6198-4 Employee Health Clinic mgmt Svcs Supplemental Info Ex 4/
RFP # 6198
Employee Health Clinic Operations and Management Services
Exhibit 4
RFP 6198 Exhibit 4
Employee Health Clinic Operations & Management Services
Supplements:
Supplement A – Health Risk Assessment Lab Draw Test Summary
Supplement B – Top 20 Drugs in 2015 by Volume
Supplement C – Top 20 Drugs in 2015 by Total Spend
Supplement D – Medical Payments by Benefit Type and Diagnosis in 2015
Supplement E – Clinic Utilization Summary
Supplement F – Floor Plan of Existing Clinic Space
Supplement G – City of Denton Healthy Incentives Program Summary
SUPPLEMENT A
HEALTH RISK ASSESSMENT (HRA) LAB DRAW TEST SUMMARY
The City of Denton’s current HRA lab draw and test includes the following:
CMP12
LP
6AC (CPT codes 80054, 80061
Hemoglobin A1c (CPT code 83036)
CBC w/ differential (CPT 85025)
SUPPLEMENT B
TOP 20 DRUGS BY VOLUME IN 2015
Levothroxine Sodium
Fluticasone Propionate
Lisinopril
Montelukast Sodium
Omeprazole
Amoxicillin
Azithromycin
Atorvastatin Calcium
Hydrocodone-Acetaminophen
Amlodipine Besylate
Pravastatin Sodium
Tramadol HCL
Amox TR-Potassium Clavulanate
Crestor
Pantoprazole Sodium
Simvastatin
Sertraline HCL
Linsinopril-Hydrochlorothiazide
Prednisone
Armour Thyroid
SUPPLEMENT C
TOP 20 DRUGS BY TOTAL SPEND IN 2015
Gleevec
Crestor
Revlimid
Serostim
Humira
Lantus Solostar
Enbrel
Noxafil
Concerta
Vyvanse
Nutropin AQ Nuspin
Adderall XR
Copaxone
Cialis
Lialda
Humalog
Metformin HCL ER
Orencia
Duloxetine HCL
Invokana
SUPPLEMENT D
MEDICAL PAYMENTS BY BENEFIT TYPE
AND DIAGNOSIS IN 2015
By Benefit Type:
Prescription Drugs
Outpatient X-Ray & Lab
Outpatient Hospital Miscellaneous
Outpatient/Professional Medical
Inpatient Hospital Room & Board
Inpatient Hospital Miscellaneous
Emergency Room
Surgery
Pharmacy – Health
Anesthesia
By Diagnosis:
Muskulo Cnctv Tissue
Neoplasms
Other Conditions
Endcr Nutri Metabolic Immun
Genitourinary System
Digestive System
Injury and Poisoning
Circulatory System
Respiratory System
Nervous System/Sense Organs
SUPPLEMENT E
CLINIC UTILIZATION SUMMARY
SUPPLEMENT F
FLOOR PLAN OF EXISTING CLINIC SPACE
SUPPLEMENT G
CITY OF DENTON HEALTHY INCENTIVES PROGRAM SUMMARY
/
The City of Denton will continue with the voluntary “Healthy Incentives Program” (HIP) for employees to promote wellness and healthy lifestyles, with changes to the component requirements
for the 2015/2016 period. The employee must earn a minimum of 2,000 activity/wellness points (“healthies”) throughout the year to qualify for the lower premium in 2017. Points can be
earned in various ways, and include meeting health indicator benchmarks (see #2 below), completing online programs on CareHere Connect, and completing City of Denton wellness activities.
The EMPLOYEE is responsible for reporting all programs and wellness activities online at www.CareHere.com to receive credit toward their “healthies” point total. CareHere staff will
record the total HRA-related benchmark healthies earned through their electronic medical record on CareHere.com.
The following components of the program must be met in order to qualify for the lower employee health insurance premium rate in 2017. All activity must be within the timeframe of Nov.
1, 2015 – Oct. 31, 2016.
The employee MUST complete the health risk assessment (HRA), including blood work, at the City of Denton Health Center, and complete a follow-up appointment WITH A Health Center Provider,
to review HRA results.
HRA, blood work, and follow-up appointments must be completed between November 1, 2015 and Jul 31, 2016, as early as eleven (11) months from the 2015 HRA blood draw date.
Each benchmark that the employee meets below is worth 100 healthies for a total of 500 healthies, if all benchmarks are met. CareHere staff will record the total HRA-related points earned
for the employee online through their electronic medical record on CareHere.com. Even if you don’t meet all five of the benchmarks, you may still be able to earn 2,000 healthies by
working with the CareHere staff, diligently working any plans that are established for you, and participating in other Activity/Wellness point offerings.
