Service that captures employee participation in corporate wellness, especially at clinics, outpatient services; provides reminders, real-time status in a portal; these help employees meet their goals; also saves $ by matching actual activity with claims to control bill paying errors

1. Proprietary and Confidential Intellectual Property of
Castlestone Advisors LLC © 2015
How Corporate Wellness Programs
Achieve Outcomes Success and Lower
Costs with Castlestone’s VisitEye
August, 2014

2. Contents
 Management challenges with Corporate Wellness Programs
• How VisitEye addresses many of the management challenges
– Captures wellness activities in real time
– Provides up-to-the minute status for portals
– Provides up-to-the minute, in context messaging to encourage action/next
steps
– Matches member activities to provider claims
• How to take advantage of Castlestone’s VisitEye in wellness program
management
Proprietary and Confidential Intellectual Property
of Castlestone Advisors, LLC

3. Challenges in managing a Corporate Wellness Program
 These programs include a number of innovations, such as financial
incentives for engaging in healthy behaviors and routine testing for life-
threatening and high-cost conditions
 Claim information is used by program management to determine the
compliance of its insured members
 Delays and errors in claim processing and filing create lags in the reporting
of member activities
 Additionally, health benefits are often administered by third parties who
have limited resources and little incentive to oversee claim activity and
potential fraud and abuse
 The resulting lags lead to:
 inaccurate status information on incentive programs,
 resources being used to answer plan members’ concerns, and
 potential impact on insureds’ insurance premiums.
Proprietary and Confidential Intellectual Property
of Castlestone Advisors, LLC

4. The impact of being able to know, in real time, if a
participant has been to the doctor/service provider when
scheduled or needed
 Reporting on medical and health activities in real time allows members to
check their program status within seconds after completing a medical
encounter.
 This reduces the costs and overheads of servicing the membership to
deliver information about their health status
 Also real-time information is more accurate, giving managers an
additional tool to oversee billing contractors. Accurate and timely data on
health care encounters and their costs enhances cost containment efforts
 Castlestone’s VisitEye contributes by:
 Making status available in a portal with up-to-the-minute data for both
program participants and managers
 Enable timely reminder messages to members, and
 Provide a match to claim information when it is provided to the plan
Proprietary and Confidential Intellectual Property
of Castlestone Advisors, LLC

5. Key elements of Castlestone’s VisitEye
 Real-time, non-financial transactions leverage Castlestone’s technology
and operating status within the MasterCard network
 we use their pipes and many of their transaction sets
 During set-up, codes are created for each office-visit-type in the corporate
wellness program
 Service providers are given their own provider cards, with encoded mag
stripes
 Providers who do not see patients, such as pathologists and radiologists, do
not get wellness program cards
 Individual employee/retiree participant cards with encoded mag stripes
are also created based on the employer/plan manager’s data
 When these cards are swiped in provider offices or via swipe attachments
to smart phones, transactions are routed to Castlestone (see next)
Proprietary and Confidential Intellectual Property
of Castlestone Advisors, LLC

6. Outpatient Provider Process:
When the participant uses a wellness service
• Authorized provider &
Location
• Service/procedure
provided matches
plan
• Time and date of
service/procedure
We now have a record of:
• A verified location for
each office visit
• The time and date it of
the visit
• Match of the
service/activity code to
the program options
If there is no card, the
provider office can register a
new card for the patient on
program portal
3) Castlestone compares
swipe with the patient’s
program
1) Provider swipes
recipient card
2) Provider enters
Service/Activity Code
• Patient ID
• Prescribing Physician ID
• Service Code
• Service Location
• Service Date
Proprietary and Confidential Intellectual Property
of Castlestone Advisors, LLC

7. Real time status updates, member reminders,
management portal data
 Castlestone can send members reminders of scheduled activities and/or
inform the managers’ systems of upcoming events
 In the same way, Castlestone can tell members of missed activities and
send messages to members indicating their status, YTD, as the plan year
end draws nearer
 Typically, Castlestone provides real-time information on visits,
procedures, and activities to a program for population in an existing
wellness program portal
 This saves employees/participants from having to visit a new and different
portal
 If no portal exists, Castlestone has a portal that can be used
 Program managers have access to transaction data either through
Castlestone’s existing manager’s portal, or via real-time or batch
transmission of transaction data to the client’s environment
Proprietary and Confidential Intellectual Property
of Castlestone Advisors, LLC

8. Matching service provider claims with known member
activity
 When wellness plan managers receive claims from providers, Castlestone matches
the swipe data with the incoming claims to verify that the member actually
received services on the time and date that the claims stipulate, e.g.:
Proprietary and Confidential Intellectual Property
of Castlestone Advisors, LLC

9. Cost and Implementation Considerations
 Card Creation
 Castlestone creates/activates/deactivates and manages cards based on guidelines. Plan
Sponsor existing card manufacturing contracts can be used if they are compatible
 Hardware cost for plan & providers
 NONE. Uses existing credit card terminals
 Network costs for plan & providers
 NONE. Uses the existing credit card networks from provider offices for transactions
 Systems & programming costs
 S&P is very simple data exchange of new/change/delete clients or full real time
integration
 Cost Structure
 Design and programming & card cost
 Hosting (data base & monthly hosting and management)
 Monthly per-member transaction fees
Proprietary and Confidential Intellectual Property
of Castlestone Advisors, LLC

10. Typical Results
 Set up completely implemented in 60-75 days, depending upon client
resources
 All technical milestones (transaction capture, claim matching, file and
interface implementation) exceed goals for speed and performance
 ROI for corporate wellness is based on:
 Member participation enhancement due to messaging
 Member participation enhancement due to confidence in real-time data
accuracy
 Program manager cost reduction by matching service claims with swipe data
 ROI for Castlestone when used in claims fraud prevention mode ranges
from 125%-300% and can significantly exceed this
Proprietary and Confidential Intellectual Property
of Castlestone Advisors, LLC

11. Options and Next Steps
 Contact us on how to use Castlestone’s VisitEye with your wellness
program
 Run a pilot (as little as 60 days to be operational)
 Begin a full program
Proprietary and Confidential Intellectual Property
of Castlestone Advisors, LLC
Doug Brockway
Advance Consulting
Castlestone New England
(617) 834-0067
dbrockway@advancecons.com
www.advancecons.com
CIO Advisory | Program Management | Business Development Jeffrey Leston
President
Castlestone Advisors LLC
(212) 874-4390
jeff.@castlestone-llc.com

12. Appendix
Other presentations and reports you may find of interest include:
Title Link
Fraud Prevention for Health Insurers http://slidesha.re/1pCGh98
Doctor Shopping and Prevention http://slidesha.re/1nNb9OL
CMS Pilot/Test of VisitEye http://slidesha.re/1vlGGeU
Management Tech. for Therapeutic Cannabis http://slidesha.re/1nQ5JkD
Corporate Wellness http://slidesha.re/1qQf6Fi