CareEssentials
Our packaged care management solution, CareEssentials, is a great way to complement your health and wellness initiatives.
This valuable resource can help manage health care costs for your company by identifying high cost health areas that need attention, while offering targeted programs to control them.
Prevention, Utilization Management, Disease Management and Case Management programs are integrated into CareEssentials to provide your employees with the resources to make intelligent health care decisions.
- Prevention|
- MyHealthProfile and Lifestyle Management |
- myhealthIQ|
- Healthy Lifestyle Coaching|
- FirstHelp™|
- Options, Vitality and My Care First
- Great Beginnings Program for Expectant Mothers
Prevention
The lifestyle decisions your employees make today impact their health as well as the cost of health care, now and in the future. Our
Did you know?
- 3 out of 5 people are overweight or obese*
- 1 out of 4 smoke cigarettes*
- 3 out of 4 fail to get any regular physical activity*
- 4 out of 5 don’t eat enough fruits and vegetables*
* Center for Disease Control and Prevention. National Center for Health Statistics.
These behaviors can increase medical costs, ER visits, and sick days as well as lower productivity at your workplace. Find out how our prevention programs can help your company today.
Check out our prevention programs:
- MyHealthProfile health risk assessment and online Lifestyle Management Programs**
- myhealthIQ biometric screenings (for self-insured groups)
- Healthy Lifestyle telephonic coaching programs**
- FirstHelp 24/7 nurseline**
- Options discount program, Vitality member magazine and My Care First health and wellness website
** These programs are core to fully insured medical products; they are available for an additional fee for self-insured employer groups.
When you want to keep the healthy, healthy – start with CareEssentials.
MyHealthProfile and Lifestyle Management
Our health risk assessment tool, MyHealthProfile, is a vital part of CareEssentials. Your employees can take MyHealthProfile online and answer questions about their:
- Medical history
- Preventive practices
- Emotional health
- Lifestyle choices
MyHealthProfile produces a customized health report that identifies potential health risks and offers recommendations for healthier living.
The results of the assessment guide employees into the appropriate online lifestyle management, coaching, disease or case management programs.
Each employee is provided access to their personal health portal, which is where they will take MyHealthProfile and retrieve their report. Customized lifestyle management programs also are housed on this portal.
Lifestyle Management Programs
The lifestyle management programs are interactive tools designed to help employees improve their health by guiding them towards more appropriate lifestyle choices. We have program modules that address:
- Exercise
- Weight and nutrition management
- Smoking cessation
- Stress management
- Depression
- Medication compliance
Features of the programs include:
- Self-directed workbooks
- Targeted health-related articles
- Follow-up assessments
- Reminders
- Feedback reports
Employees will be mailed their confidential MyHealthProfile username and password based on their health plan effective date. This service is free and automatically scheduled for all fully insured groups. For a detailed mailing schedule, check out the 2009 MyHealthProfile mailing schedule.
And to help you and your employees get the most from MyHealthProfile/Lifestyle Management programs, check out our MyHealthProfile/Lifestyle Management communication resources.
myhealthIQ
myhealthIQ is a worksite wellness program that combines a health risk assessment tool and worksite screening. This program is only available for self-insured employer groups for a fee.
The health risk assessment tool mirrors our MyHealthProfile tool and comes with the lifestyle management programs as well.
myhealthIQ takes the health risk identification process beyond the dependency of an employee’s self-reported health and lifestyle data, by scoring key indicators captured from lab results and body measurements:
- Blood Pressure – Hypertension
- Body Fat Percentage – Heart disease, Diabetes, Hypertension, Cancer
- Cholesterol – Heart disease
- Body Mass Index – Obesity
- Nicotine – Cancer
- Triglycerides – Heart disease
- Glucose – Diabetes
- GGT – Liver function
For communication materials, check out our myhealthIQ communication resources.
Healthy Lifestyle Coaching
Those employees who have been identified by MyHealthProfile as having multiple health risk factors but not currently suffering from a chronic disease will receive more personalized attention to guide them into making better decisions about their health.
The Healthy Lifestyle Coaching program includes scheduled phone conversations with clinicians (health coaches) who are trained in Motivational Interviewing and Behavior Change Theory. Health coaches help employees set achievable short-term and long-term goals so they can make changes in their everyday health behavior.
