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Oxford ConditionManagement Programs:Helping your employees learn,be encouraged and get support.

Committed to helping improve the health and well-being ofthose we serve — and improve the health care system at large.Our condition management programs are designed to help your employees — and all eligible participants of yourOxford plan — enhance self-care, identify warning signs and access resources for assistance. When individuals withchronic health issues better understand their condition, they can work more closely with their physician to manageit appropriately. This level of awareness and support may help reduce the need for urgent or emergent services.Better informationmeans better decisions. A holistic approach. ll of these touch points help us to gain more insights intoAthe member’s total care, allowing faster gap identificationto drive meaningful change — more relevant memberengagement, improved clinical outcomes and reducedcosts. Our proprietary clinical technology uses themember information we capture to activate personalizedhealth care management, providing a more coordinatedand holistic view of each member.We strive to educate our members about making smartchoices when it comes to their health, treatment optionsand physicians. By developing trusted relationships, wecan reinforce and support physician treatment plans andhelp your employees get the most out of their careencounters. Better information may help eliminateunnecessary procedures, reduce complication rates andimprove medical outcomes for higher quality care, greaterefficiency and lower costs.Targeted, transparent solutions. e can direct our condition management solutionsWspecifically to chronic and complex conditions where self-careand appropriate referrals to participating physicians maymake a significant health and financial impact. Many times,our interventions are triggered without any effort from you oryour employees. We identify individuals who could benefitfrom our solutions through:Did you know? Predictive modeling using more than450 evidence-based rules.Chronic diseases are responsible for seven of 10deaths each year, and treating people with chronicdiseases accounts for 86 percent of our nation’shealth care costs.1 Health assessments. Claims, pharmacy and lab data. Emergency department visits and hospitalizations. Nurse line (Oxford On-Call ) referrals. Member, caregiver and provider referrals. Fully synchronized pharmacy and care managementsystems, processes and teams that work toward creatingdeeper insights to members’ conditions and care.3

Overview of programs.Care CoordinationCoronary Artery Disease and DiabetesThe Care Coordination program proactively facilitates andcoordinates the care for Oxford members with chronic orcomplex conditions. The program encourages wise healthcare decisions by providing members with access to medicalinformation and clinical resources at several points of contact.Cardiovascular diseases account for more than one-thirdof all U.S. deaths. Treatment of these diseases accounts forabout 1 of every 6 spent on health care in this country.3The Coronary Artery Disease (CAD) program for Oxfordmembers is designed to help individuals manage theircondition and risk factors, in an effort to prevent heart attacksand unnecessary emergency room visits and hospitalizationswhere possible.Features include: Transitional Case Management (TCM)Support for members who are in transition from aninpatient setting to a home setting. In an effort to preventavoidable readmissions, TCM consists of dischargefollow-up and case management. The TCM teams workclosely with members and their physicians to supportand reinforce treatment plans, emphasizing symptommanagement and patient empowerment.People with diagnosed diabetes, on average, have medicalexpenses approximately 2.3 times higher than whatexpenditures would be in the absence of diabetes.4 Thegoals of the diabetes program are to help individuals bestmanage their condition, including blood glucose levels andrisk factors, reduce unnecessary emergency room visits andprevent disease progression and other illnesses related topoorly managed diabetes. Complex Case Management (CCM)Provides access to specialized nurses as well as otherresources that can assist in better managing a member’shealth and coordinate the member’s health care needs.By collaborating with members and their physicians,or other health care professionals, the nurses are able tofacilitate access to health care services. They also providesupport for health-related decisions, which may allowmembers to obtain the highest quality of care, maximizetheir health care coverage and potentially save money.The CAD and diabetes programs provide information andresources to help individuals understand their condition andits implications, and how they may try to reduce risk factorssuch as high cholesterol, high blood pressure, excess weight,obesity, cigarette smoking and lack of physical activity.Features of the programs include: Educational mailings. Biannual newsletters.Heart Failure Interactive Voice Response (IVR) phone calls with membersto address specific gaps in care.The number of adults living with heart failure increased fromabout 5.7 million (2009-2012) to about 6.5 million (20112014), according to the American Heart Association’s 2017Heart Disease and Stroke Statistics Update.2 Information about condition-specific websites.Managed InfertilityThrough our Heart Failure program, we seek to help Oxfordmembers maintain the highest possible level of function.We do this by:The Managed Infertility program offers Oxford membersaccess to: Monitoring the member’s weight, symptoms, treatment planand medication adherence. Education — straightforward information about the clinicaland nonclinical issues surrounding infertility and itstreatment, including clinics and physicians. An infertility Centers of Excellence network. Working with both the member and the member’s doctor toaddress early heart failure complications.The program has a holistic focus that takes into accountthe member’s: Information and ongoing support from nurse consultantsabout options to help individuals make informed decisionsabout their care. Other health risk factors (e.g., hypertension, highcholesterol, excess weight, smoking). Coverage for care at infertility clinics, including care toreduce the risk of multiple births. Conditions (e.g., diabetes, coronary artery disease, COPD,depression, etc.). Education from our infertility nurses about infertility and itstreatment, direction on where to obtain additional infertilityresources, and information about why certain infertilityfacilities and physicians are included in the Centers ofExcellence network.These efforts are intended to help the member proactivelymanage his or her symptoms, reduce emergency room visitsand avoid unnecessary hospitalizations.4

