HealthWatch^TM encourages self responsibility through its employee education programs and activities directed at early identification and effective treatment. The areas of interest for the Mental Health Parity are Stress Management and Depression within GPA’s Lifestyle Coaching and Care Coordination services.

In addition, the Employee Assistance Programs (EAP) will become a key player in providing service and controlling utilization of services. HealthWatch is the point of contact for all EAP calls related to Mental Nervous admissions or treatment for groups. HealthWatch professionals will triage the calls to the appropriate health care professionals to expedite referrals to appropriate providers and review over-utilization or under-utilization of care.

GPA Account Managers will provide additional information and specific plan design adjustments for your consideration.

The Mental Health Parity Act of 2008 accomplished several new steps toward achieving mental health parity including:

• Expanding health plan coverage to include treatment of substance use disorders.
• Requiring financials for mental health and substance use disorders treatment to be equivalent to any requirements for physical and/or medical problems: this refers to deductibles, co-payments and out-of-pocket expenses that patients are expected to pay. For example, treatment for medical/surgical procedures including frequency of treatment and number of visits and days of coverage are to be the same for mental health / substance abuse treatment procedures.
• The health plan must make mental health / substance use disorder medical necessity criteria available to current or potential participants, beneficiaries or providers upon request.
• A plan must make reasons for payment denials available to participants or beneficiaries on request or as otherwise required.
• A plan may not apply separate cost sharing requirements or treatment limitations to mental health and substance use disorder benefits.
• Coverage for treatment by out-of-network providers shall be the same for mental health / substance use disorders and for medical/surgical services.

The bill will become effective January 1, 2010 for most health plans.

GPA received the Most Improved award and Navy Army Federal Credit Union and American Marazzi Tile received the Healthiest Companies Overall award. Winning companies were selected based on best year-to-year aggregate Interactive Health Index (IHI) score improvement and best overall IHI score, respectively. The organizations were selected from more than 2,000 that participate in the IHS program.

GPA, Navy Army Federal Credit Union and American Marazzi Tile received the honors for making highly measurable progress in reducing medical costs and encouraging employee health through prevention-based healthcare. All three companies use GPA’s HealthWatch^TM Medical Management Solutions, which provide integrated wellness tools, programs and resources to help employees manage their overall health while minding the bottom line impact of healthcare.

For more information on HealthWatch Medical Management Solutions or to schedule an on-site Health Evaluation/Screening, please contact your Account Manager or Sales Representative. To view the press release on GPA’s award, click here

One Call Medical is a patient driven and claim cost control product and “concierge” type service that assist patients with scheduling testing at the most cost effective credentialed testing center. As with all diagnostic studies, HealthWatch^TM will integrate the results in the treatment plan for patients in Large Case Management, Disease Management or Maternity Management.

About One Call Medical
OCM is the premier provider of diagnostic imaging (MRI and CT scans) and electrodiagnostic (EMG/NCS) services at low cost. OCM provides unique scheduling services to assist patients with access to more than 5,300 providers. The result? Significant cost savings, exceptional medical report turnaround and the best quality diagnostic testing in credentialed facilities.

For more information, please contact your Account Manager or Sales Representative.

Coaching is offered in the following categories:

• Weight Management
• Smoking Cessation
• Stress Management & Emotional Well-Being
• High Blood Pressure
• High Cholesterol
• Back Pain

Participants enrolled in Lifestyle Coaching receive printed workbooks, materials and access to online programs to help maintain their healthier behaviors independently.

HealthWatch Lifestyle Care Coaches outreach telephonically to individuals with an elevated risk of a health condition. Participants receive personal support from their own specialized Care Coach to help them reach their health goals. Working with a personal Care Coach gives employees the motivation and accountability they seek to be successful.

The professional credentials of Care Coaches include:

• Registered Dietitians
• Registered Nurses
• Respiratory Therapists
• Exercise Physiologists
• Licensed Mental Health Professionals

Researchers from the Center for Disease Control indicate, “individual coaching may be the critical component for effective worksite health promotion programs.” Please contact your Account Manager or Sales Representative for more information on how to implement an effective program to foster a healthier workforce.

For more information on our Cost Plus program, please contact your Account Manager or Sales Representative.

The components of BeWell are managed in-house, and our integrated design utilizes one phone number, one web site, and one resource for all employee health improvement needs. Each program is uniquely designed to meet an employer’

s needs and has online points and incentive tracking capabilities. BeWell programs include awareness, education, and behavior change components designed to improve and maintain employee health and well-being, both in and outside of the work environment. The result equals lower health care costs, increased productivity and healthier populations! Please contact us for more information.

For the last year, we have provided our clients with an Annual Analysis Report that provides some of the answers. This report uses our MedStat Advantage Suite database to help benchmark clients against many various thresholds that are utilized by consultants and financial individuals to ascertain cost drivers. You can learn about your groups specific trends over that last few years, and the type of clinical conditions that are occurring within an organization. Most importantly, the report helps identify “outliers” and “red flags” that are driving costs over multiple periods.

