Performance Jumps 200%, $9 Million Generated

Case in Point
Carenet Healthcare Services (www.callcarenet.com) partnered with a leading Medicare Advantage Plan to improve member health and reimbursement rates by increasing annual physical exam compliance among high-risk seniors.

Situation & Opportunity
Forty percent of seniors have unreported and untreated chronic conditions. By raising annual exam compliance, the Plan could accurately identify and treat members ultimately boosting member health and reimbursement rates. Various compliance initiatives conducted by the Plan, such as direct mail, newsletters and website announcements, were unsuccessful. The Plan turned to Carenet to help them effectively reach members and motivate them to take action.

Success Strategy
Carenet’s expert engagement team executed a multi-touch member outreach strategy focused on building one-to-one relationships with members and coordinating their care. Using direct, personalized contact, members were informed on exam benefits, educated on benefit eligibility, and assisted with appointment scheduling with their primary care physicians.

Performance Delivered
Educating and empowering members enabled them to make informed decisions and take a more active role in managing their health. Carenet improved the Plan’s performance by 200% and, through successful risk adjustment analysis, generated approximately $9 million in annualized adjustments. Plus, member satisfaction and loyalty grew thanks to the kind, resourceful assistance they received from Carenet’s expert engagement specialists.

It’s Time to Get Personal
With nearly 25 years of customer-relationship management experience in the healthcare arena, Carenet knows nothing drives lasting change more than genuine, personal interaction. Designed to proactively connect with members throughout the year, Carenet’s full Medicare Engagement Solution is a multi-touch outreach program focused on cultivating one-to-one relationships with individual members. The result: member engagement, health and retention improves ultimately boosting plan performance and Star rating bonus payments while lowering everyone’s costs.

Education and ER Diversion Saves $3.25 million

CASE IN POINT
A Health Maintenance Organization (HMO) partnered with Carenet (www.callcarenet.com) to provide its Medicaid members with better healthcare access and care coordination to improve health outcomes, reduce emergency room usage and contain costs.

SITUATION & OPPORTUNITY
Limited member support and knowledge, insufficient clinic access, and a provider shortage resulted in low member engagement and the misuse of hospital emergency rooms (ER) for non-urgent care. Inappropriate ER usage diverted resources from critical cases, overcrowded facilities, disrupted care continuity between patients and doctors, and raised overall costs.

By enhancing support services and educating members on their options, the HMO could break down care barriers and ensure their members received the right level of care at the right time, saving everyone time and money while boosting member health and satisfaction. 

SUCCESS STRATEGY
To remedy the HMO’s challenges, Carenet crafted a customized, multi-pronged solution featuring both inbound and outbound services, including:

24-7 Nurse Advice – Easily accessible, around-the-clock medical care was provided by Carenet’s highly skilled registered nurses. After conducting a thorough symptom analysis, they directed members to the most appropriate level of care whether it was an at-home treatment or a visit to their physician, an urgent care facility or the ER.

Proactive Outreach – By employing Carenet’s cost-effective agentless-messaging technology, the HMO was able to quickly communicate to a broad audience their services, such as the Nurse Advice line and urgent-care facilities with extended hours. In addition, Carenet’s engagement team personally contacted frequent ER users to educate them on alternative, less-expensive options and to reinforce the importance of the primary medical home.  

Expanded Member Support – Operating as a seamless extension of the HMO, Carenet’s Member Support team augmented the plan’s customer care service by providing support during high-volume periods, after hours, and on weekends and holidays. Aid ranged from benefit eligibility questions and translation services to provider referrals and transportation coordination.

PERFORMANCE DELIVERED
By collaborating with Carenet, the HMO was able to diminish inappropriate ER usage, optimize their operations, and improve member engagement, health and satisfaction while containing costs. Eighty-eight percent of the contacted members were unaware of their options and a post-campaign survey indicated that the majority of agentless-messaging recipients would first turn to the Nurse Advice service instead of the ER for future care.

In just one year, Carenet diverted 65 percent of the callers from the ER to a more appropriate level of care resulting in an annualized savings of $3.25 million.

BECOME A SUCCESS STORY
Working with the government requires a deep understanding of its unique populations, regulatory measures, and the challenges with providing high-quality care while facing growing financial demands. Nearly 25 years of experience with both Medicare and Medicaid programs has given Carenet the know-how needed to implement solutions that streamline processes, cut spending and boost efficiencies.