Neonatal Resource Services Assistance in navigating the health care system.The Neonatal Resource Services Program for Oxfordmembers helps enable parents to receive education andsupport during this stressful time that may help avoidreadmissions and post-discharge complications. Ourdedicated team of neonatal intensive care unit (NICU)nurse case managers, social workers and medical directorscollaborate in monitoring the clinical care and other servicesprovided to the baby and parents. Transplant Medical Director support.Cancer SupportThe Cancer Support Program offers members with acancer diagnosis and their families a source of informationand guidance navigating the health care system. Throughdedicated assistance from oncology nurses and socialworkers, the program is intended to enhance the quality ofcare and quality of life for members.Chronic Kidney DiseaseOur dedicated cancer nurses: Help members learn how to prevent and managesymptoms and side effects, leading to fewer inpatientadmissions and emergency room visits.Through this program, a nurse will be available to helpmembers in a number of ways, from referring the member to anephrologist, to helping the member manage other conditionsthat may have developed as a result of kidney disease (e.g.,diabetes, high blood pressure and heart disease). Membersalso can receive help preparing for dialysis, including hometherapies and outpatient treatment. Collaborate with treating providers to fill gaps in knowledge,and offer support with care management. Help manage pharmacy costs by reviewing medicationsand comparing them to evidence-based standards.Kidney Resource Services/End-Stage Renal Disease Provide support to help patients make informed decisionsabout their treatment.The Kidney Resource Services/End-Stage Renal Diseaseprogram (KRS/ESRD) delivers integrated, evidence-basedcase management services to members with end-stage renaldisease. A goal of the program is to help improve the member’soutcomes and help reduce medical costs among this lowprevalence, clinically complex and high-cost patient population. Educate patients about hospice services and palliative careas appropriate. Help patients move more effectively through the health caresystem and refer them to specialists as needed.Additional support from specialized social workers offersmembers and their loved ones help with family, work,financial and other needs.Program nurses work to help: Reduce avoidable hospitalizations and emergency roomvisits by proactively managing associated health risks.Members can self-refer for the program by calling us at1-866-936-6002, Monday through Friday, 8 a.m. to 8 p.m.ET. Or, we may identify members for the program throughour internal processes and programs. A member can also bereferred to the program by his or her provider. Reduce admissions and readmissions by comprehensivepost-discharge outreach and follow-up. Eliminate ongoing dialysis costs through earlytransplantation, where medically necessary. Reduce cost through referrals to in-network dialysis facilities.Our Condition Managementprograms provide informationthat may help members:Managed TransplantThrough the Managed Transplant program, clinical casemanagers guide Oxford members through every aspect ofthe transplant process, including evaluation, pre-transplant,transplant, post-transplant, transportation arrangements,lodging and aftercare. Clinical case managers also assistmembers in making informed decisions about their transplantcare through: Achieve and maintain optimumhealth levels. Manage risk factors and comorbidities related to theseconditions, including smoking, hypertension, obesity,dyslipidemia and depression. Receive the most clinically appropriate, cost-effectiveand timely diagnostics and procedures. Treatment education. Centers of Excellence education and referrals. Adhere to medication regimens, physician treatmentplans and a healthy lifestyle. Considerations in choosing where to get care.5