The Annual Analysis Report is produced once every twelve months, upon request. We recommend the report be provided during the pre-renewal planning process that usually takes place 3 to 6 months before the renewal date. This will allow you to understand what is driving plan costs and determine how to allocate the limited plan resources more effectively in the coming plan year.

For example, your cost is increasing and you don’t know why. The report shows high emergency room utilization, limited preventive care visits, and a significant increase in the number of patients with hypertension and diabetes. Now you have the data to see if changing the ER benefit, improving the preventive care benefits and/or implementing a disease management or wellness program would be cost effective. We will help you determine what will help manage the cost with minimal capital expense.

One simple report that takes a week or so to complete, and you can have the answers! And best of all, someone from GPA will present and help translate the clinical medical terminology to you.

We want to help you know what is driving your cost! Ask your Account Manager for more information.

The Disease Management (DM) Industry is at a crossroads. With health care costs on the rise and a changing economy, programs are no longer just employee benefits, they have to produce results. Employer groups are ready to see evidence that the programs are generating positive health outcomes and that they are indeed working.

According to the Disease Management Association of America (DMAA), successful DM programs include population identification practices, evidence-based practice guidelines, collaboration models with the entire care team, education, and outcomes measurement. The primary purpose of these programs should be to improve overall health and reduce health care costs related to chronic conditions. DM programs must provide all of this under a cost effective program built on reliable and valid data.

Threats to Validity of Program Outcomes
Potential sources of bias must be identified and controlled when developing program evaluation strategies. Take selection bias, for example. The most valid method for selection bias is to introduce a control group. If the intervention group improves and the control group stays the same, then you have a successful program. Another area that requires attention is regression to the mean. This can be controlled by using a pre and post measurement for both the intervention group and the control group. It is also important to measure programs over several years in order to show movement outside of just the regression to the mean.

To give an example, researchers from the Indiana University School of Medicine designed a study to determine whether chronic disease management of individuals with diabetes and/or congestive heart failure (CHF) improves health outcomes and lowers health care costs. In contrast to earlier studies, the researchers randomly assigned individuals with the two chronic conditions to either chronic disease management or a control group based on their primary care provider’

s location. The researchers used a predictive model to identify individuals at risk for high levels of future health care utilization.

Individuals judged to be at highest risk were given intensive health care management conducted by a Care Manager. Those with lower risk were provided with education and care support as needed over the phone. Their findings were very positive. “The telephonic support resulted in a significant reduction in subsequent health care claims paid,”

 said study senior author Thomas S. Inui, M.D., IU School of Medicine.

One of the strengths of this evaluation is that the fiscal impact analysis included the costs of delivering the chronic disease management intervention, not just the impact on claims for subsequent utilization.

Disease management has and is proving to be an effective claims control measure. The model that will most impact program outcomes is the one that can produce valid and reliable results using control groups and predictive risk scores. DM vendors must also be willing to include their fees in a claim cost analysis. The programs must be cost effective to produce a real return on investment.

The Disease, Maternity, and Lifestyle Management Programs at GPA use the above practices in evaluating our programs. Our statistical methods have been evaluated and approved by URAC.

For more information about our programs, please contact wellness@gpatpa.com.

According to a recent issue of the MyHealthGuide newsletter, a significant number of employers are moving to self-funding and away from using traditional insurance carriers – negatively impacting the profits of large insurance companies. At GPA, we have long touted the benefits of self-funding, which puts the profit where it belongs - in the employer’s pocket!

 
It’s no secret that the costs of large insurance carriers’– that offer fully insured health insurance at a premium — are rising, due to increased medical costs and demand for improved shareholder value.

Self-funding health plans, which often have lower administrative costs and are able to spend your investment dollars directly on your health care expenditures, as opposed to covering margins, are being received as the more cost-effective option in today’s economy.



Self-funding trends: Advantages that manage costs

• Flexibility: self-funding plans offer total flexibility in health plan design – you are not required to ‘pay’ for benefits that do not make sense for the unique needs of your organization.
• Branded health plans: more and more employers are self-branding their health plans. Aware that this is “their” plan, employees become more accountable and employers save over the long term.
• Transparency: employers are demanding transparency with pharmacy programs, compensation and hospital costs. Self-funding plans provide this.
• Focus: sharp-eyed employers have increased their focus on the net paid amount by the health plan rather than the discount offered for the managed care contract.

• Customization: employers are using health plan data to customize specific wellness and disease management programs.  
• Tangible value: investing in employee education, wellness and disease management programs improve employee productivity and your bottom line.
• Cash flow benefit: money is available to you, the employer, as opposed to being held in the form of unreported claims or pending claims.

GPA offers self-funding programs and customized solutions to help employers manage costs. Our custom claims data analysis identifies positive and negative trends in each employer’s plan, so we can modify as appropriate and deliver the most cost-effective care. To learn about our self-funded programs, please contact us.