Independence Blue Crossp

Health Management Programs

April 13, 2010

Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.

Supporting members th tiacross the care continuum

At every stage of health programs and services are there to

D i iWellness Urgent Needs Complex Care Chronic and other T t d C diti

At every stage of health, programs and services are there to provide members with the support they need.

Decision Support

Wellness Support

Urgent Needs Support

Co p e Ca eSupportTargeted Condition

Management

24x7 Whole Person Health Coaching24x7 Whole Person Health Coaching

Evidence, Analytics, Risk Stratification

IBC Approach to Medical Management

State of the art predictive modeling to target right State of the art predictive modeling to target right member at right time with the right intervention

Whole person coaching that enables all of member’s p gneeds to be addressed by one health professional

Member profile and risk scores available for all members lt i f d d ti t h– result in focused, productive outreaches

Integration and co-management results in seamless member experiencemember experience

Proactive outreach to high-risk members

Comprehensive Member Identification and Stratification Process

100% of the population assessed monthlyClaims (medical, pharmacy) mined monthlyLab claims and results mined monthlyLab claims and results mined monthlyRadiology data mined monthlyReferrals to specialists mined monthlyAuthorization data mined dailyAuthorization data mined dailyPersonal Health Profiles included in monthly algorithm

f l f h h l h l Referrals from physicians, health plan case managers, self-referrals received daily

ConnectionsSM Health Management ProgramsConnections Health Management Programs

Disease ManagementgCongestive heart failureDiabetesCoronary artery diseaseAsthmaChronic obstructive pulmonary diseaseChronic obstructive pulmonary diseaseMigraineHypertensionGERD/PUD

16 complex, chronic conditions (i.e. Multiple Sclerosis Sickle Cell Rheumatoid Arthritis)Sclerosis, Sickle Cell, Rheumatoid Arthritis)

ConnectionsSM Health Management ProgramsComplex Chronic Conditions

Multiple Sclerosis

Seizure Disorders

P ki ' Di

ALS (Amyotrophic Lateral Sclerosis)

DermatomyositisParkinson's Disease

Rheumatoid Arthritis

Systemic Lupus

Dermatomyositis

Polymyositis

SclerodermaSystemic Lupus

Cystic Fibrosis

Hemophilia

CIDP (Chronic Inflammatory DemyelinatingPolyradiculoneuropathy)Hemophilia

Myasthenia Gravis

Sickle Cell Anemia

Polyradiculoneuropathy)

Gaucher Disease

Crohn’s Disease

Decision Support Topicspp pBack pain, back surgery

Hip replacement

Over 30 decision support

Knee replacement

Heart surgery

videos/DVDs are available

on these topics. Health

Weight loss surgery

Women’s health issuesHysterectomy Hormone replacement therapy

Coaches distribute videos/

DVDs to members when

Hormone replacement therapyMenopauseBreast cancer

Prostate problemsappropriate. Colon cancer screening

Depression

7

Member ExperienceGoals:

assist members with managing chronic conditionsprovide members with information regarding their condition, help them p g g , pprevent complications and better understand their conditionassist members with any co-morbid conditionprepare members for visits with their doctor

Components:24/7 telephone access to a health care professionalWeb-based informationWeb based informationTargeted mail and phone outreach

About the staff:Licensed experienced clinicians, mostly nurses with 10+ years experience; access to dietician, respiratory therapist, pharmacist and social workerProvide most current medical evidence-based information available

Member Experience

Outreach:Automated telephonic outreachAutomated telephonic outreach

Post-hospital discharge calls

Sophisticated algorithms for member identification

C i d h bCustomized outreach to membersMulti-culturalMulti-lingualFamily composition

Member Experience

Member diversity is taken into consideration in the development of materialsin the development of materials

Using claims information, census data and analytic models, members are segmented into community groups based on location lifestyle are segmented into community groups based on location, lifestyle, ethnicity, education, income, etc.

Outreach materials use a member centric approach to attend to diversity via tailored messaging such as targeted language, taglines diversity via tailored messaging such as targeted language, taglines and photos.

Member focus groups were conducted to gather recommendations on preferences within the communications. Groups looked at overall preferences within the communications. Groups looked at overall layout, photos, language, etc.

G l H l h I f iGeneral Health Information

Information about everyday health concerns from A to Z — rashes, bee stings, sprains and general nutrition

Rx information drug to drug interaction medication Rx information — drug to drug interaction, medication compliance, brand vs. generic

Web tools available through ibxpress.comg p

24/7 Health Coach 365 days/year available to all members

ConnectionsSM Health CoachesAccessible

1-800-ASK-BLUEPhone/Internet, 24x7x365

Dedicated personal coachesEstablish relationships Follow up with member and providerComprehensive and confidential

Specially trainedLicensed experienced clinicianspShared decision-makingBehavior modification and listeningTreatment options and proceduresCertified educators

Medical director oversight

Computer supportComputer support

Actual vs. expected costs for members with h i ditichronic conditions

Bend the trendExpected Year

Expected Year 4

Expected Year 2Expected Year

1

Expected Year 3

Year 2

Year 3savings

Year 4savings

Actual Year 1

Actual Year 2

Actual Year 3

Actual Year 4

Year 1savings

Year 2savings

Base Year 1 Year 2 Year 3 Year 4

Year 1

Utilization savings by service typeth t 4over the past 4 years

18%20%

% reduction from expected utilization

10%12%14%16%18%

11% 11% 10%

2%4%6%8%

%

0%

Inpatient days Outpatient professional visits Professional services

Member SatisfactionMember Satisfaction

95 percent of chronic members indicated that they 95 percent of chronic members indicated that they were able to follow their Health Coach’s guidance.

