PreventDirect™

Mobile and On-Site Workplace PreventiveHealth & Wellness Services

Background: An Overview of Chronic Disease in America

Chronic illnesses – ongoing, generally incurable illnesses or conditions, such as heart disease, asthma, cancer and diabetes – are among the greatest threats to Americans’ health. More than 133 million Americans, or 45 percent of the population, have at least one chronic condition.

As a result of many factors – including poor lifestyle choices, as well as lack of access or emphasis on preventive care – the incidence of chronic diseases has increased dramatically over the last three decades. With the growth in obesity – especially among younger Americans – the diagnosis of childhood chronic diseases has almost quadrupled over the past four decades, and rates of chronic disease are expected to continue to rise.

Chronic Disease FactsTotal U.S. Population

133 million Americans have one or more chronic conditions – 45% Source: RAND Corporation Nearly half of Americans have one or more chronic diseases.

Without change, by the year 2023 the incidence of chronic disease in the United States is expected to rise dramatically.

Projected Rise in Cases of Seven of the Most Common Chronic Diseases,

2003-2023*

• Cancer – 62%• Mental Disorders – 54%• Diabetes – 53%• Heart Disease – 41%• Hypertension – 39%• Pulmonary Conditions – 31%• Stroke – 29%

*This study evaluated the burden of seven of the most common chronic diseases/conditions(cancer, diabetes, heart disease, hypertension, mental disorders, pulmonary conditions, and stroke). Source: The Milken Institute

The Burden of Chronic Disease on Business andU.S. Competitiveness

Businesses are the primary providers of health insurance in the U.S., yet rising health care costs are making it increasingly difficult for them to provide coverage to all their employees. Employee health benefits are the fastest growing cost component for employers and represent an increasingly large percentage of payrolls. The increasing prevalence of chronic conditions within the U.S. workforce is one of the primary reasons for these trends.

Not only does a sicker American workforce have higher health care costs, but it is also less productive. Chronic illnesses lead to absenteeism and presenteeism – or decreased effectiveness while present at work. These problems represent real loses of productivity for U.S. businesses.

Boosting U.S. Health and Prosperity by Reducing Chronic Disease

Chronic disease prevention and management holds great promise for reducing our nation’s health care spending. But far too little is being invested in improving Americans’ health and effectively preventing and managing common and costly chronic health problems.

Well-designed disease prevention and management programs are proven to yield economic and health benefits, especially ifimplemented in communities, schools and the workplace. Programs designed to change poor health behaviors – such as those to reduce smoking or improve medication adherence – have been shown to reduce costs and improve health.

Keys to Enhanced Productivity, Morale &Lower Healthcare Costs

1. Develop and embrace an organizational vision for health 2. Secure senior management commitment and

participation3. Address workplace policies and the work environment4. Employ program evaluations using informatics and

metrics5. Set health goals and tailor program elements to meet

them6. Create a value-based plan design7. Integrate patient-centered medical home and chronic

care management

Employ Program Evaluation Using Informatics and Metrics

– Population health management begins with :• Data• Demographics• Behaviors

– Data analytics enables selection of interventions matched to the population’s needs

– Data analysis must include more than medical and pharmaceutical claims data

– For every dollar spent on worker medical or pharmacy costs, lost-productivity costs can absorb at least 2 to 4 dollars

– Periodically scheduled reporting time frames• Progress against goals• Reasonable time frames (e.g., monthly, quarterly, annually)

Set Health Goals and Tailor Program Elements to Meet Them

– As organizations progress they:• Broaden their health goals to promote productivity• Focus on treating high-risk employees• Put at-risk employees on the road to better health• Keep healthy employees healthy• Seek continual improvement in health outcomes

– Phase 3 organizations:• Both the employer and employees take responsibility for meeting

health goals• Have established health committees/teams to support and

execute the organization’s health vision• Use incentives to increase participation in health improvement

programs

Create a Value-Based Plan Design (VBPD)

– VBPD facilitates appropriate, positive utilization of services (fiscally responsible – clinically sensitive)• Tailors co-payments to the evidence-based value of specific services

for targeted groups of employees

– Packages benefits and incentives according to health value they offer individual employees

– Organizations using VBPD may offer incentives and rewards tied to programs such as: • Completion of health risk assessments• Non-smoking status• Medication adherence• Weight management• Management of chronic conditions

Portrait of a Phase 3 Organization

– Roadmap template (North Star Health’s Lumina™) assists in creating a culture of health • Improves employee health status • Improves productivity and competitiveness• Reduces full costs of ill health• Increases retention

