ADVOCARE GROUP

ADVOCARE GROUP OF COMPANIES

ADVOCARE MCO | Managed Care OrganizationAdvoCare MCO offers knowledgeable, compassionate medical case management for injured workers and timely, effective cost-containment solutions for employers. AdvoCare MCO Nurse Case Managers work with injured workers, employers, and healthcare providers immediately from the First Report of Injury throughout the return-to-work process.

BENEFITS 1 GROUP | Third Party AdministratorA full-service Third Party Administrator (TPA), Benefits 1 Group designs and coordinates employee health, disability, workers’ compensation, and unemployment benefits programs, reducing health care costs and eliminating bureaucratic hassles. Benefits 1 Group provides accident/loss prevention, cost/ risk mitigation and claims management services.

VOCARE SERVICES | Field Case Management/Vocational Rehabilitation/Litigation SupportA professional rehabilitation company, VoCare Services, Inc.’s primary goal is to help injured or disabled employees return to work as quickly and safely as possible. VoCare provides field case management, job placement, return-to-work analyses, rehabilitation counseling, Medicare Set-Aside Agreements, litigation support and expert witness testimony services.

BEGIN PPO, INC. | Workplace Wellness / CAM Provider NetworkBEGIN works with companies interested in offering complementary and alternative medicine (CAM) benefit options, wellness incentives, and integrated health and wellness education to employees. BEGIN maintains an exclusive focus on building a comprehensive, holistic medicine network, ensuring that employees have access to qualified CAM practitioners and wellness resources and education.

ADVOCARE HEALTH SERVICES | Group Health & Case Management Services AdvoCare Health Services provides expert case management, utilization review, and bill processing on behalf ofself-insured employers with third party administrators. The Group Health services team of clinical and administrativeprofessionals educate and guide employees on treatment options and disease management, wellnessprograms, and maternity care.

SPECTRUM OF SERVICES

• Financial Management• Claims Administration • Workers’ Compensation • Group Health • Long-Term Disability • Short-Term Disability• FMLA / Total Absence Management• Safety Services• Drug-Free Workplace• Risk Management• Unemployment Claims Management• Pre-Employment Background Check• Integrated Systems Application

Third Party Administration

Group Health

• Case Management• Disease Management• Maternity Management• Utilization Management• Wellness

• ADAAA Employer Consultation Services• Case Management• Career Counseling• Transferable Skills Analysis• Job Placement Assistance• Transitional Work

Field Case Management/Vocational Rehabilitation

• Medical Case Management • Occupational • Non-Occupational

• Utilization Management

• Bill Review/Processing• Tailored Reporting

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• ADAAA Employer Consultation Services• Expert Witnesses• Life Care Plans• Vocational Opinions• Medicare Set-Aside

Litigation Support• Credentialed Holistic Health Advisors• 2200+ Qualified Preferred Providers• Health & Wellness Services

BEGIN PPO

Managed Care Organization

ADVOCARE HEALTH SERVICES & ADVOCARE MCO

• Utilization Review• Bill Processing• Maternity Management• Disease Management• Disability Management

• Wellness Programs• Return-to-Work

Strategies• Dispute Resolution

Services

GROUP HEALTH SERVICES & MANAGED CARE

AdvoCare is a leading Group Health and Workers’ Compensation Managed Care Organization (MCO) offering knowledgeable, compassionate care for injured workers and timely, effective solutions for employers. Our healthcare expertise, dedicated teams, effective processes, and state-of-the-art information systems combine to create the AdvoCare Advantage for injured workers and employers.

COMPREHENSIVE SERVICES

ADVOCARE

• Dedicated Nurse Case Managers• On-site visits to review lost-time claims• Diligent monitoring of cost and quality of

care• Physician treatment plans and protocols• Grant and discount program guidance• Education on how to handle an injury and

keep workers’ compensation costs to a minimum

• Readily available customer service specialists to answer any questions or challenges

• Experts available to handle catastrophic injuries

• Nationally recognized medical guidelines that are used to monitor providers, allowing for consistent, quality care based on the leading industry practices

MEDICAL CASE MANAGEMENT

AdvoCare Medical Case Management is a core strength of our team, which includes our physician Medical Director and Nurse Case Managers who work on individualized plans for every customer need.

WHAT TO EXPECT

VOCARE SERVICES, INC

FIELD CASE MANAGEMENT/ VOCATIONAL REHABILITATION

VoCare Rehabilitation Services provides injured workers and individuals with disabilities a complete portfolio of services including, but not limited to, Case Management, Employability Analyses, Vocational Counseling, Vocational Opinions, and the coordination Occupational and Physical Therapy both on- and off-site.

