Introducing a New Idea in Health Management

Whole Health Dimensions supports the medical home concept, which centers on the relationship between an individual and his or her clinician – an approach endorsed by the American Academy of Family Physicians. It focuses on improving employees’ overall health, and optimizing the value of employers’ premium dollars by facilitating the patient-clinician relationship and providing resources for employees to navigate the health care system.

In previous editions of NEWS FROM BLUE, you read about two of Whole Health Dimensions programs, including pregnancy care and disease management that are now available to help members at highest risk.  In this month’s edition of NEWS FROM BLUE, learn more about Personal Health Assistant 24/7, a new telephonic service to support all employees with every day health care questions.  Personal Health Assistant 24/7 is a standard feature of all fully insured Wellmark health plans. For self-funded groups, Personal Health Assistant 24/7 is offered as a buy-up option.

In future issues of NEWS FROM BLUE, we will continue to educate you on Whole Health Dimensions suite of wellness services and provide the information you need to implement these programs into your workplace. You can also contact your Wellmark representative for more information.

Helping Your Employees Navigate the Health Care System
Personal Health Assistant 24/7, a new telephonic service available through Whole Health Dimensions, is an innovative solution to help your employees navigate the health care system and obtain the health care information and help they need, when they need it.

Call Toll Free: 1-800-724-9122

Around-the-Clock Help for Health Care Questions
Employees now have a resource to provide support and guidance when making health care decisions, from suggestions on remedies for a cold to clarification of a recent diagnosis. Personal Health Assistant 24/7 provides a direct connection to specially trained health professionals who can provide tools and support to Wellmark members.

• Nurse Support 24/7 - employees can receive answers to health care questions from a registered nurse 24 hours a day, seven days a week.  In addition, the nurse can help you better understand a specific diagnosis or condition and uses nationally accredited guidelines to assess your symptoms and recommend next steps.
• Care Navigation 24/7 - care coordinators are available around-the-clock to help members locate the right resources.  Recently diagnosed with a disease?  A care coordinator can provide information about a local support group.  The care coordinator can also recommend other Whole Health Dimensions programs and services appropriate for your employees.  For example, if an employee calls with a pregnancy question, the care coordinator can encourage participation in the Pregnancy Care program. 

Introducing Personal Health Assistant 24/7 to Your Employees
We’re excited to tell your employees about this new service, and we will be sending an announcement to all fully insured contract holders. Included in the postcard mailer will be will be two wallet-sized cards and two key chain cards with the phone number, so employees can always have convenient access to the Personal Health Assistant 24/7 number.  To help manage call volumes, the postcards will mail throughout the month of January and early February.

To help you promote Personal Health Assistant 24/7 and other Whole Health Dimensions wellness services to your employees, we are pleased to introduce the Whole Health Dimensions Resource Center, found in the Employer Toolkit on www.wellmark.com. The Whole Health Dimensions Resource Center features worksite marketing tools such as posters and flyers, which you can get at no charge.

• Nurse Support 24/7 (Three Scenario) Flyer: P-2012
• Nurse Support 24/7 (Three Scenario) Poster: P-2013
• Twisted Ankle Flyer: M-20206
• Twisted Ankle Poster: M-20207
• Upset Stomach Flyer: M-20205
• Upset Stomach Poster: M-20204
• Baby Crying Flyer: M-20202
• Baby Crying Poster: M-20203

Wellmark's Pharmacy Trend at an All-Time Low

“Wellmark and its pharmacy benefit manager strategically worked together to determine the programs to implement in 2007 that were clinically appropriate and helped to drive lower costs for our customers, Andringa said.  “In many cases, these programs also helped our members save on their out-of-pocket costs at the pharmacy by encouraging the use of generics as a first-line therapy.

“As more blockbuster drugs become available as generics, Wellmark will continue to explore ways to encourage the use of generic drugs.  Studies have shown that patients are more likely to follow their drug therapy when their out-of-pocket costs are low.  If you are taking a maintenance medication, choosing a generic can save hundreds of dollars a year on out-of-pocket costs.”

On a three-tier drug plan, the average generic copayment is $10.  Copayment for Tier 2 drugs averages $30 a month while a Tier 3 copayment averages $50 a month.

The chart below shows projects implemented in 2007 that helped to generate pharmacy savings:

Educational Campaign Encourages Generic Statins
Wellmark Blue Cross and Blue Shield has launched an educational campaign to  employers, physicians, and members about the cost savings of using generic statins versus brand-name options such as Crestor, Lescol, Lescol XL, Lipitor, and Vytorin. Three generic statins are now available, providing the same reductions in LDL or “bad” cholesterol¹ at lower out-of-pocket costs with an average savings of $240-$480 a year.

Letters and postcards have been sent to physicians and members, and Blue, Wellmark’s quarterly member magazine, will feature a story in its winter issue about generic statins. 

¹Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III Final Report) http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf

Zyrtec Moving to Over-the-Counter
Zyrtec, a popular allergy medicine, will be available over-the-counter on January 21, according to the manufacturer.  In anticipation of this change, Wellmark Blue Cross and Blue Shield will be mailing a letter and a $5 coupon in mid-January to current Zyrtec users for the purchase of an over-the-counter Zyrtec product.