– Investing in health of employees is as important as investing in training to develop skills

– Capitalize on market place analytic resources to establish strategy and monitor program performance • Use tools available in the marketplace• Link internal systems over time

– Phase 3 organizations select and implement a full range of integrated health-program elements– Plan design encourages cost-effective and high-quality care

The Difference: The Employer Roadmap is an Innovative Guide that…

– Introduces cost-effective health programs for organizations in economically tough times

– Provides a map that includes 7 elements for building a healthier workforce

– Gives insights into the role of top decision-makers for framing a strategy and making it work

– Focuses on improving the quality of life for employees and their families – Demonstrates successful implementation of health improvement

initiatives and supplies tools to measure their impact– Encourages organizational self assessment and provides direction to

increasing productivity– Provides lessons from successful organizations’ case studies– Provides updated lists of references and Web sites and a glossary of

terms and tools

The 3 Phases of a Healthy Organization

Phase 1:The organization has a basic understanding of the need to change its approach to employee health and has implemented some basic health programs.

Phase 2:The organization is in a transitional process to facilitate and engage in activities that improve employee health.

Phase 3:The organization has a fully integrated strategy for managing employee health as a business asset.

Health Education Promote social support interventions and/or health education activities in

the workplace. Action Steps:1. Offer regular health education presentations on various physical activity, nutrition, and wellness-related topics.2. Provide health education information through newsletters, publications, websites, email, libraries, and other company communications.3. Conduct preventive wellness screenings for blood pressure, body composition, blood cholesterol, and diabetes.4. Provide confidential health risk appraisals.5. Host a health fair.6. Provide healthy cooking demonstrations with taste tests.7. Start employee activity clubs (e.g., walking, bicycling).8. Offer on-site weight management/maintenance programs at a convenient time for employees.

Conduct preventive wellness screenings for blood pressure,body composition, blood cholesterol, and diabetes.

Why: Health screenings help identify risk of serious illness.

Preventive wellness screenings provide measurements or evaluations of certain biomarkers that indicate a person's degree of risk for specific diseases. Many preventable diseases and the biomarkers are interrelated. For example, an individual with excess body fat is also at risk for high blood pressure and cardiovascular disease.

Mobile Workplace Screenings and Health Fairs…

Inconvenience and cost are barriers that often prevent people from getting routine health screenings. When offered at work, these screenings are very convenient and cost-effective. Early identification of risk can often prevent the development of more serious health issues. When serious risk is identified, early intervention will lead to better outcomes.

How… ♦ Offer health screenings as part of a health fair. ♦ Host periodic screening events as an alternative to full health fairs. ♦ Host a Health Fair or encourage employees to attend a Health Fair in

their community. ♦ Offer different wellness screenings each month along with an

educational program on that specific topic. This allows people to focus on different topics and reinforces wellness and prevention throughout the year. For example, during February, American Heart Month, offer cholesterol and blood pressure screenings.

♦ Many companies pay for part or all of the screenings for their employees. Other companies do not have this option, but can still offer convenient, lower-cost worksite screenings. Screening/wellness companies should be able to offer reasonable rates for their services on a cash (no insurance) basis.

Preventive Wellness ScreeningsA variety of health screenings are easy to offer in the workplace. Listed below are some of the most common screens for cardiovascular disease, diabetes, osteoporosis, and cancer.

♦ A1c: People who have been diagnosed with diabetes should ideally have this test four times a year. A1c level is a good measure of a person's average blood glucose level over the previous two to three months, which indicates his or her glucose control. It is not used to diagnose diabetes.

♦ Blood pressure: Elevated blood pressure, also called hypertension, is a major risk factor for heart attack and stroke. About 60 million Americans have it, and nearly one-third do not know it. High blood pressure is closely related to lifestyle and dietary factors. A normal blood pressure reading is 120 (systolic)/80 (diastolic).

Preventive Wellness Screens (Cont.)

♦ Body composition or body fat: Measuring the percentage of body fat and lean muscle mass is a better indicator of health than weight alone. Two people weighing exactly the same could have very different percentages of fat and muscle. Several different methods can be used to measure body composition: underwater weighing (expensive and requires special equipment), skin fold measurement using calipers (should be done by someone skilled with caliper use), and bioelectrical impedance (easy to use, requires handheld or standing equipment).