90% of respondents stated they would recommend p yConnections

88% of chronics were satisfied with their Health Coach

Member Satisfaction Survey2009 DMAA award!y

100% 2004

award!

60%

80%

94%90%87%

86%87% 88%

92% 96%88%

95%

2005

2006

40%

60% 2006

2007

2008

0%

20%

Chronic Non Chronic

2008

How satisfied were you with the assistance the Health Coach provided you? (Percent of respondents indicating “Very Satisfied” or “Satisfied” displayed)

88 percent of 2008 chronic and 95 percent of 2008 non chronic users indicated that they were

Chronic Non Chronic

88 percent of 2008 chronic and 95 percent of 2008 non-chronic users indicated that they were “very satisfied” or “satisfied” with the assistance provided to them by the Health Coach.

IBC - a leader in Disease Management: Independence Blue Cross won the Disease Management Association of America’s Outstanding Health Plan

award in December 2006 and the DM Leadership Award in 2009award in December 2006 and the DM Leadership Award in 2009.

17

Adventist Program LaunchAdventist members launched with the

Population Overview Count PercentCurrently Eligible 24,265 -

ConnectionsSM

Health Management Program on

No Chronic Condition 22,508 92.8%

Any Chronic Condition 1,757 7.2%

January 1, 2010.

As of February, 7.2 percent of the

Condition Prevalence Count Percent

Asthma 567 2.3%

population was identified with a chronic condition, which is within

Coronary Heart Disease 311 1.3%

Heart Failure 48 0.2%

Diabetes 960 4.0%

range of similar commercial groups.

Chronic Obstructive Pulmonary Disease

40 0.16%

Hypertension 1,710 7.1%

Migraine 380 1.6%

Program LaunchMail and telephonic outreach to educate and support members with chronic, preference-sensitive, and other conditions such as Migraine and CardiometabolicRisk began in February.

As of March, 84 members have called inbound to speak with a Health Coach, 25 members have been attempted in a post-hospital discharge call, and 483 members have been targeted in an outbound or AutoDialog® call campaign.

Outreach* Members TargetedAutoDialog® Calls

Chronic Welcome 120

P f S iti C diti W l 15Preference-Sensitive Condition Welcome 15

Back/Joint 22

Chronic Gaps in Care 154

Migraine 9

Cardiometabolic Risk Management 12

Health Coach Calls

Inbound Calls 84

O tb d C ll 151

*As of 03/29/2010

Outbound Calls 151

Post-Hospital Discharge Calls 25

Program LaunchAll households received a letter welcoming them to ConnectionsSM, as well as a magnet with the Program phone number encouraging members to call with health

Program Launch

g g p g gquestions 24 hours a day, 7 days a week.

In addition, members have received targeted mailings providing them with information on other conditions such as depression, weight loss surgery, and preference sensitive conditions such as back and joint pain preference-sensitive conditions such as back and joint pain.

Outreach* Members TargetedMail Mail

Non-Chronic Welcome Letter and Magnet 9,649

Variable Chronic Condition Letter and Magnet 1,560

Pediatric Asthma Welcome Letter 185

Pediatric Diabetes Welcome Letter 6

Preference-Sensitive Condition Letter 370

Depression Screening Letter 27

Weight Loss Surgery Letter 38*As of 03/29/2010

Weight Loss Surgery Letter 38

Healthy LifestylesSM Promotion Guidey y

Web based library of resources that employer groups can Web based library of resources that employer groups can use to design a worksite wellness campaign

12 monthly themed campaigns that groups can use or they can mix and match to create a customized campaign

Materials include posters, articles, flyers, and payroll stuffers that group can use to promote IBC programs

Includes disease-specific information, sample Health C h ti ti h lth i f tiCoach questions, preventive health information

Includes information on programs available to members to help them manage their health (e.g., Connections, Healthy Lifestyles, etc.).Healthy Lifestyles, etc.).

ibxpress.comIBC’IBC’s new websitewebsite

Enhanced capabilitiesFind a provider

Request an ID cardTreatment cost estimator

P l H lth R d Request an ID card

Change your PCPPersonal Health Record

Personal Health Profile

H i l/ id fi d Review open referrals

Print a temporary ID card

Hospital/Provider finder

View claims

Lifestyle Improvement ProgramsTrackers

Symptom checker View claims

View benefits informationHealth Management Center

Symptom checker

Health Management Center

Personal Health Profile (PHP)

MEMBER NAME HERE

GINA compliantp

Health Tools and TrackersHealth Tools and Trackers

Blood pressure trackerPrintable results

Making the most of every doctor’s appointment

Personal Health Record (PHR)Personal Health Record (PHR)

JOE CONSUMER’S

Thank you!Questions?Questions?