Carenet’s services improve member engagement, compliance and vitality by encouraging healthy behavior such as well-child exams, perinatal care, screenings and immunizations. With the number of Medicaid members skyrocketing, it’s more vital than ever to have a partner like Carenet to help you do more with less while providing the utmost level of care.

What Slow Down?

Carenet Healthcare Services has enjoyed positive growth since 2009 which has been the catalyst for the company’s expansion in both people and facilities.  

We are continuing to hire for a variety of positions now and this trend does not show signs of abating.  Currently, we are recruiting for:

Clinical Services
Clinical Services, Supervisor (RN)
Care Adviser (RN) Weekends – Full Time
Care Adviser (RN) Weekends – Part Time

Client Services
Account Executive
Associate Account Executive

Member Services
Inside Sales – Medical
Care Coordinator
Engagement Specialist 

Information Technology
Programmer
Applications System Analyst
Software Developer
Interactive Intelligence Engineer


Admin Services
Administrative Assistant – Sales Department

If you are interested in learning more about these positions, please visit www.carenetjobs.com.

Carenet is an award winning company having appeared on the Inc. 500II5000 list of “Fasting Growing Private Companies” for the last three years, as well as being recognized with multiple awards from the San Antonio Business Journal for its steady growth.

Carenet Healthcare Services delivers measurable value through our cost-effective and efficient solutions, which provide personalized member support and medical assistance exclusively to America’s leading healthcare organizations. We help our clients build and strengthen their vital relationships with their members/patients. Founded in 1988 and headquartered in San Antonio, Texas, Carenet supports 15 million members nationwide. Learn more about our customized solutions at www.callcarenet.com.

Winning RX Solutions

Case In Point
One of the nation’s largest pharmacy benefit managers (PBM) partnered with Carenet to inform their members of the value and convenience of prescription drug mail-order service.

Situation & Opportunity
Millions of consumers use maintenance medications, such as drugs to control blood pressure or cholesterol. PBM’s can supply these medications with great accuracy, speed and safety via home-mail delivery for substantially less money than retail pharmacies. Enrolling members into a mail order and automatic refill prescription service saves them time and money by providing access to less-expensive drugs, multiple-month supplies, and lower co-payments while eliminating inconvenient monthly trips to their local pharmacy. Health plans also benefit as this highly efficient option reduces their plan’s cost and thus their members’ premiums. The PBM identified a key sector of its member population to target based on current medication regimen and potential cost savings. They turned to Carenet to provide the personalized support required to convert this valuable audience to their home-delivery service.

Success Strategy
A customized communication and conversion strategy was developed by Carenet to encourage members to enroll all their maintenance medications into the PBM’s mail order and automatic refill services. Carenet’s knowledgeable engagement specialists contacted more than 100,000 members to inform them of the program’s benefits. By leveraging the engagement team’s ability to build one-to-one relationships and the PBM’s customer data, Carenet was able to tailor each conversation to a member’s specific needs and medications, and advise them of the potential cost savings and convenience factors associated with the service.

Performance Delivered
By combining expert engagement specialists with finely tuned customer relationship management (CRM) technology and skills, Carenet converted 45 percent of the contacted target audience from retail to mail service and enrolled over 75 percent of their eligible prescriptions into the mail program—an average of five drugs per member. Of the enrolled prescriptions, 95 percent were registered for automatic refill service. This high conversion rate far exceeded the PBM’s expectations and has led to many more successful programs.

Become a Success Story
As drug costs and chronic-disease management needs grow, both payers and members seek strategies for lowering costs without compromising quality. Carenet’s pharmaceutical engagement programs can help. By personally reaching out to members and informing them of their options from generic drugs to mail order service, Carenet’s engagement specialists save everyone time and money. With nearly 25 years in the healthcare arena, Carenet knows how to deliver measurable results. Learn how you too can become a success story; contact Carenet today.

Innovative Healthcare, what does that mean?

In a recent article by Laura Landro that appeared in The Wall Street Journal, the author explores the necessity of innovation in healthcare.  Much of the new legislation that is shaping the future of our healthcare system  will require those who operate within its confines to transform the way they do business. 

