Care Management Client Administration Guide

Health and Wellness Overview

The UMR Health and Wellness program is designed to assist your members in lowering their risk for future disease . A member who understands their overall health picture and engages in healthy lifestyle choices is less likely to develop a chronic, costly and often debilitating condition in the years to come.

The Focus
At the core of the UMR Health and Wellness program is an assessment process that gathers data and then stratefies, identifies and targets interventions for people at various risk levels and risk types.  Education, goal setting and individualized health coaching are essential to the program's success.  Education, goal setting and individualized health coaching are essential to the program’s success.  Health coaching is offered to participants at highest risk to develop chronic health conditions in the future. The highest risks include:
  • Pre-diabetes
  • Heart disease risk
  • Multiple lifestyle risks
  • Tobacco use with readiness to change
In this program, all members are asked to complete a Clinical Health Risk Assessment (CHRA) and on-site biometric screening. Biometric screening includes blood pressure measurement and blood tests that measure cholesterol levels and glucose.
Based on the CHRA analysis, high-risk members are invited to participate in up to ten coaching sessions by phone with a health coach who is experienced in working with a wide variety of people interested in making lifestyle changes. Once the coaching sessions are complete, the member is asked to provide feedback about the sessions to help us keep you up to date with information about the value of the program.
We strongly encourage using incentives in conjunction with the UMR Health and Wellness program to maximize participation and overall program success. Incentives should be available for members at all risk levels to encourage participants to meet program objectives. UMR Care Management would be happy to discuss incentive ideas with you.
Note : Incentives including gift cards may be considered taxable income for the member.
Clinical Health Risk Assessment
The CHRA tool allows us to gather a member’s health information, such as personal and family health history and lifestyle habits, that is critical to the assessment of future risk for chronic health conditions. Conditions that qualify for engagement in the coaching program are discussed in the coaching section of this document.
UMR Care Management has partnered with Protocol Driven Healthcare, Inc. (PDHI) to electronically collect and stratify CHRA data. By feeding data gathered in the CHRA through PDHI’s stratification engine, we can successfully identify those members at highest risk for developing a future chronic health condition. The privacy of personal health data is strictly maintained under HIPAA guidelines.  
The CHRA is available in two formats, online and paper. A Spanish paper version is also available. You will be asked to assist by distributing the Member Enrollment Instructions document electronically or as hard copy to your employee group. Also included in this document are the compliance rules required for a member to retain their incentive. Your UMR Transition Leader will assist in creating the documents. A copy of the Member Enrollment Instructions and Compliance Rules is included as an attachment to this Client Administration Guide.
CHRA Open Period
During the implementation process, the UMR Transition Leader will ask your representative to determine what period of time they want to designate for members to complete their CHRA. Our recommendation is to limit the CHRA open period to four weeks, maximum. This limitation was found to be the most effective in terms of both member engagement and timely initiation of coaching and other program activity. The four week open period will be valid for both paper and online submission of the CHRA. If it is determined that the CHRA open period must be longer than the four week maximum, this need must be communicated as soon as possible so the impact on program deliverables, including reporting, can be assessed.
CHRA completion status reports are delivered to you by theAccount Manager twice during the CHRA open period. The reports give you the opportunity to send reminders to those who have not yet enrolled while there is still time during the open period. An End of Period HRA Activity report is delivered about two weeks after the CHRA open period has ended.
Member CHRA Reports
Approximately 4-6 weeks after the CHRA open period has ended, a Clinical Health Risk Assessment Report that includes a cover letter will be sent to the participant’s home. The information in this report communicates the stratified results of the CHRA. The member can use this information to see how their health compares to nationally accepted standards. A sample CHRA Report is included in the Attachments section of this guide.
Onsite Biometric Screening
The UMR Health and Wellness program offers onsite biometric screenings to obtain additional information about the health of program participants. Currently, screenings include weight, blood pressure, glucose and cholesterol levels (total cholesterol, LDL, HDL and triglycerides). You may or may not have decided to provide on-site screenings for your participants. If so, specific details regarding the dates, times and procedures for the screenings will be provided by the UMR Transition Leader. Preferred dates for on-site screenings must be confirmed at least six weeks in advance by your representative.
Note: A significant cancellation penalty occurs for a screening that is cancelled with less than two weeks notice!
The on-site screening coordinator from your company will be responsible for coordinating lab sign-up times by participants, securing and setting up the on-site screening area(s) and securing access to the building(s) for screening personnel.
If a member is unable to attend the onsite screening session, two options are available. The UMR Transition Leader will provide the necessary forms.
  • Option #1 Participants may submit recently completed (3 months or less) blood work by their health care provider.
  • Option #2 Participants may go to their health care provider and have blood work completed. The participant may then submit the results.
UMR Care Management utilizes a comprehensive recruitment/enrollment approach. We first contact individuals identified as high risk via a welcome letter, followed by two outbound recruitment calls, if needed, at various times of the day. If no response is received, we mail an ‘ unable-to-contact’ letter. Thirty days later, if the member still has not responded, we mail an attention-grabbing, recruitment brochure outlining the benefits of health coaching and reasons why members should participate. This brochure introduces the stages of change model. The 30-day waiting period gives the targeted member an uninterrupted period of time to think about our invitation. The brochure serves as our final opportunity to convince the member to enroll.
Our enrollment specialists have been trained in customer service and engagement techniques. Once we successfully contact a potential participant, our enrollment specialists, trained on the behavioral change model, schedule the first health coaching call.
For members who chose not participate or do not respond to our contact attempts, we provide educational materials through the mail and also offer additional encouragement for them to enroll in the program.
Health Coaching
UMR requires our Health Coaches to have a minimum of a Bachelors degree in a related health field and must have or obtain a coaching certification without one year. Health Coaches are much more than a source of health information. Trained in behavior change techniques, they become a partner to the member in the change process. They help the member zero in on their readiness to change so they are better prepared to move forward. Coaching includes goal setting and specific behavior steps that help lower the risk for future health problems.
Health Coaching phone sessions are by appointment and scheduled to meet a member’s availability. Generally, coaching is conducted 7:00 a.m. to 9:00 p.m. CT, Monday – Thursday and 7:00 a.m. to 5:00 p.m. CT, Fridays and on weekends as requested. Health Coaches focus on behavior change in the following areas:
  • Eating habits
  • Weight loss and/or management
  • Activity and exercise
  • Stress
  • Tobacco use
  • Personal health management
The Health Coach and member will typically meet seven to ten times for one-on-one phone conversations over a period of 6-8 months. The Health Coach will provide the member with educational materials such as the Eight Weeks to Wellness Guide that helps the member set goals, change habits and learn about healthy lifestyle choices. Health Coaches will provide links to Web-based information and materials from nationally accredited organizations, and share their in-depth knowledge based on years of working with a vast variety of members.
Health and Wellness Coaches
The Health and Wellness team of Health Coaches includes professionals from a variety of specialties, including dieticians, nurses, health educators and exercise physiologists. Health Coaches are required to have a minimum of 2 years direct health education/coaching experience. They complete a Wellness Coach certification program through Wellcoaches® that provides 25+ hours of behavior change training.
Ongoing Member Communication
It’s important to keep wellness in the forefront of employee’s minds throughout the year. UMR has developed some program materials to assist with this.