These services have one simple aim: to get injured and disabled individuals back to work safely and as quickly as possible.

• Vocational Assessments• Job Analysis• Transferable Skills Analysis• Job Placement Assistance

• Labor Market Analysis

• Employability Assessments• Skills Enhancement/ Work Adjustment

SERVICES

VOCARE SERVICES, INC

FIELD CASE MANAGEMENT/ VOCATIONAL REHABILITATION

The average case is referred to VoCare Services 90 days after a claim has been filed and an injured worker has been off of work. Research shows that after 12 weeks of absence, an injured worker is 50% less likely to return to the job. Our field case managers have a proven record of meeting these challenges resulting in positive return-to-work outcomes at any stage of a claim.

A leader in returning individuals to work quickly and effectively, VoCare Services boasts 50 - 75% return-to-work rates, while our competitors report 40 - 47%

RTW rates on average.

VOCARE SERVICES, INC

LITIGATION SERVICES

VoCare Services Litigation Support experts provide specialized training to assist in the resolution of cases involving serious or catastrophic injury, commercial casualty, product liability and medical malpractice. The development of Life Care Plans, the management of those plans, and Vocational Opinions are also part of its portfolio of services.

Our team of consultants carries credentials including registered nursing, rehabilitative counseling, certified life care planning, and Medicare Set-Aside certification.

VoCare Services provide the following:

• Life Care Plans• Cost of Future Care Plans• Employability Analysis• Vocational Expert Opinions• Guardianship Assistance Services• Medicare Set-Aside Arrangements

THIRD PARTY ADMINISTRATION

Benefits 1 Group provides Third Party Administration (TPA) cost control solutions designed to help employers hold down healthcare costs associated with workers’ compensation and related employee absence while offering needed employee benefits. From strategy to implementation, the experts at Benefits 1 Group offer over 150 years of specialized expertise and a one-stop source for coordinated employee health, disability, and workers’ compensation benefit needs including:

INTEGRATED SERVICE

•Discount Programs & Cost Controls•Case & Policy Management•Return-to-Work Services•Risk Assessment, Financing, and Management•Unemployment Claim Administration & Planning•Claims Management

•Case Management•Accident and Loss Prevention•Long-term Disability (LTD)•Short-term Disability (STD)•Absence Management•Safety & Wellness Programs

THIRD PARTY ADMINISTRATION

Benefits 1 Group claims examiner cases are limited to a company-imposed restriction that is, in some cases, less than 50% of the claims load carried by claims examiners at other TPAs. This ensures quality and maximum oversight.

• 150+ years combined experience

• The highest standards of integrity

• Fine-tuned, yet adaptable practices

• Timely reporting

• Dedicated Claims Adjusters• Hearing representation

• 1992-NIH created Office of Alternative Medicine (OAM)• 1998 OAM became freestanding center of NCCAM w/ $50 million

budget• 40% of all U. S. adults use some form of CAM• Between 1990 and 1997 the total number of CAM visits has increased

50%• By 1997 total CAM visits exceeded total number of visits to primary

care physicians• Out of pocket expenditures for CAM range from $27 - $34 Billion

History of CAM

• Patients do not often tell primary care doc about CAM use• This helps explain controversy• Skeptics charge persons using CAM less educated – actually reverse is

true• Consumers of CAM are highly educated and believe in importance of

body, mind, and spiritual health• Ultimate goal of CAM Therapies is not to supplement modern medicine

but rather to integrate validated alternative approaches with the best of current conventional practices

Insights

HOLISTIC APPROACHES TO HEALTH & WELLNESS

• Holistic Health Coaching• Guidance/pre-certification hotline• Full time physician support• Access to 2,200+ nationally credentialed CAM Providers• Online access to CAM education and resources• Forms for billing• Provider directory• Replacement ID cards for members

For Plan Participants

Wellness & Complementary Medicine

AVAILABLE SERVICES

•Acupuncture•Allergy/Sensitivity Management•Biofeedback•Bio-identical Hormone Therapy•Botanical Medicine•Chelation Therapy•Craniosacral Therapy

•Essential Oil Therapy•Homeopathy•Hyperbaric Oxygen Therapy•Hypnotherapy•IV Therapy•Longevity Therapy•Medical Nutrition

•Prolotherapy•Reflexology•Reiki•Rolfing•Therapeutic Massage •Therapeutic Yoga •Thermography

Wellness & Complementary Medicine

• The goal of the CAM PPO process is to uphold the highest standards of practice, advancing CAM and empowering patients. Seeking a CAM provider can be confusing, and few patients have the time or resources to investigate practitioner education and related criteria.

