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HEALTH CONNECT 360®

A clinical model delivering guaranteed clinical outcomes and financial savings by connecting the right people with real-time data for the right outcomes, paving the way to more affordable care.

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Care silos are more common than ever.

Patients have more options than ever about when and where they get health care. But not all health care providers are connected. That means more silos preventing their information from being viewed holistically. 

This siloed care leads to poor health outcomes, excessive out-of-pocket spending for members, and complicates the care journey for those with complex medical issues. 

Doctor review with patient
Two women laughing

Tailored Medicare solutions to support your Star rating goals

Health Connect 360 Flex Medicare evaluates your entire population to determine members AND physicians who would benefit from an adherence outreach or an outreach to address health and safety concerns. The measures improve patient health outcomes and support your Medicare Star rating goals.

 

Our program, tailored to Medicare populations focuses on: 

Improved adherence for diabetes, hypertension, and cholesterol

Closing gaps in care for statin use in persons with diabetes

Providing retroactive health and safety monitors

Fragmentation can raise costs and frustrate the care journey.

80%

of our health is affected by what happens outside of the doctor's office1
 

 

 

1. www.mnhealthycommunities.org/health-happens-outside-the-hospital
2. Centers for Disease Control and Prevention, Deloitte 2018 Study: The Convergence of Health Care Trends
3. Centers for Disease Control and Prevention

60%

of adults live with a chronic condition2

$3.4T

spent on chronic conditions each year3

Doctor and patient look at chart

Health Connect 360 provides total visibility for more holistic solutions.

By improving care coordination across the health care continuum, you can ensure your members receive holistic, quality care and drive down total costs.

Health Connect 360 is the first of its kind in our industry, offering performance-based clinical outcomes that improve your members' health and your total costs of care. Together, we can set clinical and financial goals that matter most to you as each plan’s optimal approach means a different level of guarantee.  

Addressing conditions that impact costs most

We’ll customize an approach based on your data and best practices in clinical management, patient engagement, and what’s possible in your peer set. We target conditions that drive higher costs, such as:

+ Diabetes

 

+ Cardiovascular

 

+ Digital health support

+ Oncology

 

+ Geriatrics

 

+ Behavioral health

+ Opioid use

 

+ Pulmonary

 

+ Musculoskeletal

Customizing to lower costs and improve outcome.

Your enrollment in Health Connect 360 offers a customized, consultative way to lower total care-costs and improve your members’ experiences.

Guaranteed outcomes, or financial performance

Clinical capabilities available, such as remote monitoring vendors

Dedicated pharmacist support through a Population Health Manager

24/7 access to your data and insights in the Care Insights Hub

Smiling medical professional with stethoscope

Health Connect 360: 2021 Medicare Performance

86%

of patients maintained or improved adherence4  

 

 

4. 2021 Health Connect 360 Results: Medicare - An Evernorth Report

88%

outreach to members with ≥1 chronic medication4

$536

total health care savings PMPY4

If we don’t provide the value we agreed upon, you pay less.
Select which clinical care capabilities we leverage to ensure your members’ receive the right support at the right time – or leave it up to us.

HC360: Case Study

A Population Health Manager identified a 37-year-old male with a history of asthma and referred his case to a Therapeutic Resource Center pharmacist for outreach.
CHALLENGE

Untreated, the constant inflammation destroys the surface layer of the airways. Without the layer acting as a “filter,” pollutants and allergens have direct access into the lungs. During an attack, these muscles also tighten and further restrict the amount of air getting into the lungs. Eventually, the constant inflammation and muscle constriction can have irreversible effects.

CLINICAL CARE SUPPORT COORDINATION

Patient was late to fill inhaled corticosteroid, Symbicort. During the conversation, the patient stated he was using less medication, due to cost concerns, as his son was recently diagnosed with autism.
 

RESULTS

Patient refilled Symbicort. The Population Health Manager referred the patient to a medical vendor that offers assistance to families for individuals with a diagnosis on the autism spectrum.

Bespectacled woman looks off in distance in front of large data visual

Connecting data for more holistic views.

Health Connect 360 links providers with data insights through both specialist pharmacists and electronic health record communications via your Care Insights Hub, available day or night.

The Care Insights Hub allows us to determine which patients are most in need of outreach, helps clinicians tailor their approaches according to what is and isn’t working, and provides members with continuous opportunities for gaps-in-care, omission of essential testing, medication safety, and preventative care.

Health Connect 360 uses medical data to identify relevant, actionable gaps-in-care and health opportunities 14 times faster.