Conditions managed include:
- Stress Management
- Smoking Cessation
- Weight Management
- Exercise
FirstHelp™
The FirstHelp program is our 24-hour, 7 days a week nurse help line. FirstHelp is staffed by registered nurses who can answer your employee’s general health care questions and help guide them to the most appropriate care.
How FirstHelp Works
- Employee calls (800) 535-9700 to speak with a registered nurse
- Employee explains symptoms (the information a member provides to a FirstHelp nurse is completely confidential)
- Nurse uses clinical background and advanced information research systems to help employee decide on best source of care
- Nurse may suggest self-care options, a call to the doctor and/or urgent or emergency care
Our FirstHelp nurses can answer questions and assist your employees in determining their options. They cannot, however, provide employees with:
- Benefit information
- Claims information
- Utilization management and pre-authorizations
Promote FirstHelp using these communication resources.
Options, Vitality and My Care First
Options Discount Program
The Options discount program offers discounts on a variety of health and wellness services from laser vision correction, hearing care services, fitness club memberships and mail order contact lenses, to alternative therapies such as acupuncture, massage therapy and chiropractic care. These discounts are available to all CareFirst members.
Visit our Options page for more detailed information on services available at a discount. Read more about the Options program by downloading our employee brochure.
Vitality
Vitality is our member health magazine that includes health and wellness articles to help employees achieve a healthier lifestyle. Each issue is filled with information such as food and nutrition, physical fitness and preventive health care tips, among other valuable information. Vitality is mailed to all of our CareFirst members.
View recent issues of Vitality or send this link to your employees so they can get monthly health news by e-mail.
My Care First
My Care First is our member health and wellness website. Employees can find information on more than 300 topics including nutrition, fitness, chronic illness and mental health. The site offers interactive tools such as weekly polls, quizzes and health calculators that are both educational and entertaining.
Visit My Care First or check out a flyer for your employees.
Great Beginnings Program for Expectant Mothers
Great Beginnings provides support and health information to women throughout pregnancy. The program is designed to supplement the prenatal care and education that employees receive from their doctor.
Case managers contact participating expectant mothers during each trimester and strive to help them stay as healthy as possible during their pregnancy.
Our Case Management program is fully accredited by the Utilization Review Accreditation Commission (URAC). See our other awards.
For more details on our case management services, check out our Case Management communication resources.
Utilization Management
Our Utilization Management services involve coordinating hospital care so employees receive the right care in the right place at the right time.
The Utilization Management nurses receive more than 2,500 calls each day for new admissions, continued hospital stays or transfers to home or hospice care. Our nurses work with your employees and their doctors to achieve medically appropriate, cost-effective health care.
The following reviews are completed:
- Prospective – pre-authorization process
- Concurrent – evaluation of hospital stays that are longer than expected
- Retrospective – medical data is analyzed for complex and high-cost cases
Utilization Management ensures that:
- care is provided in the most appropriate setting
- medical services aren’t duplicated
- focused care follows discharge
- drugs are prescribed appropriately
- services are coordinated between health care providers.
Disease Management
In the U.S., 70% of all health care spending is for care of chronic diseases. Unfortunately, half of these patients do not comply with their health care treatment plans, which may cause:
- increases in inpatient admissions, ER visits, overall cost of care, days lost of work, chances of complications and/or
- decreases in productivity, morale and overall health.
Through our Disease Management program, Care Managers offer information, personal support and coordination of physician care to employees with chronic diseases.
Care Managers focus on:
- educating employees about disease and prescribed medications
- ensuring employees follow recommended testing and exams
- developing an action plan for healthy living
Programs are available for:
- Asthma
- Diabetes
- Heart failure
- Coronary artery disease
- Chronic obstructive pulmonary disease (COPD)
- Low back pain
- Osteoporosis
- Osteoarthritis
- Hepatitis C
- Urinary incontinence
- Fibromyalgia
- Decubitus (pressure) ulcers
- Atrial fibrillation
- Inflammatory bowel
- Irritable bowel syndrome
- Acid-related disorders
Self-insured employers may also purchase programs for:
- Chronic kidney disease
- End stage renal disease
- Comprehensive back pain
- Depression
Disease Management participants will receive the following:
- Welcome packet and call
- Regular phone calls from Care Manager
- Care reminders
- Action plans
- Targeted educational materials
- Disease newsletters
CareFirst is one of only five health plans in the U.S. to have both the Disease Management Purchasing Consortium certification and the Health Industries Research Companies award for three years in a row. See our other awards.