♦ Body mass index (BMI): Body mass index is the measurement of choice for many physicians and researchers studying obesity. Body mass index uses a mathematical formula that takes into account both a person’s height and weight. Body mass index equals a person’s weight in kilograms divided by height in meters squared (BMI=kg/m2). Body mass index, rather than scale weight, is a more accurate assessment of an individual's risk for obesity.

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Preventive Health = WellnessSimple Health Screens

Provide Confidential Health Risk Appraisals

Why: A Health Risk Appraisal is a technique for determining the presence of disease and estimating the risk that someone with certain characteristics will develop disease within a given time span. The three components of a Health Risk Appraisal are: 1) questionnaire, 2) risk calculation, and 3) educational reports. Health Risk Appraisals:

♦ Are easy to use. ♦ Are popular with clients and may increase participation in health promotion

programs. ♦ Provide a systematic approach to organizing preventive health information and

tend to emphasize modifiable risk factors. ♦May provide data on stages of change for behavioral risk factors. ♦ Provide group data that summarize major health problems and risk factors. ♦ May increase motivation to make positive behavior changes, when integrated

into a broader health promotion program.

Limitations of the Health Risk Assessment

♦ It does not diagnose disease. ♦ It does not provide a complete medical history,

nor is it a substitute for a medical exam. ♦ It is not a predictor of an individual's medical

future, chances of death, or most likely cause ofdeath.

♦ It is not an assessment of social or environmental risk factors.

♦ It is not a health promotion program in itself.

How…

On average, a Health Risk Appraisal costs $25-$50 per employee.Computer-based appraisals:

♦Most cost-efficient ♦Most popular ♦ Require a computer-literate population

Pen and paper appraisals: ♦ Staff intensive ♦ Take longer for feedback

Provide Healthy Cooking Demonstrations with Taste Tests

Why: Cooking demonstrations at the worksite make a great lunchtime seminar or health fair attraction.Demonstrations can be tailored to fit a variety of settings and time limitations. Seeing and tasting foods prepared quickly and easily can provide people the incentive they need to get creative in the kitchen.How:

♦ Host a one-hour cooking demonstration over the lunch hour or as part of a health fair.

♦ Create a theme for your demonstration such as .meals in minutes., .bone up for good health., .take nutrition to heart. or .healthy holidays..

♦ Invite a chef to participate in cooking demonstrations or health fairs. ♦ Consider cold recipes if adequate equipment is not accessible. ♦ Start a video lending library of cooking videos. ♦ Offer a cooking class that includes a demonstration, hands-on participation, and

sampling.

Start Employee Activity Clubs (e.g., Walking, Bicycling).

Why: Employee activity clubs encourage employees with similar interests to interact in an environment outside of the workplace. Activity clubs help foster camaraderie, improve physical fitness, reduce stress, and build self-esteem.How: These clubs can be formally or informally organized, depending on the company's resources.They can be initiated or coordinated by either interested employees, wellness committees, or through onsite fitness center or wellness staff.

Activity Club Guidelines ♦ Obtain support and permission from your organization's management,

often human resources. ♦ Request any necessary budget for the program. ♦ Check with your legal department for possible liability issues with the

activity club.The American College of Sports Medicine resource listed below has sample liability forms and a health history Par-Q (Physical Activity Readiness Questionnaire) that participants may need to sign.

♦ Send out an interest advertisement that follows company communication policies.

♦ Establish a meeting time and location for the activity. ♦ Advertise the activity club via the intranet, company newsletter, email,

or flyers in high traffic locations.

Weight ManagementWhy: Ongoing programs, such as weight management classes, provide the support and motivation employees need to facilitate lasting behavior change.How:

♦ Conduct an employee survey to determine interest in such a program and best day of the week and time of day to host it.

♦ Determine which program you want to offer. Research your options and take into consideration program reputation, class content, instructor credentials, cost, etc.

♦ Offer an on-site program before work, over the lunch hour, or after work. ♦ Consider subsidizing the program so that the employer and employee each

pay half of the class registration. ♦ In smaller communities where programs might not be available, invite a

registered dietitian or exercise physiologist to speak about nutrition and physical activity.

Smoking CessationA healthy lifestyle not only includes eating right and staying active, but also making other healthy choices. Tobacco use is the single most preventable cause of death and diseases in our society. By quitting smoking, you can greatly reduce your chances of developing many chronic diseases such as heart disease, stroke and cancer.

According to 2003 statistics:• 25% of adult Georgians smoked, compared to 23% nationally. • Smoking triples the risk of dying from heart disease among middle-aged men and

women. • Annually exposure to secondhand smoke causes an estimated 3,000 deaths from

lung cancer. • Nearly 70% of the 46.5 million American adults who smoke cigarettes want to

quit.