Zyrtec is on Tier Three of Wellmark’s Drug List.  There is no generic available for Zyrtec.  The over-the-counter price of Zyrtec is expected to be well below the average Three Tier copayment of $50.

Wellmark's Pharmacy Benefit Manager Achieves Recognition
For the second consecutive year, Wellmark Blue Cross and Blue Shield’s pharmacy benefit manager, Catalyst Rx, received the highest customer satisfaction ratings for "Overall Service and Performance" in the Pharmacy Benefit Management Institute (PBMI) 2007 Pharmacy Benefit Manager (PBM) Customer Satisfaction Report. PBMI independently conducts an annual customer survey to benchmark PBM performance on overall customer satisfaction.

Catalyst Rx received the highest ratings among its competitors in all major categories, including:

• Overall Service and Performance
• Delivering Promised Services
• Delivering Promised Savings

Peter Roberts, group vice president for Wellmark’s Provider Relations & Health Management division, said these results demonstrate a commitment to delivering a financially transparent model that is clinically focused.

“Pharmacy Insights is focused on providing a pharmacy benefit that supports the most clinically effective drug therapy at the lowest net cost,” Roberts said.  “Through our collaborative relationship with Catalyst Rx and both companies’ focus on service excellence, we have been able to achieve a zero percent pharmacy trend (rate of increase on a per member basis from 2006 to 2007) for 2007.  This is a phenomenal indication of the collaborative relationship between Catalyst Rx and Wellmark and the two company’s commitment to a transparent, collaborative, and mutually-aligned partnership.”

As part of its fully transparent arrangement with Catalyst Rx, Wellmark is providing “pass through pricing” to its self-funded customers.  This means the rates that Catalyst Rx has negotiated on behalf of Wellmark are being directly passed on to self-funded customers.

“When Wellmark implements clinical programs that lead to greater efficacy and in aggregate, lowest total net spend, pass through pricing allows our self-funded customers to directly receive the benefits of those savings,” Roberts said. 

Pharmacy Benefit Management (PBM) Accreditation Program
Catalyst Rx has also been completing the requirements for two URAC pharmacy accreditation programs.  In October 2007, Catalyst Rx was one of four PBMs accredited by URAC for Drug Therapy Management. URAC’s Drug Therapy Management Accreditation standards address many functions including the development of clinical policies using evidence-based medicine; patient communication regarding medication use; and promoting consumer rights, shared decision making and education.  In addition, Catalyst Rx is completing the requirements to receive the Pharmacy Benefit Management Accreditation in the first quarter of 2008.

Independent Speech Pathologists Added to Wellmark's Networks

Prior to January 1, 2008, speech therapy services were a covered benefit only when provided in an inpatient or outpatient facility.  Please note Wellmark’s medical policy for speech therapy is not changing and prior approval is recommended prior to receiving speech therapy services.

Because this is a benefit change, amendments are required.  Even though all members will not have updated amendment language by the effective date, Wellmark is implementing this change across the board for all fully insured members effective January 1, 2008, for the following reasons:

• This is a benefit enhancement, which will make it more convenient for members to receive speech therapy services
• When receiving services in an office setting, members will no longer be required to meet deductible before benefits are applied
• There is no premium impact

Large group fully insured members will receive updated benefits certificate or coverage manual language at renewal. 

Self-funded groups can choose to opt out of this benefit change.  However, since there is no premium impact and the change makes it more convenient for members to receive speech therapy services, self-funded groups are encouraged to implement this change.

Tools to Promote Online Access to Your Employees

Worksite marketing tools can help you promote Wellmark’s online, self-serve tools and resources to your employees:

myhealth@wellmark Worksite Marketing Tools:

• Fact Sheet: M-23217
• Payroll Stuffer: M-20153
• Poster: M-20154

Healthy Tips for a Happy 2008

• Wash your hands: good hygiene reduces the spread of infections and germs.
• Exercise: exercising 30 minutes a day will lower your risk for diseases such as diabetes and heart disease, and an hour a day will help you avoid gaining weight.
• Eat colorfully, feed your brain and don't skip breakfast: Red, orange and green vegetables can lower your risk for a number of diseases. People who eat a nutritious breakfast are more likely to maintain a healthy weight and meet daily nutritional needs.
• Don't smoke: Besides increasing risk of heart disease and cancer, smoking also impairs your body's ability to heal wounds after surgery or injury.
• Laugh: laughter is a great stress reliever and can boost your energy.
• Keep good records: carry a medical profile in your wallet. The profile should have information such as your blood type, allergies, medications you're taking, contact information for your doctor, and your organ-donation preferences.
• Sleep: Sleep may help the body conserve energy and other resources that the immune system needs to mount an attack against infectious diseases such as flu.
• Slather sunscreen: Wear sunscreen and moisturizer every day, avoid sunburns, and tanning salons – it is the best way to avoid skin cancer.