education and referral.        expectant mothers that enroll in the Future
                                          Moms program in the first trimester.

                                                                           7/29/2012   8
Future Moms Program Flow
                                   Registration via:
                 800#, MD Referral, Health Plan Referral, Claims Data

                              Assessment by RNs via Phone

                         Assessment Results Shared with MD

       High                                                                   Low
                                    Prenatal Kit Mailed
     Intensity                                                              Intensity

Proactive nurse counseling calls for patient mgt
                                                   • Prenatal education
   • Monitor compliance with physician visits      • Telephonic assessment
     and plan of treatment                          Reassessment at 28 weeks to reevaluate risks
   • Develop and manage intervention plan           24/7 RN Access
    Coordinate benefits as needed
    Provide 24/7 RN Access

                                    28 Week Educational Mailing
                                    Birth Kit delivery
                                    Postpartum Assessment
                                    Satisfaction Survey
                                    NICU Referral as needed
ConditionCare Program
 Our care management programs surround members with
 the help they need to live healthier lives.

                           ConditionCare helps members
                           better manage the following
                           prevalent, high-cost conditions:
                            • Asthma
                            • Diabetes
                            • Chronic Obstructive Pulmonary
                            • Coronary Artery Disease
                            • Heart Failure
                            • Low Back Pain
                            • Vascular at Risk
                            • Musculoskeletal

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ConditionCare Program Overview
 ConditionCare                       Programs Include:
 Our programs provide
 personalized support                Asthma, adult and pediatric
 tailored to the needs of            Diabetes, adult and pediatric
 each member to improve
 their health while                  Chronic Obstructive Pulmonary Disease
 reducing medical costs.             Heart Failure
     Multi-specialty team
      approach that includes         Coronary Artery Disease
      registered dieticians, CSWs,
      pharmacists, and exercise      Low Back Pain
     Dedicated care managers
      provide a wide variety of      Vascular-At-Risk (Hypertension, Hyperlipidemia,
      educational tools to help                Obesity, Metabolic Syndrome)
      members manage their

                                                                             7/29/2012   11
ConditionCare – Identification Process

               Screen Data from Medical/Pharmacy/Lab/HRA

     Diagnosis Codes (ICD-
                                      • Asthma (Pediatric and Adult)

                                      • Chronic Obstructive Pulmonary
       Procedure Codes
                                        Disease (COPD)
                                      • Coronary Artery Disease (CAD)
                                      • Diabetes (Pediatric and Adult;
       Drug Codes (NDC)
                                        Types 1 and 2)
                                      • Heart Failure (HF)
           Lab Data
                                      • Enhanced conditions (low back
                                        pain, musculoskeletal, and
                                        vascular at risk)

    Members can always self refer into the program, as well as accept
        referrals from Anthem Case Management, UM, and MD

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ConditionCare – Intervention Approach

                                    Targeted intervention focused on condition
                           High     stabilization / Intensive intervention for health &
                                    cost optimization
                                     Primary Nurse Manager            Dietary Counseling

                                     Holistic assessment              Access to a nurse 24x7
 (Clinical & Pharmacy)

                                                                       Quarterly educational
                                     Comprehensive care plan
  Therapeutic Alerts

                                     Depression screening            
                                     Pharmacy counseling              Monthly re-stratifications
                                     Moderate risk participants are managed on average
                                     for 6 months, high risk participants for approx. 12-18 months.

                                     Education, support & self-management tools
                                        Access to a nurse 24x7
                                        Quarterly educational newsletters
                                        Monthly re-stratifications

                                                                                          7/29/2012   13
Promotional Avenues
Promotional Avenues for VBA

   Customized flyers
       have been
   developed for VBA
     to promote the
  various Anthem 360
    Health programs.

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Wrap-up & Open Discussion

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