Tips to Help You Quit• Consider using medication to help you quit. There are prescription and over-the-counter medications that can help

you deal with withdrawal symptoms or even help to reduce the urge to smoke.

• Enlist support. Many states, communities, and health care organizations have free or low-cost counseling available to help you quit.

• Get help or ask for help from your health care provider.

• Don't keep your intention to quit a secret. Include your friends and family in your quitting process; they can offer much needed support.

• Clear the places where you usually smoke of anything that reminds you of cigarettes – like lighters, ashtrays, or matches. Also ask other smokers not to smoke around you, and clean your house and car thoroughly to remove the smell of cigarettes.

• Avoid places where smokers gather. Go to the movies, museums, or other places where smoking is not allowed.

• Calm the nervous energy you may feel with physical and mental activities. Take long strolls and deep breaths of fresh air, and find things to keep your hands busy, like crossword puzzles or gardening.

• When the urge to smoke strikes, do something else. Call a supportive friend. Do brief exercises such as pushups, walking up a flight of stairs, or touching your toes. Keep oral substitutes like carrots, apples, raisins, or gum handy. And never allow yourself to think that “one won't hurt,” because it will.

Physical ActivityAction Steps:1. Support physical activity breaks during the workday, such as stretching or walking.2. Implement incentive-based programs to encourage physical activity, such as pedometer walking challenges.3. Host walk-and-talk meetings.4. Post motivational signs at elevators and escalators to encourage stair usage.5. Offer flexible work hours to allow for physical activity during the day.6. Support recreation leagues and other physical activity events (on-site or in thecommunity).7. Offer on-site fitness opportunities, such as group classes or personal training.8. Provide incentives for participation in physical activity and/or weight management/maintenance activities.9. Explore discounted memberships at local health clubs, recreation centers, or YMCAs.

On-Site Fitness OpportunitiesWhy: The benefits of on-site fitness opportunities include:

♦ Increased employee satisfaction and health ♦ Informal building of company networks ♦ Increased employee engagement and energy ♦ Building of positive company culture ♦ Potential reduction in overall healthcare costs ♦ Potential reduction in employee absences

On-site fitness opportunities can include: ♦ Group fitness classes led by an instructor ♦ Group fitness classes following a fitness video ♦ Dedicated room with fitness basics such as stretching mats, exercise balls,

small hand weights, exercise videos, a TV, VCR or DVD player, etc. ♦ On-site shower facilities

How…NOTE: It is strongly recommended that you read the following book before creating any on-site fitness opportunities: ACSM.s Health/Fitness Facility Standards & Guidelines, Second Ed., American College of Sports Medicine, 1992

♦ Survey employee population to ascertain desired videos and/or classes. ♦ Work with employer to find an appropriate existing space such as a conference

or meeting room. ♦ Partner with a local health club for fitness class ideas and for qualified

instructors. ♦ Purchase TV, VCR or DVD player, and fitness videos. ♦ Research potential liability issues.

- Contact your employer's legal department regarding participant waivers, necessaryinsurance, and any other liability concerns.

♦ Provide shower facilities for employees who want to bicycle/run to work or exercise over the lunch hour.

♦ Provide bike racks or other bike storage facilities.

Healthful EatingAction Steps:1. Offer appealing, low-cost, healthful food options, such as fruits and vegetables, juices, and low-fat dairy products in vending machines, snack bars, break rooms, and/or cafeterias.2. Promote the adoption of 5 A Day in catering/cafeteria policies.3. Offer healthful food alternatives at meetings, company functions, and health education events.4. Post motivational signs about 5 A Day, nutrition, and healthful eating in the cafeteria.5. Make water available throughout the day.6. Provide protected time and dedicated space away from the work area for breaks and lunch.7. Make refrigerators available for employees. food storage.8. Provide incentives for participation in nutrition and/or weight management/maintenance activities.

Worksite EnvironmentAction Steps:

1. Provide bicycle racks in safe, convenient, and accessible locations.2. Provide clean, safe, and aesthetically appealing stairwells, and promote their use.3. Establish on-site fitness rooms or exercise facilities.4. Designate specific areas to support employees with sensitive health issues, such asdiabetics and nursing mothers.5. Establish workplace programs that promote breastfeeding.6. Add weight management/maintenance, nutrition, and physical activity counseling as a member benefit in health insurance contracts.7. Create a company culture that discourages sedentary behavior, such as TV viewing on breaks and sitting for long periods of time.8. Create a company culture that minimizes consumption of low-nutrient foods andbeverages such as cakes at parties, candy bowls, and sweets as rewards.

