Frequently Asked Questions

1. What is disease management?
2. How does disease management lower healthcare costs?
3. What services are provided by Matria?
4. What is Matria’s targeted market?
5. What is Matria’s mission statement?
6. What is Matria’s business strategy?
7. How does Matria address co-morbidities (multiple chronic conditions)?
8. What national clinical guidelines does Matria utilize?
9. What accreditations does Matria hold?
10. What are Matria’s hours of operation for patients?
11. Can Matria serve hearing-impaired callers?
12. What languages does Matria offer?
13. What is Matria’s disease management system platform?
14. Does Matria offer an engagement or enrollment period?
15. Describe Matria’s performance guarantees.
16. How long does it take for Matria to show financial or clinical results from a disease management program?
17. Does Matria conduct satisfaction surveys?
18. On what percentage of Matria’s business do you conduct satisfaction surveys?
19. What are the results of Matria’s satisfaction surveys for the past three years?
20. How does Matria monitor HIPAA regulations?
21. Please describe Matria’s security measures and Matria’s plans for compliance with the HIPAA security regulations.
22. What protections are in place to protect patient confidentiality? Address how Matria’s program complies with the requirements of the HIPAA Data Privacy Act.

Disease Management

1. What is disease management?

Disease management is a new approach to medical cost management based on the premise that a minority of healthcare users drive the majority of total costs. Disease management programs use information technology to identify individuals who have or are at risk for chronic conditions. Programs offer customized education and clinical support to help individuals take more responsibility for self-care and avoid expensive medical events down the road.

2. How does disease management lower healthcare costs?

Disease management focuses primarily on the 15 percent of the employee population that generates 85 percent of the medical costs. By proactively improving the health of these employees, the likelihood of major medical expenses is greatly reduced, including hospitalization, ER visits and physician/specialist visits.

3. What services are provided by Matria?

Founded in 1970 and now a national leader in the healthcare industry, Matria Healthcare, Inc. is a provider of comprehensive, integrated disease management programs, as well as clinical and fulfillment services to patients, physicians, health plans and employers. We provide management services for high-cost diseases and conditions, including high-risk pregnancies, neonatal disorders, diabetes, asthma, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), congestive heart failure (CHF), end stage renal disease (ESRD), cancer, depression, back pain, smoking cessation, obesity, substance abuse, Hepatitis C, case management, utilization management and health risk assessments.

4. What is Matria’s targeted market?

Corporations/employers, health plans and governmental entities.

5. What is Matria’s mission statement?

Matria dedicates our total resources to improving population health. Our disease management, care management, clinical services and information technology enable health providers and payers to immediately impact the plan of care and improve clinical and cost outcomes.

6. What is Matria’s business strategy?

Our goal is to further expand our position as a leading provider of disease management services. We seek to achieve this goal by pursuing the following strategies:

• Capitalize on our position as an industry leader in the disease management market. We believe our extensive experience, established infrastructure and list of existing customers provide us a significant competitive advantage as we seek to capitalize on the growing market for disease management. We have more than 15 years of experience in providing disease management and related services. Our established infrastructure includes our proprietary TRAX™ technology platform, call center operations located throughout the United States, supply distribution channels and a national network of skilled multidisciplinary clinicians.

• Leverage our TRAX technology. We will continue to make significant investments in TRAX in order to better identify patients for intervention and improve treatment plans for these identified patients. A major challenge of disease management programs is to link the design and monitoring of treatment plans with the actual clinical services and fulfillment of drugs and related supplies. We believe that our TRAX technology platform is uniquely capable of addressing this issue and coordinating both treatment objectives and treatment activities.

• Further penetrate all key segments of the growing disease management market. We intend to expand our customer base within the employer, health plan, Medicare, Medicaid and pharmaceutical markets.

7. How does Matria address co-morbidities (multiple chronic conditions)?

Co-morbidities, or multiple chronic conditions, are identified through the multicondition risk screen and assessment process after an individual completes the initial health risk assessment. Each participant is assigned to a primary disease program based on the severity of the illness and on the hierarchy of disease states. Co-morbidity is managed as a subset of the primary disease with carepaths specific to the disease state.

8. What national clinical guidelines does Matria utilize?

All programs at Matria Healthcare follow industry-recognized clinical practice recommendations and guidelines for each chronic disease or condition:

Asthma – National Heart Lung and Blood Institute (NHLBI) Guidelines for the Diagnosis and Management of Asthma

Diabetes – American Diabetes Association (ADA) Clinical Practice Recommendations

CAD – Institute for Clinical Systems Improvement Stable Coronary Artery Disease,

American College of Cardiology/American Heart Association (ACC/AHA) Guideline Update for the Management of Patients with Unstable Angina

CHF – Institute for Clinical Systems Improvement Congestive Heart Failure in Adults

COPD – The Gold Initiative for Chronic Obstructive Lung Disease (GOLD) Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease

Cancer – Cancer guidelines are proprietary and developed in-house with a panel of nationally renowned academic and community oncology specialists.