 

5. In most cases, medical data is uploaded in bulk every two weeks, continuously refreshed data within 24 hours is therefore 14 days earlier

Social Determinants of Health

On top of traditional data sets, we can uncover even more by applying our analytic capabilities—including potential social determinant of health challenges. Looking at information such as access to food, shelter, and transportation is important because we know that 80% of an individual’s health is affected by what happens outside of the clinical setting. To effectively address clinical needs,  we must identify members that may have been missed in the past, while seeking new ways to deliver on social needs.

Community Food Bank

Unrivaled Care Coordination

Health Connect 360 doesn’t rely solely on automated processes. Our entire care coordination team is made up of clinicians specially trained in providing care to your members and coordinating with their providers as needed. 

Your Population Health Manager will be a clinician trained in data analysis dedicated to studying your data each day for suggested clinical engagements and to target individual patients based on their needs. 

Through use of data insights, our clinicians helped close over 330,000 clinical gaps-in-care in a single year. That’s around 3,200 clinical gaps closed in a year for around 12,000 lives.6

Each day they will be looking for opportunities to address areas that need clinical attention, keeping you informed about the best available engagement options, making operations across different healthcare services easier and helping you achieve optimal outcomes.

 

 

 

 

6. Express Scripts PBM, Health Connect 360 book of business results 1/1/2020 – 12/31/2020

Colleagues look at various data visuals

Specialist pharmacists provide care to your members, coordinating with their care providers as needed and working with your medical carrier care management clinical teams to understand services available to the jointly managed membership. 

More than 15 medical carriers are already integrated and active within the Care Insights Hub.

Our pharmacists identify patients in need of additional care, and refer the case to the member’s care/case management team for additional support via the Care Insights Hub. 

Personalized care plans for each member leverage what is best for them, whether it’s a clinical solution we offer in house, or through another vendor you work with. Personalized care plans adjust with each member as needed, and this unique model has resulted in 96% member satisfaction with our specialist pharmacists.7

 

 

7.  2019 cumulative Therapeutic Resource Center member satisfaction rating

Smiling pharmacist shows customer his or her or their prescription

Care and case management teams can also leverage the Health Connect 360 clinical team to provide necessary member support. This facilitation of member case referrals is executed through the Care Insights Hub, allowing team members to leverage member’s recorded data via remote monitoring devices and perform outreach to the member’s provider to consult on a care plan for the member.

Your case management member consultation can review recent case notes from the Health Connect 360 care teams, to continue the care plan the specialist pharmacist discussed with the member’s provider. 

Woman looks at blue bar graphs on computer screen inside office

Fragmentation can raise costs and frustrate the care journey.

$62

overall PMPY reduction in medical costs8

 

 

 

8. The Impact of Clinical Care Support on Pharmacy and Medical Cost and Utilization - An Evernorth Report, February 2022
9. Health Affairs, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2019.01088?journalCode=hlthaff

23%

fewer inpatient hospitalizations for members in the overall Health Connect 360 sample8

$90

PMPY decline in inpatient visit costs9

Helping the Whole System

Health Connect 360 supports new efficiency, for decreased pain points across the health care spectrum and improved outcomes.
Personalized for Patients

Personalized engagement means each member gets the most effective interactions and outreaches for their specific condition needs, health risk, and optimal engagement method. They will only get what they need, when they need it, and nothing they don’t.

More Insights for Pharmacies

Pharmacies get increased visibility of actionable clinical support opportunities. 

Improved Care Coordination

Your case managers and nurses use data to take action based on the best recommendations. Our daily insights are available on-demand to help you deliver effective counseling for your individual  members, preventing them from falling through the cracks. 

Better for Physicians

Physicians use health insights from interactions with other clinicians to make better clinical and cost-effective decisions when prescribing for their patients. 

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Expand into a 360 view of your health care ecosystem.
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Powerful Capabilities, Connected with Purpose

PHARMACY+

Get specialized solutions to treat general and complex conditions—personalized to you and meaningful to your people.

 

Learn about Pharmacy+

BENEFITS MANAGEMENT+

Save costs with personalized pharmacy and medical solutions that are built to work with you and for you.

 

Learn about Benefits Management+

CARE+

Elevate employee productivity, quality of life, and whole-person health, with accessible behavioral and clinical care.

 

Learn about Care+

 

INTELLIGENCE+

Unlock opportunities and value, for you and your people, with advanced analytics, predictive models, and tailored insights.
 

Learn about Intelligence+