Let’s Get Moving! ♦ Designate a coordinator who:

• Assumes overall responsibility for the program• Along with committee, determines length of the program• Plans the next phases of "On the Move. - considering seasonal activities• Determines any contests to challenge participants

♦ Form an “On The Move” committee ♦ Secure upper management support

• Emphasize health and economic benefits for a healthy work force• Encourage and get permission for active breaks during the work day• Encourage managers to lead by example and join employees for walks• Use as an opportunity to help employees create healthy families• Use as a tool to unify a company with many work sites• Show employees that they are valued

♦ Look for existing programs or activities within the worksite with which to link such as wellness programs, or company sports teams like baseball, volleyball, basketball, etc.

♦ Advertise your “On the Move” program through e-mail, brochures, newsletters

Let’s Keep Moving! ♦ Plan a kick-off event

• Order healthy snacks or have a brown bag lunch• Arrange for speakers• Get buy-in from upper management• Choose an appropriate location• Order step counters• Prepare materials such as log sheets/books, instruction sheets, Quick Start Guide

♦ Determine how long you will collect data using log sheets, on-line forms, etc. ♦ Hold a kickoff event

• Create a fun, festive atmosphere (balloons, decorations)• Consider who will speak at the event to draw more attendees• Distribute step counters• Provide participants with details of program log sheets, contests, or events• Provide participants with a list of upcoming physical activity events

♦ Provide weekly reminders to increase steps and decrease calories using e-mail, newsletters, orposted signs in and around the worksite

♦ Ask participants to share ideas and stories through the company newsletter

And Moving… ♦ Consider holding a "halfway there" event at 6-7 weeks

• Give prizes for progress to date• Recognize individuals or groups• Set up an opportunity for sharing

♦ Collect best or funniest ideas for moving forward ♦ Provide input to America on the Move on hints and ideas from your

worksite ♦ Start advertising the next "On the Move" phase at your worksite

Remember, this is only the beginning. Starting with simple fun activities will lead to more progress than trying to do everything at once. Keep your messages and goals small and attainable. Keep moving forward with new ideas to constantly refresh your program.

Tracking and Rewarding Results

Incentive programs attempt to build motivation by offering individuals external rewards for taking steps in the right direction. Incentives range from recognition in the employee newsletter for participating in the company baseball team to a small monetary bonus for quitting smoking.

They can also include contributions to a “health promotionmedical savings account,” merchandise awards (e.g., cups,t-shirts, etc.), extra time off from work or travel awards.A common incentive for important behavior changes isdiscounted health insurance premiums.

Determine SuccessPeriodically review a program to determine its efficiency and effectiveness. A good program evaluation looks at information to learn both how well the program is working (process measures) and whether or not it is achieving expected results (outcome measures).

Program costs and outcomes can also be compared. Occasional modifications based on these reviews can ensure that a program is following a course that leads to success.

Adapted from Healthy Workforce 2010: An Essential Health Promotion Sourcebook, for Employers, Large and Small. 2010, Partnership for Prevention: Washington, DC at:

www.prevent.org/publications/Healthy_Workforce_2010.pdf

• Completion of the Health Risk Assessment is a requirement to receive health insurance benefits.

• The employee must make at least one call to a health coach every quarter. The first call focuses on their HRA results and setting up an action plan. Successive calls are designed to provide information, support and accountability. Each call earns the employee $25, for a maximum total of $100.

• We offer a range of options that promote a culture of health and wellness. • Our solutions are grounded in our proven, individualized coaching. Delivered

through the means that works best for the participant — phone-based, online or onsite – our health coaching delivers incomparable results. More than 90% of participants rate our personal coaching services "better" to "significantly better" than other resources they have used.

• Our individualized focus extends across our range of offerings, from our customized programs to our turnkey solutions.