Health Indicator
Benchmark (as determined by CareHere Medical Director)
Body Mass Index (BMI)
30 or less (or a waist circumference within normal limits - Male <= 40 inches or Females <= 35 inches)
Blood Pressure
140/90 or less (May be repeated once 15 minutes past original elevated BP. If BP is still 140/90 or greater, it does not meet benchmark.)
Cholesterol Level
220 or less (or Total Cholesterol/HDL ratio is within normal limits)
Blood Glucose Level
Below 100mg/and A1C <5.7
Tobacco (all types, including E-Cigs)
Patient is Tobacco Free for past 12 months
NEW this HIP period – employees who meet all five benchmarks will earn an additional 250 bonus healthies.
Employees who do not meet one or more of the benchmarks will be required to complete a program specific to the benchmark not met (selected by a CareHere Provider), i.e., elevated blood
glucose level will require the employee to complete a diabetes management program.
Programs vary in length, between three (3) to ten (10) weeks; and
Program must be completed no later than October 31, 2016.
Employees will need to earn additional points (to reach the total of 2,000 or more) by:
Completing plans/activities on CareHere Connect as recommended by the health center Provider; and
Reporting completion of City of Denton approved Wellness Activities listed online in your CareHere Electronic Medical Record (EMR)’s Task List” by Oct. 31, 2016.
The employee must maintain their activity records throughout the year (receipts, EOBs, etc.) in the event they are audited and have to provide documentation to verify their activity.
Activities vary on the point value allotted, depending on the type of activity, and are noted on the list of approved activities.
CareHere will provide a final report to the City of Denton in November 2016, outlining the employees that completed the HRA, blood work, follow up visit, and reached 2,000 “healthies”
or more to qualify for the 2017 Healthy Incentives Program.
ACTIVITY/WELLNESS POINTS
As part of the City of Denton HIP, employees must earn activity/wellness points (“healthies”) throughout the year. Points can be earned by working Wellness programs and daily tasks on
CareHere Connect and completing City of Denton specific activities described below. NEW THIS YEAR! Total points from benchmarks met, CareHere Connect programs/tasks completed, and
City of Denton activities reported will be available to view in ONE PLACE…in your CareHere patient EMR! There should no longer be any delay in points reporting for Benchmarks met!
You will receive a step-by-step instruction guide by October 31, 2015. The following list should help you keep track of your activities throughout the plan year. All online or wellness
activity points must be earned between November 1, 2015 – October 31, 2016.
*Points assigned by CareHere
Activity/Wellness Points
(As Appropriate, Based on Age and Gender)
Point
Value
Date Completed
(for your records)
EMPLOYEE Blood draw/HRA &
Provider Follow Up Visit at Employee Health Center*
Up to 500
Bonus for employee who meets all five benchmarks*
250
SPOUSE Blood draw/HRA at Employee Health Center
25
SPOUSE Provider Follow Up Visit at Health Center
75
Colorectal Cancer Screening
100
Breast Cancer Screening (Mammogram)
100
Annual Physical/Wellness Exam
75
Annual Eye Exam
75
Annual Dental Cleaning/Preventive Exam (up to 2/yr)
50 each
Prostate Screening Test (PSA)
75
Skin Cancer Screening by Physician
75
Cervical Cancer Screening (Pap Test)
75
Thyroid Disease Screening (blood test or scan)
75
Online Tobacco Cessation Course*
Must enroll through City of Denton Risk Department and must be a tobacco user; programs have start/end date and are worked through CareHere Connect with Health Coach Support
250
Oral Cancer Screening
75
Bone Density Screening
50
Annual Flu Shot
50
2016 National Start Walking Day
50
Attend 2016 Financial Wellness Fair
50
Attend 2016 Benefits & Wellness Fair
50
Donate Blood through Carter BloodCare (max 3)
50 each
Additional points may be earned through on-line activities by visiting www.carehere.com
Points will vary
Earn points for email or telephonic Wellness consulting session with CareHere Health Coach.*
Points will vary
Total Activity/Wellness Points Accumulated
(HRA benchmark points will be added to the employee record online by CareHere staff)
Benchmarks + Assigned Program Completion + Activity/Wellness + Online Activity must be equal to or greater than 2,000 points
The employee must maintain their activity records throughout the year (receipts, EOBs, etc.) in the event they are audited and have to provide documentation to verify their activity.
The City of Denton will take into account the applicable provisions of the ADA when implementing our wellness program. First, the City will act upon any reasonable accommodation requirement.
Second, the City will not make any disability-related inquiries. Our program will comply with the ADA’s reasonable accommodation requirement, and the City will engage in an interactive
process with the disabled employee to develop a reasonable alternative that satisfies the goals of the wellness program and the individual’s need for a reasonable accommodation. See
42 U.S.C. § 12102(1); C.F.R. 1630.2.