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SHPS, a leading health advocacy and health benefits firm, today announced a contract with the North Carolina State Health Plan (State Health Plan) to offer intensive case management services to support plan members with complex medical needs. SHPS case management is a collaborative effort, where personal nurse advocates work with members and providers to coordinate, educate and counsel members on the appropriate care during acute health crises. By identifying at-risk members via health claims – in addition to the industry standard of pre-authorization calls – SHPS ensures members are reached in time to achieve significant health improvement and reduced costs. It leverages a sophisticated rules-based system to identify members, stratify them using more than 3,500 clinical rules and provide targeted interventions based on their unique risk profile. “For our members with severe illness, intensive case management services help us improve the member’s quality of care across medical care settings,” said Dr. Nancy Henley, medical director for the State Health Plan. “The program focuses on early identification and assists members with serious medical needs, including: multiple hospitalizations; a sudden, catastrophic event; a high-risk pregnancy; or an extended neonatal intensive care stay.” Chronic diseases made up almost 70 percent of the State Health Plan’s costs for members under the age of 65, as per the most recently available data. For that same year, 2004, medical benefits for a member with a chronic disease cost an average of $7,400, compared to an average of $800 for a healthy person’s care. “We appreciate the trust and confidence the North Carolina State Health Plan has placed in SHPS to provide this important, personalized service to members,” said Reed Keller, SHPS’ president, health management solutions. “Intensive case management services, when delivered appropriately, can provide members a source of support and security as they navigate different health benefits, providers and procedures. It is an extremely valuable service, and one that SHPS is pleased to provide State Health Plan members.” Keller believes that SHPS’ passion and extensive experience in working with government employers contributed to SHPS’ ability to win the business, citing a contract with the State of Alabama announced earlier this year. The State of Alabama’s State Employees’ Insurance Board retained SHPS for integrated health advocacy services, including disease management, utilization management, case management and a 24-hour nurse line. The State Health Plan’s case management services will be available through its healthy living initiative, NC HealthSmart, beginning January 1, 2008. “These services help us to ensure the appropriate care for our members, which in turn reduces health risks and controls healthcare costs,” said George C. Stokes, executive administrator for the State Health Plan. “The services provided by SHPS underscore the State Health Plan’s commitment to quality and cost-effective healthcare.” About SHPS SHPS provides a broad range of innovative health management tools, resources and services that empower consumers to make wise healthcare decisions. With comprehensive services that transform consumer health behaviors, SHPS’ integrated delivery system maximizes the value of consumers’ and employers’ healthcare dollars. Among its many clients, SHPS serves large and mid-sized employers, health insurance carriers, third party administrators, Medicare Part D providers and government agencies. The company employs registered nurses and health professionals, employee benefit specialists and IT experts in facilities across the United States. Visit www.shps.com. About the State Health Plan The North Carolina State Health Plan covers approximately 628,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, state hospital staff and their dependents. Dependents include spouses and unmarried children under age 19 (or under age 26, if full-time students). The State Health Plan also administers NC Health Choice, a fee-for-service program that provides health insurance to more than 116,000 uninsured children in North Carolina. Through the healthy living initiative, NC HealthSmart, the State Health Plan empowers members to make healthier lifestyle choices and become partners in addressing their health care needs. The State Health Plan is self-insured and exempt from ERISA as a government-sponsored plan.
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