Check out our Disease Management communication resources
Case Management
Accidents and chronic illnesses mean serious choices for your employees and their families. Registered nurses trained to work as patient advocates are assigned to high profile cases to:
- answer questions about the treatment process
- coordinate the care plan with patients, families and health care providers
- identify community resources
- provide emotional support
Types of conditions managed (but not limimted to):
- Catastrophic conditions
- Extended care hospitalizations
- Oncology
- Pediatrics
- Pregnancies
- Rehabilitation
- Serious trauma
- Terminal illnesses
- Transplants
Our Case Management program is fully accredited by the Utilization Review Accreditation Commission (URAC). See our other awards.
Check out our Case Management communication resources
Great Beginnings Program for Expectant Mothers
Great Beginnings provides support and health information to women throughout pregnancy. The program is designed to supplement the prenatal care and education that employees receive from their doctor.
Case managers contact participating expectant mothers during each trimester and strive to help them stay as healthy as possible during their pregnancy.
Our Case Management program is fully accredited by the Utilization Review Accreditation Commission (URAC). See our other awards.
For more details on our case management services, check out our Case Management communication resources.
Communication Support
The following resources can be used to promote the CareEssentials programs to your employees. Materials with an asterisk are available in print and may be ordered by contacting your broker or CareFirst Account Representative. Please note that a quantity limit may apply.
Self-insured groups should contact their CareFirst Representative for customization requests.
Resources marked by an asterisk(*) are available in printed copies. Quantities are limited. Please contact your broker or CareFirst representative to order.
| MyHealthProfile/Lifestyle Management | Resource Type | File Type |
|---|---|---|
| Introducing MyHealthProfile | Template Letter |  |
| A New Wellness Tool Developed Just for You - MyHealthProfile | Poster* |  |
| Introducing MyHealthProfile | Flyer* | |
| 4 Easy Steps to Complete MyHealthProfile | Flyer* | |
| MyHealthProfile Notification | Postcard* | |
| MyHealthProfile Reminder | Postcard* | |
| What's Next? After MyHealthProfile | Flyer | |
| Lifestyle Management Program | Postcard | |
| Commonly Asked Questions | Reference Document | |
| myhealthIQ | Resource Type | File Type |
|---|---|---|
| Introducing myhealthIQ | Template Letter | |
| Introducing myhealthIQ | Flyer | |
| 4 Easy Steps to Complete myhealthIQ | Flyer | |
| How to Prepare for Your Health Screening | Poster | |
| Disease Management | Resource Type | File Type |
|---|---|---|
| Introducing Disease Management | Template Letter | |
| Disease Management Program | Brochure* | |
| Manage Your Condidtion for a Fuller Life | Poster* | |
| My Care First Chronic Condition Centers | Flyer* | |
| Success in Managing Chronic Conditions | Article | |
| Personal Support for Health Challenges | Article | |
| E-mail Messages | Template E-mails | |
| Case Management | Resource Type | File Type |
|---|---|---|
| Case Management - English | Brochure* | |
| Case Management - Spanish | Brochure* | |
| Great Beginnings Program - English | Brochure* | |
| Great Beginnings Program - English | Poster | |
| Great Beginnings Program - Spanish | Brochure* | |
| Great Beginnings Program - Spanish | Poster | |
| Other CareEssentials Programs | Resource Type | File Type |
|---|---|---|
| CareEssentials Program Overview | Flyer* | |
| FirstHelp Nurse Line | Flyer | |
| FirstHelp Nurse Line | Poster | |
| Options Discount Program | Brochure* | |
| Vitality Magazine | Web Page* | |
| My Care First | Flyer* | |
| CareEssentials For The Employer | Resource Type | File Type |
|---|---|---|
| Playbook for fully-insured employer groups | Reference Document* | |
| Playbook for self-insured employer groups | Reference Document* | |
| Sample Communications timeline | Flyer | |
Resources marked by an asterisk(*) are available in printed copies. Quantities are limited. Please contact your broker or CareFirst representative to order.
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