Carenet Healthcare Services is uniquely positioned to be a driver of innovation for many of these companies.  With a long list of clients in markets that include health plans, government programs, U.S. military system, employer groups and hospital systems, our solutions address a host of opportunities to better serve the member population.

Read how our program assisted an MA Plan in setting mammogram appointments.

 One of our recent programs helped to successfully increase appointment setting for an MA Plan's member population by 165 percent. 

  

The Time to Innovate Is Now 

The Wall Street Journal
By LAURA LANDRO

Finding innovative ways to deliver health care has never been more important than it is today.

Read the complete Innovations in Health Care report.

With the passage of sweeping health-care legislation last year, 32 million more people are expected to flood into a health-care system already strained by rising costs and a short supply of physicians, nurses and other clinicians.

At the same time, reining in health-care costs is crucial if the government is going to deal with a long-term budget deficit that is spiraling out of control.

How will an increasing number of people get quality care at a cost that the nation can afford? The answer isn't hard to figure out. It's innovation.

Easier said than done, of course. Unlike many other industries, health care has remained highly fragmented, with a hierarchical culture resistant to change, and a payment system that rewards providers for quantity rather than quality of care. It has been slow to adopt technologies like electronic medical records that have the potential to make care more efficient and safer for patients. Even when new practices have been shown to improve care and reduce error, hospitals and doctors have been slow to adopt them.

The government is determined to be part of that solution. The new health-care law also created a Center for Medicare and Medicaid Innovation charged with identifying, testing and spreading new ways of delivering and paying for care. In introducing the new innovation center, Donald Berwick, head of the Center for Medicare and Medicaid Services, promised that it will work with caregivers, insurers, and employers to replicate successful innovations in communities across the country.

But, he warned, "none of this will be easy. Government cannot and should not do this alone."

In fact, as you'll see in this report, government is far from doing this alone. You'll read of doctors, hospitals, insurers, researchers and cities that are all experimenting with novel methods to improve the quality, safety and effectiveness of care at a reasonable cost. Some are pioneering new delivery systems that encourage providers to coordinate patient care, rather than work at cross-purposes with little communication. Others are rigorously testing safety practices to determine how teams of caregivers can reduce adverse events and errors. Still others are mining medical records to identify patients who aren't taking their medications or might benefit from enrollment in a clinical trial.

And then there are all those attempts to give consumers the resources they need to stay healthier in the first place. That can mean things as simple as building more sidewalks and bike paths, or getting schools to bring back exercise at recess. Sometimes innovation means getting back to the basics.

Finding Healthcare's Funny Bone

Healthcare is a serious issue, more serious for some than others? An article recently published in HealthLeaders Media looks at the role of humor in this sacred space. Is there a right time or place to inject a slightly skewed view of the issues facing us today? 

At Carenet Healthcare Services we try to find the most appropriate way to tell our story everyday. It's a struggle because as a team we are different from the traditional healthcare company, but we still want to be respectful of the space. Do our recent ads reflect this for you?

 

 

 

 

 

  

Humor's Role in Healthcare Marketing
Anna Webster, for HealthLeaders Media , May 18, 2011

Can humor be used to address serious healthcare problems? Many ads and marketing campaigns for healthcare services tend to take the safe (and more serious) route when discussing the quality or reliability of an organization. But some healthcare marketers are walking the line between funny "haha" and the type of funny that raises eyebrows.

Mixing healthcare and humor can be a risk – is it one that pays off?

HealthLeaders recently featured a campaign spotlight centering on a marketing campaign from Blue Cross Blue Shield of North Carolina. The BCBSNC website, features goats dressed in shirts with the tag line, "let's stop looking for scapegoats" in reference to escalating healthcare costs.

"If we're going to make a difference and address out-of-control costs, we have to start somewhere. The campaign we've launched featuring the scapegoats was a way for us to do that," said Kathy Higgins, VP of Corporate Affairs for BCBSNC, in response to a blog critique of the website.

My question: is Blue Cross making light of the situation of rising medical costs? The point of the website is that everyone (consumers, doctors, hospitals, and insurers) can be seen as a scapegoat – we are all in the same boat and thus no one should be offended. This type of satire works well on shows like Family Guy but in healthcare, it's less common and may ruffle a few feathers.

Using farm animals could be taking the point past humor and toward mockery.