Recommended Incentives

PreventDirect™ Programs & Services

• Integrated Solutions for Employee Wellness • Health Management Consultants • Health Risk Assessments (HRA's) • Hine’s Lifestyle and Disease Management • Employee Work-Life Balance Assistance • Online HRA and Self-Management Services • PreventDirect™ HelpLine • Onsite Health Screenings • Employer Fitness Center Management • Health Awareness Programs and Campaigns • Reporting and Program Evaluation

Unlimited access to the members-only section of PreventDirect.com, which includes:

• Online Health Risk Assessment • Health & Wellness Resource Locator • WellTips and other educational information • WellClip Videos

• WellChat - Instant messaging program to enable confidential communications with our health coaches

• WellQuit - Online Smoking Cessation Program • WellWeight - Online Weight Management Program • WellWalk - Online Walking Support Program

Program Fees (For Package Bundle Below)

$25/Fully-Participating Employee/Month1. Wellness Program Consulting – Intro & Planning, Goals/Health Plan Design &

Incentives Development, etc.2. Awareness & Education – Health Risk Assessment, Health Screening, Personal

Road Map to Better Health3. Action Plan Including Risk Profile, Case/Disease Management, Further Plan &

Programs Design Based on Actionable Data4. Program Implementation, Education, Analysis & Care Mgt.5. Program Monitoring with Monthly Progress Reporting Versus Targeted

ROI/Outcomes6. Incentive Management Per Results Achieved7. Online Access to Health Profile, Plan Benefits, Progress Reports & Health

Resources8. 24/7 Access to Health Coaches, Program Manager & Care/Case/Disease

Management Team

Itemized Service Fees

• Health Risk Assessment: Online = $25, Paper Form = $45 (includes population health analysis and results translation report)

• Health Screenings with; A1c, Cholesterol (HDL/LDL/Triglycerides), BMI, Hypertension, Height, Weight, Tobacco Use, Etc. = $125 per Individual

• Personal Road Map to Better Health with All Health Data, Risk Stratification, Action Plan, Progress Reporting & Full Administrator Reporting Set = $7 PEPM

• On-Site Health Coaching = $50 per Individual ½ Hour Session• On-Site Fitness Program Management = $25 per Employee per

1 Hour Daily Session

Case/Critical Care/Disease Management

Fee Utilization Review (For groups >25 fees, billed per employee per month.)Hines’ UR (Precertification) services include: Preadmission Review, Concurrent Review,Discharge Planning, Large Case Management Identification, PPO Channeling, StandardQuarterly Reports Additional Precertification Items:Outpatient Surgery and SSO $3.40 pepmOutpatient Testing Review (MRI, CT, PET Scan Review) $ 0.50 pepmTargeted Outpatient Surgery $ 0.30 pepmDiagnostic Testing and Second Surgical Opinion$ 0.50 pepmDME > $5,000.00 $ 0.20 pepmDME < $5,000.00 $ 0.50 pepm Optional Precertification Services:Billed through when SPD requires: Cardiac Rehab, Home Health Care, Hospice, IVTherapy, Skilled Nursing Facility, & Therapy (OT/PT/ST).$150.00 / hour

Case/Critical Care/Disease Management (Cont.)

Optional Programs Billed Per Employee Per Month:BABE Maternity Management Program – PEPM24 Hour Nurse Assistance Line & Online Library – PEPM(With no UR package, fee would be $3.50)$ 0.60 pepm$ 2.30 pepm Medical Case Management (hourly) $150.00 / hourCapitated Medical Case Management (per employee per month)Only available with UR. Excludes Transplant, Neonate, and Psychiatric CM.Does includes optional precertification services billed through this service when SPDrequires: Cardiac Rehab, Home Health Care, Hospice, IV Therapy, Skilled Nursing Facility,& Therapy (OT/PT/ST).Physician peer review rates will apply when necessary.CCM not available without UR$ 4.00 pepm Transplant Case Management (not available pepm) $150.00 / hourPsychiatric/Substance Abuse Case Management (not available pepm)Partial, Sub-Acute Psychiatric Hospitalization, Residential, or Outpatient Psychiatric care aremanaged and billed through this service.$150.00 / hour

Case/Critical Care/Disease Management (Cont.)

Capitated Disability Management $ 1.30 pepmDisease Management with Claim Scrubbing (Basic or Expanded)Basic Disease Management(Asthma, Coronary Artery Disease, Diabetes, Hypertension, High Cholesterol)Expanded Disease Management(Above plus COPD, Heart Failure, & Arthritis.)Capitated DM available only with UR and CM for groups >299ees$140.00 / HourBasic =$ 4.25 pepmExpanded=$ 4.50 pepm Neonatal (BABE Critical Care) Case Management (not available pepm) $150.00 / hourShock Loss Reports $150.00 / hourMedical Peer Review – Standard 7-10 day turnaroundIncludes Reconsiderations and Appeals $500.00 / hourNo Set Up or Additional Fees if existing/standard Hines programs, materials, reports and services meet customer’s needs.

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