Depression – Institute for Clinical Systems Improvement Major Depression in Adults for Mental Health Care Providers

Maternity – Institute for Clinical Systems Improvement Routine Prenatal Care, Preterm Birth Prevention

Pain Management – Institute for Clinical Systems Improvement Assessment and Management of Acute Pain and Adult Low Back Pain

ESRD – National Kidney Foundation K/DOQI Guidelines (Kidney Disease Outcomes Quality Initiative)

9. What accreditations does Matria hold?

• National Committee for Quality Assurance (NCQA)
• Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
• URAC

10. What are Matria’s hours of operation for patients?

Care center hours are 8 a.m. to 11 p.m. Monday through Thursday, 8 a.m. to 9 p.m. on Friday, 9 a.m. to 6 p.m. on Saturday and closed on Sunday. After regular business hours, calls are handled by our 24/7/365 registered nurse call line.

11. Can Matria serve hearing-impaired callers?

We offer TDD services for the hearing-impaired.

12. What languages does Matria offer?

All of our educational information and communications are available in English and Spanish.

We also have multilingual capabilities. Matria has in-house clinicians that are fluent in English, Dutch, French, Spanish, German, Hindu and Korean. We also utilize AT&T’s translation services that can accommodate as many as 150 different languages.

13. What is Matria’s disease management system platform?

The centerpiece of Matria’s disease management suite of applications is the TRAX Disease Manager. This application is a proprietary, Web-based solution, designed to implement our disease management program in accordance with nationally recognized clinical and quality standards in a consistent manner across each of our client populations. Matria hosts and maintains this system in its data center. This application provides workflow that supports both an integrated population care strategy and individual care strategy.

The TRAX Disease Manager represents the primary work tool employed by Matria’s care center and includes such functionality as:

• Automated task To-Do-List assigned by call center role and skill level in accordance program design standards
• Participant-centric records
• Collection, analysis and storage of participant data in accordance with automated scheduled tasks and assessments
• Consistent delivery of verbal and written education materials pertinent to each participant’s current condition
• Storage and access to lab, pharmacy and healthcare utilization information for each participant record
• Plan of care module that allows for the establishment and management of specific participant goals
• Secure access to participant program information by external case managers, healthcare advocates and other client-designated healthcare providers

14. Does Matria offer an engagement or enrollment model?

We offer both engagement (opt-out) and enrollment (opt-in) models for diabetes, CAD, CHF, asthma and COPD. In the engagement model, the candidate is enrolled unless they decide to opt out. In this model, we have the opportunity to reach more members. In the enrollment model, a candidate is enrolled once they advise our care center of their decision to participate.

Performance Guarantees

15. Describe Matria’s performance guarantees.

Matria uses multiple types of performance guarantees with our clients. These guarantees can be based on clinical outcomes, financial outcomes, satisfaction survey outcomes, enrollment results, participation percentage and implementation timeline results. All performance methodology and measurements are mutually agreed upon.

16. How long does it take for Matria to show financial or clinical results from a disease management program?

Six months.

Client Satisfaction

17. Does Matria conduct satisfaction surveys?

Surveys of participants and practitioners, along with client-specific reporting, are provided at no additional expense to the client.

18. On what percentage of Matria’s business do you conduct satisfaction surveys?

A sample is selected to provide statistically valid results; at least 25 percent of participants per client per year are surveyed.

19. What are the results of Matria’s satisfaction surveys for the past three years?

2001 - 99 percent

2002 - 90 percent

2003 - 90 percent

Privacy

20. How does Matria monitor HIPAA regulations?

The protection and appropriate use and disclosure of patient information will continue as a prime objective for Matria Healthcare, Inc. In order to ensure compliance with all Federal HIPAA regulations (Privacy, Security, Transactions & Code Sets and Identifiers) our HIPAA Steering Committee oversees and reviews all our current practices and identifies implementation needs specific to the HIPAA regulations. Further, Matria has a full-time Compliance and Privacy Officer.

21. Please describe Matria’s security measures and Matria’s plans for compliance with the HIPAA security regulations.

Matria has a security policy and procedures manual in place. Matria will implement all requirements of the security rule by the April 2005 compliance date.

22. What protections are in place to protect patient confidentiality?

In our role as a Business Associate to our clients, we are bound by the terms of a
Business Associate Agreement to uphold the confidentiality of all participants.
During telephonic encounters, Matria will not discuss participant PHI with anyone
other than the participant without first securing verbal consent. This verbal consent
is discussed at the onset of the call and documented in the participant record.