BCBSNC doesn't see it that way. "We used goats to emphasize that no one group is to blame, but to make it clear that everyone, including us, has a role to play," added Higgins. "The humor in these ads helps us make our point and address the complexity of the issue, but we are serious about the need to control medical costs."

I applaud BCBSNC for starting the conversation and looking for solutions to an escalating problem. The payoff for Blue Cross may be measured in audience participation on the website. Site visitors may post questions and receive answers from other patients or members or BCBSNC employees. But as far as a monetary payoff goes, BCBSNC has not disclosed how much was spent on the campaign, so ROI remains unknown.

"This is not to make light of a serious issue," Brad Wilson, CEO of BCBSNC, said in a recent News & Observer article. "We made a conscious choice to use humor in this campaign as a way of opening the door to a conversation that can be complex and, at times, uncomfortable. Finding solutions to rein in medical costs is in the best interest of our company, our customers and everyone in North Carolina."

Humor is tough because it can be mistaken for downplaying the issue at hand. Lexington Medical Center in West Columbia, South Carolina has also used humor to highlight selected healthcare services or departments. Its television campaign features scenarios of people injuring themselves during the holidays. The tagline is: "We see some crazy things during the holidays. Please try and take it easy this year, have a safe and merry Christmas."

The physical comedy of holiday accidents in the Christmas commercial of 2010 won Lexington Medical Center an Aster Award in Healthcare Advertising, a national healthcare marketing award competition based on creativity, quality, message effectiveness, consumer appeal, graphic design, and overall impact.

In the Lexington Medical Center campaign, the acting is over-the-top and makes the point that the ad is meant to be taken light-heartedly. In the BCBSNC campaign, though the ad is meant to be humorous, the issue at hand is a serious one.

I can see laughing at hanging a wreath or tripping down the stairs, but escalating healthcare costs…? Not so funny to me.

A recent story in the Chicago Tribune does a great job of exploring the upcoming patent expiration on some of the top drugs in the U.S. The report also explores and reinforces the safety of generics and why patented drugs are so expensive when they come to market. 
 
Health plans and pharmacies will look for ways to effectively market the patent expirations and provide savings information to members and customers, helping bring their annual drug spends down. 
 
Carenet Healthcare Services understands the engagement opportunities available with the upcoming status changes for these drugs. Carenet designed and rapidly deployed an engagement program for a health plan that encouraged its members to try at least one generic equivalent for three brand name statins. Within a six-week period the engagement team achieved a 440 percent lift in savings over the health plan’s prior direct mail campaign. 

Big savings coming from emerging generic drugs, patent expirations

Some of the top-selling drugs in the U.S. — including Lipitor, Plavix and Actos — will lose patent protection in the coming years, promising big savings for consumers

By Bruce Japsen, Tribune reporter

10:16 PM CDT, May 4, 2011

Lipitor. Actos. Plavix.

These are some of the most-prescribed medicines in the U.S., drugs that are so commonplace they are responsible for a huge chunk of the $300 billion spent on brand-name pharmaceuticals each year.

That is about to change as patents on these pricey pills begin to expire, opening the door for generic competition. And that can translate to savings of up to 90 percent, analysts say, making these drugs affordable to more consumers.

Americans will see cheaper copies of some of the biggest drug names starting this fall. Out-of-pocket costs of the generic form of Lipitor, a widely used and advertised cholesterol drug that loses its patent protection in November, will be reduced to as little as $4 for a month's supply. Even for a person with health insurance, Lipitor can cost $25 to $40 — or more — each month.

In the next two years, six of the nation's 10 best-selling drugs are expected to be available in generic form. They include Lipitor, which lowers levels of the bad (LDL) cholesterol; Actos, a blockbuster diabetes drug; and Plavix, which reduces the risk of deadly blood clots after surgery.

"The human scale of all this is unprecedented," said Michael Kleinrock, director of research development at IMS Health, a market research and information firm that tracks the health care industry. "For most of the last two decades, many of the most popular drugs were for large populations in the primary setting. When those drugs go off patent and become available, there are going to be big savings coming for patients."

More than $100 billion in annual brand-name drug sales will be at risk for generic competition from 2011 to 2015. That's about one-third of the annual spending on all prescription drugs in the U.S., according to IMS data.

Pharmacies and health insurance plans are expected to step up marketing and education to get consumers to use generics.

