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Welcome!
National Association of State Comprehensive Health Insurance Plans
October 21, 2005Panama City, Florida
• WellPoint/Anthem 2004 merger forms largest U.S. health benefits company
• Blue Cross and Blue Cross Blue Shield subsidiaries in 13 states
• Specialty companies and affiliates in other states: behavioral health, dental, life, pharmacy, vision, workers compensation, PPO, TPA, disease management
• 28 million medical lives
• 35,000 associates nationwide
WellPoint, Inc.
Clinical / Medical ManagementClinical Business Plan Intervention ProgramsTherapy Management Disease ManagementPatients-At-Risk
FormularyManagementTreatment GuidelinesP&T CommitteesManufacturer DiscountsPreferred Rx ProgramsPrior Auth Center
ReViewPoint®
Online Reporting @ ReportsRx.com
Claims ProcessingClaims KeyingOnline DUR
Network ManagementNational NetworkCustomized Local NetworksMAC Programs
ConsultativeServicesIncentive ProgramsBenefit DesignsInterventionsAccount ManagementSales SupportBusiness StrategiesPharmacy Care Pharmacy Care
ManagementManagementPrecisionRxIntegrated Mail Service PharmacySpecialty Pharmacy
Web Toolswww.wellpointrx.comwww.myrxbenefits.comwww.healthenvelope.comwww.precisionrx.comDynamicCME
Full Spectrum of Services
Provider Education - What works?
• Overall• Concise educational materials• Evidence-based and unbiased • Highlight and repeat essential messages• Specific recommendations or patient profiles for intervention• Positive reinforcement• Multi-faceted approach*• Aligned with financial incentives**
• Web-based• Short and concise courses• Level of interactivity• Quality of content• Ease of use
*
Impact of Inappropriate Prescribing
• Over and Under Utilization• Pharmacotherapy
• Increased Cost• Pharmacy• Medical
• Increased Resources • Diminished Treatment Outcomes
• Increase Side Effects• Reduced Drug Effectiveness
Patients @ Risk Drugs of Abuse
• Program Goals• Communicate possible excessive use situations to
prescribers• Identify abuse situations • Decrease utilization and potential abuse situations
• Rx’s per member• 41% decrease
• MD’s per member• 24% decrease
• Pharmacies per member • 25% decrease
ITOPITOPSMSM ProgramsPrograms
• Interactive problem-based learning roundtables with CME accreditation
• Target physicians using pharmacy claims• Utilize national or community expert in disease state to
share best practices• Discuss difficult clinical cases with participating physicians• Physician receive patient specific data relevant to their
practice• Outcomes focused
• Improve quality and clinical outcomes• Optimize the use of appropriate therapies• Promote formulary compliance• Reduce costs
IMPROVED TREATMENT OUTCOMES through PHARMACOTHERAPY
ITOPSM Program Results• ‘Statin Formulary Compliance
• Target: High prescribers of NF ‘statins• Results:• New Start: +5.8% vs -2.4% (control)• Continuing: +4.5% vs -1.2% (control)
• Hypertension – Combination Therapy• Target: Physicians with patients who are candidates
for combination therapy• Results: 2.3% ↑ (absolute) in use of combination
therapy
Post-MI TM Program Example
Post-MI TM Program Results
• Appropriate therapies• 46% added beta-
blocker• 32% added ‘Statin• 18% added antiplatelet• 11% added ACEI/ARB
• Medication Adherence• 25% refilled within 2
weeks• 35% refilled within 4
weeks• 42% refilled within 6
weeks• 45% refilled within 8
weeks
• Target Population: 802 physicians (848 patients)• Follow-up: Patients with 6-month follow-up data
Health EnvelopeHealth Envelope®®/MyRxBenefits/MyRxBenefits
• An innovative health management and member self-service platform that offers:
• Health Information• Disease Management• Case Management• Compliance Programs• Consumer Directed Pharmacy
• Integrated medical and pharmacy claims database
• Personalized messaging system• Supports NCQA standards including new
Quality Plus• Interventions designed to help improve
HEDIS scores • URAC accredited• Revenue generating• Owned and operated by WellPoint PBM
Health Envelope®/MyRxBenefitsHealth Envelope®/MyRxBenefits
•• Consumer Driven ApplicationConsumer Driven Application
• Generic and Mail Pricing
• Generic and Brand Formulary Options
• Drug monographs and pill imaging
• Accumulators and OOP tracking
• Benefit and Eligibility
• Claims History
• Downloadable Forms
• 18 Month EOB (2006)
• Member specific formulary-look (2006)
• OTC alternatives and coupons (2006)
• Co-branding (forms, logos, etc.)
MyRxBenefits
Claims History
Tax Summary
Formulary Search Tool
MyRxOptions
• Personalized messaging and targeted health education
• Health status survey, blood glucose, medication, food and activity logs, goal setting and performance feedback
• Retrospective personalized graphs and reports
• Refill and preventive health screening reminders
HealthEnvelope® – Diabetes DSM
HealthEnvelope® Drug Information
• Drug Alerts (FDA Recalls, New Drugs, New Indications, Voluntary Withdrawals)
• Drug Search (monograph and pill image)
• Drug Information FAQ (i.e. Formulary, Generics, etc.)
• Refill Reminders
• Retail to mail interventions
• Generic switch interventions
• Detailed treatment options section for all health topics
• Medication Adherence Tool
• Generic Finder
• RxEducator
• Drug Interaction Checker (2006)
Half Tab Program
• Voluntary tablet splitting program• Selected products- Statins and SSRI’s• Notified all members and providers • Tablet splitter avaliable
• Benefits• Member copay reduced• Plan paid ingredient cost reduced
• Retail to Mail Conversion Programs• Targeted to members’ individual needs• Communication of benefits and
advantages of mail service• Delivered via the most effective medium for
your members (i.e., email, phone, or mail)• Specifically targeted patients based on
client specifications (medication, benefits, savings, etc.)
Retail-to-Mail Conversion Programs
Summary- Pool/ WellPoint Projects
• Drugs of Abuse• 6 quarters- 277 pts, 597 MD’s, 401 pharmacies
• ITOP- Diabetes 50 MD’s invited• Point of Reference
• Osteoarthritis- 1500 members, 1200 MD’s• GERD -2400 members, 1700 MD’s• Hyperlipidemia – 500 members , 500 MD’s• Diabetes- 2500 members, 1000 MD’s
• Health Envelope/ My Rx Benefits- all members• Half Tab- 7500 members, 1700 MD’s• Retail to Mail- 1500 members• Formulary Change Notification- 4800 members& MD’s
Thank you !
jane.o’[email protected]