• CAM PPO credentialing impacts the caliber of every network practitioner, and communicates our commitment to quality to members, prospective providers, and employers. Our process helps to

Minimize risk of harm for employees seeking CAM treatment options Empower patient confidence in care Enhance provider confidence in the professional standards of the

Network Ensure CAM PPO of America, Inc. functions in the highest interests of

members and affiliates Advance the credibility of CAM treatment options Medical Director maintains direct oversight of the credentialing process

with responsibility to uphold the criteria outlined in CAM PPO’s internal standards & licensing requirements

Credentialing

Credentialing (cont)

The process includes an extensive analysis of each applicant, including:

Provider license verifications Confirm consistency in scope of practice and license

Insurance status Investigate any issues, if needed

Certifications in CAM techniques and approaches Evaluation of board certifications, Accreditation of education,

and relevant continuing education Professional Memberships and Affiliations

Establish expertise in CAM

Precertification with concurrent review helps to curb abuses, controls costs, and assures high quality care.

• Checks and balances using UR helps control the obvious abuses/problems

• Medical diagnosis and authorizations mandated for coverage

• Payments for treatment must be within Network

• Partnerships with providers enhances quality care

• Art in not ‘handcuffing’ provider but promoting effectiveness and maintaining accountability

Medical Management

Worksite Wellness services are programs provided to employees with a primary purpose of improving employee health by preventing or delaying the onset of chronic disease or illness.

Chronic disease is the leading cause of direct healthcare costs. In fact, 75% of all healthcare costs are preventable chronic health conditions such as type 2 diabetes, hypertension and obesity.

Chronic disease significantly contributes to lost workplace productivity, disability and absenteeism.

Comprehensive Workplace Wellness Program

• Corporate culture values employees as key business asset• Multiple locations / states – present decentralized management of TAM

issues• Committed to leveraging innovative technology as a solution • Seeks innovative solutions to HR / Benefit / Risk Management issues • Strong commitment to a RTW philosophy for all employee absence

events • Strong commitment to equitable, unbiased treatment of all employee

absence / leave / disability events• Concerned about the “total costs” of employee absence / lost

productivity • Concerned about reducing exposure to HIPPA, GLB, EPL and Labor

Relations issues• Wants to gain competitive edge over their own business competitors

Companies that are good candidates for wellness

• Is anchored in the three areas of appropriate CAM treatment to include, primary intervention, secondary intervention, and prevention and on-going care for optimal health and wellness.– Ability to recommend alternative medicine therapies or traditional medical

therapies as appropriate to the diagnosis– Work with diverse populations and troubleshoot medical problem– Employees easily obtain CAM service– Employees being able to work with one advisor who can facilitate and

implement CAM service– Review treatment requests and complete intake assessment– Provide current CAM protocols/costs/and quality of care

Holistic Health Coaching

Holistic Health Coaching

Cost containment benefits of Holistic Health Advisor:• Effective Holistic Claims management• Efficient implementation and follow up• Increase productivity

Implement Proactive solutions and benefits for using• Preventive and sustainable healthcare and wellness interventions• Less invasive therapies first• Self-care education

• Advise and educate employees/employers on both traditional and integrative medicine

• Help identify integrative providers to implement a patient care plan

• Provide self-care education• Help employees increase productivity in work and life situations• Build lasting relationships with employee/providers to continue

preventive and self care practices• Monitor costs and quality of care

Holistic Health Coaching

The overall role of the Holistic Health Coach is to:

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WORKPLACE WELLNESS PROGRAMS

• BEGIN Wellness considers the health needs and risks of each unique client and its employee population. The program is confidential, results-driven, and educational program intended to lower the cost of health care through prevention and intervention

Screening for On- and Off-Site Participants• Health Risk Assessment• Health Fair and Biometric Screening /

Packets• Testing, feedback, food, etc.• Outcalls to at-risk people (top 25%)• Organizational Health Assessment

SERVICES

ABOUT

INTEGRATED MEDICINE PREFERRED PROVIDER NETWORK

BEGIN works with companies interested in offering complementary and alternative medicine (CAM) benefit options, wellness incentives, and integrated health and wellness education to employees.

ABOUT

• Access to 2200 credentialed national providers

• Exclusively focused on building a comprehensive, holistic medicine network

• Pre-Determination hot-line with access to Nurse Case Managers with Holistic Health Advisory Credentials

• Support and education required to truly and positively impact an individual’s health

• Telephonic nurse case managers / holistic health advisors

SERVICES

Comprehensive Workplace Wellness Program

• The radical changes necessary in health care reform are occurring rapidly. Change has always been the rule in health care. These changes provide us with greater opportunity to integrate caring, healing, work, and research into our lives. It is up to each one of us to help determine what these changes will be.

Conclusion