"You are going to see more and more people being pushed to generics," said Linda Bannister, health care analyst with Edward Jones in St. Louis. "For patients, I see a big dividend for the research the drug companies put in in the late 1980s and 1990s."

As for consumers' concerns about the effectiveness of generic drugs, doctors say the cheaper versions have the same active ingredients as their brand-name counterparts. Also, the Food and Drug Administration requires that these cheaper copies be as safe and effective as the patented versions.

The primary reason generics are cheaper is because the companies that make them don't have the expenses tied to bringing a drug to the market.

"The medical profession has struggled to dispel the perception that generics are somehow inferior, but it is simply bogus," said Dr. Caleb Alexander, an internist at the University of Chicago Medical Center and a pharmacoepidemiologist who studies the quality of prescription drugs as well as pharmaceutical cost issues. "(Generics) are the same."

Many of the brand-name drugs were launched in the 1990s, a golden age for the pharmaceutical industry when breakthrough treatments for some of the most chronic health conditions such as diabetes, high cholesterol and hypertension became available to the masses.

They have been credited with helping to reduce deaths as well as the need for expensive surgeries. The volume of open-heart surgery, for example, has dropped nationally since 1998, according to statistics from the American Heart Association.

But these expensive medications also have been blamed for a spike in health care costs. And their price has made them prohibitive for many Americans.

Certain brands cost $3 to $5 a pill, which quickly adds up for consumers who need to take them daily to manage their health conditions.

Pharmaceutical companies say they have to charge a premium to recoup their investment for research and development, which can reach into the hundreds of millions of dollars for just one drug. Patents are granted for 20 years, but drug companies have argued they have 10 years or less to market the product exclusively due to the many years it takes to discover, research and develop the drug before it is approved by the FDA.

The biggest impact for consumers will come from generic competition for Pfizer Inc.'s Lipitor, which has grown to be the top-selling drug of all time, generating more than $9 billion in U.S. sales at one point in its history. Competition from other statin drugs has started to make a dent in Lipitor's sales, which slowed to about $7 billion last year — an early sign of what Pfizer faces when its drug loses patent protection in November.

"Recognizing the significant role Lipitor has played in the cardiovascular health of millions of people with heart disease or risk factors for heart disease around the world, Pfizer is actively exploring how the Lipitor brand can continue to improve cardiovascular health following its loss of market exclusivity," Pfizer said in a statement to the Tribune.

Analysts note that drug companies typically find ways to fend off generic competition for as long as possible. There's the widespread tactic of creating "patent extenders," which involves slightly altering a brand-name drug by developing extended-release versions or prescriptions that require different dosages.

Some also try to protect their patents by taking makers of generic drugs to court, which can delay the release of cheaper copies by months. "The dates are a movable feast because there is always patent litigation, so the dates (of patent expiration) may move a little bit," Kleinrock said.

Meanwhile, makers of generic drugs eagerly await the opportunity to make cheaper copies, a business worth tens of billions of dollars around the world. The generic drug business has become a fast-growing industry, particularly in emerging economies such as India and China where consumers don't have as much money to spend on medical care and generics are a way to provide more affordable treatments.

Drugmakers have seen their sales take a hit after their generic versions are launched, often forcing them to cut thousands of jobs. To find other ways to make a profit, many companies have turned their attention to biotechnology drugs, specialized treatments derived from animal or human cells. Such therapies are booming as the medical industry sees biotech drugs to be more effective than older treatments, but they come with a higher price tag.

While biotech drugs are complex to develop and manufacture, making them very expensive for consumers, they can pay off for drug companies.

Take Abbott Laboratories, which bought Knoll Pharmaceuticals in 2001 for $6.9 billion largely to get a single drug.

In that deal, the North Chicago-based drug giant obtained Humira, a drug derived from human cells used to treat a variety of autoimmune diseases such as rheumatoid arthritis and Crohn's disease. Today, Humira is on pace to generate more than $7 billion in annual worldwide sales for Abbott.

Analysts see future drug development moving toward biotechnology as scientists look for ways to treat diseases and conditions that include cancer, multiple sclerosis and Alzheimer's disease.

"A lot of people think drug development is cyclical," Bannister said. "There are a lot of innovative medicines on the horizon. Hopefully, there will be new products."