If purchased as a program option, our quarterly newsletter “ Healthy Living” will be sent to each participant employee. The newsletter is produced through a partnership with Hope Health, a nationally recognized leader in health education. The award-winning format is reader friendly and written in a casual style that is both comfortable for the reader and fun. Each issue contains evidence-based, medically reviewed, health information. The newsletter contains useful and interesting health tips, helping employees understand the value of their health benefits, become smarter consumers of health care and lead healthier lives.

The UMR Health and Wellness program provides a teleseminar ten times a year (this year’s schedule is included in the Attachments section) open to all employees. The teleseminars are presented by our Health Coaches and provide the latest information on health, nutrition and lifestyle topics.

12-Month Communication Schedule
UMR Care Management provides a 12-month Health and Wellness Communication Schedule (included in the Attachments section) that includes program posters, flyers and short articles suitable for your company newsletter and/or intranet. The communication plan includes important health and wellness information and helps keep the program in front of your participants.

Billing – for “Fee for Service” customers
In most cases, an invoice will be delivered monthly. Any costs associated with the CHRA, newsletters or coaching sessions will be included in your UMR invoice. You will be invoiced for each (unique) CHRA (paper or online) initiated, regardless of whether every field is completed.
Program Results and Reports
The Health and Wellness program provides a variety of reports to show the value of the program and keep you on track with regard to member compliance. The following outlines the standard reports we provide to you, a brief description of each report and the timing in which the report is delivered.
Report Name
Clinical Health Risk Assessment Activity Report
CHRA Activity Report - This report provides status of completed and incomplete Clinical Health Risk Assessments to date. A member list is included with each report indicating who has and who has not completed a CHRA.
End-of-Period Report – This report also includes graphs and percentages of the population in various lifestyle (activity, nutrition, stress, tobacco, weight) and biometric (labs and b/p) risk categories.
·      Two times during open enrollment
·       An End-of-Period report (EOP) is delivered 2 weeks after the CHRA open period ends
Health and Wellness Coaching Program Participation Report
This report provides:
  • Number and percentage of members eligible to participate in health coaching
  • Number and percentage of cases still in recruitment
  • Number and percentage of members who refused/quit/did not respond to program invitation
  • Number and percentage of members who completed all coaching sessions
  • Number and percentage of members with invalid contact information
  • Number and percentage of termed members
Member Compliance Report
This report includes member compliance information in these areas:
  • CHRA activity
  • Lab activity for those groups with labs
  • Enrollment and Participation in Coaching = those cases that are open and being actively worked
  • Rating the health coaching participant
Member Satisfaction Survey Results
This report provides feedback from the Member Satisfaction Surveys
Annually (included in the Annual Report)
Annual Report
This report provides:
  • Year-to-Year comparison (if applicable) of CHRA participation, age/gender breakdown, risk factor analysis, and self-perception of health analysis
  • Year-to-year comparison (if applicable) of group nutrition, physical activity, tobacco and stress profiles
  • Health coaching outcomes – baseline and post-coaching outcomes
  • Results of member satisfaction survey (if available)
  • Our conclusions and recommendations for your group
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