Tom Olenzak

Director, Independence Center for Health Care Innovation

Independence Blue Cross

Payer-Provider Partnership Models for

Health Care Innovation

Independence Blue Cross at a Glance

Medical, service, and ancillary

Medical and ancillary

Service and ancillary

Medical

Service

Ancillary

Potential expansion markets

AmeriHealth Caritas

AmeriHealth

Administrators

AmeriHealth

Administrators

AmeriHealth Caritas

AmeriHealth Caritas and

AmeriHealth Administrators

AmeriHealth Caritas

AmeriHealth

AmeriHealth Caritas

AmeriHealth

Administrators

AmeriHealth Caritas

AmeriHealth CaritasPA & NJ Market

Independence Blue Cross

AmeriHealth

AmeriHealth Administrators

AmeriHealth Casualty

AmeriHealth Caritas

AmeriHealth Caritas

AmeriHealth Caritas

AmeriHealth and

AmeriHealth Administrators

AmeriHealth

Administrators

AmeriHealth Caritas and

AmeriHealth Administrators

AmeriHealth Caritas and

AmeriHealth Administrators

Serving 8.2 million people in 24 states as well as the District of Columbia.

• Once-in-a-generation transformation of our industry

• Convergence of economics, regulatory will, and public opiniono Our core risk-based business is becoming a commodity

o Product migration: fully insured to self insured to defined contribution

o Transformation from payments management to care management

o Our key business model is shifting: BTB to BTC

• Traditional silos are breaking down, new business models are emerging.

o Our core business is evolving at an accelerating rate

o We are now vulnerable to new entrants and disruptive innovators

Why innovation?

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• Innovation in health care can’t be done alone.

• Identify and align priorities with other entities within the region and nation.

• Focus on targets that eliminate waste, enhance the customer experience,

and/or improve outcomes.

• Work with others to reduce costly fragmentation in the market.

• Seek, evaluate, and monitor new and potentially game-changing

companies, technologies, and business models.

We want to work with partners

IBC Innovation Structure

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We are building a culture ready and willing to embrace innovation

We scour the

landscape to find and

engage with innovative

companies and

technology to inform

and support our growth

strategy.

We identify and

evaluate new

corporate opportunities

through our Deep Dive

and Tiger Team

processes.

We lead the effort to

accelerate the

development of the

health innovation

community in our

region.

We are creating a partnership with operating units and HR to design

creative methods to incentivize innovative behavior

We are building a network through which we are embedded in the health

care, technology, and innovation communities

We created the Center for Health Care Innovation

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• Penn Medicine

o Leveraging IBC’s vast databases of claim information and

Penn’s research expertise to identify new ways to keep

people healthy.

o Collaborated on breakthrough Medication Adherence

research program.

• New York University

o Research collaboration between IBC and NYU to use IBC

medical and pharmacy claims data to develop artificial

intelligence methods for predicting members who have

undiagnosed diabetes or who are at risk of developing the

disease.

• Also in the Region

o Leading the creation of HealthShare Exchange of

Southeastern Pennsylvania, the first health information

exchange in our region that went live in 2012.

o Exploring ways to leverage claims, clinical, and other

health data to create a joint regional research asset.

Early partnership effortsEarly Partnership Initiatives

• Team: Volpp/Asch (PIs), Troxel, Terwiesch, Mehta

• Objective: Prevent vascular events or rehospitalization in the 12 months

following heart attack

Medication Adherence - $5mm CMMI Grant

• Design:

o 2 arm RCT of 1500 patients

o 1 in 5 chance of $5, 1 in 100 for $100

o IF they took their meds (daily)

o Social support…e.g., family gets an

alert

o Low personnel ratio

Demonstrates Enduring Adherence to Medication Following a Heart Attack

Early Detection of Diabetes

• Who will develop diabetes in the

next 12, 18, and 24 months?

• Which diabetics have undiagnosed

comorbid conditions?

Incorporate broad data sources

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Early Results

Model:

• Current models use over 1,200

features

• Area under ROC Curve = 0.79 across all

ages

Results:

• 590,000 members not diagnosed

with diabetes by 2011 were enrolled

though 2012

• Model produces probability of being

diagnosed with diabetes within 24

months for every member:

• 54,000 with > 0.70 likelihood

• 18,000 with > 0.80 likelihood

• 2,500 with > 0.90 likelihood

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Early Diabetes Detection: Next Steps

Implementation

• Bring algorithms in-house

• Outreach to providers

• Outreach by case management

• Candidates for peer mentoring

program

Expansion of

Models

• Refine models

• Answer additional research

questions

• Expand outreach capacities

• DreamIt Health Philadelphia

o Powered by Independence Blue Cross and Penn Medicine.

o Four-month startup accelerator.

o $50,000 in seed funding.

o Free work space and legal council

o Access to industry executives and Penn & IBC data

• 2013

o 10 out of 10 companies still active.

o Pilots with both Penn and IBC.

o 8 companies remain in the Philadelphia region.

• 2014

o Currently accepting applications for the DreamIt’s 2014

class of companies.

DreamIt Health

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STAT Medical Transport Pilot

Challenge

• IBC generates LOH lists

• Care Management works with the

Member to manage conditions

• Transport to providers can be a

significant barrier

Pilot

• Utilize STAT, a Dreamit Health

2013 Company, to manage

transport options

• Utilizing CMS grant to pay for

transport

• Success measured [tbd]

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Other Joint Initiatives

Medical Transport

• IBC generates LOH lists

• Care Management works with the

Member to manage conditions

• Transport to providers can be a

significant barrier

• Utilize STAT, a DreamIt Company

• CMS grant pays for transport

Tele-Dermatology

• Discontinuity in specialist referral

process allows preventable conditions

to worsen

• Provides immediate access to

dermatologists from PCP location

• Tele-derm not reimbursed today

• IBC provides payment structure

Next Step: Expand the network to other providers and partners

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Tandigm Health

IBC and DaVita Healthcare Partners have formed a new company,

Tandigm Health, that will work in tandem with primary care physicians

to deliver high-quality, affordable care

• Combines traditional doctor-patient relationships with innovative tools and support

• Focuses on enabling, not acquiring, primary care physicians

• Provides PCPs with enabling technology including access to real time data and

services such as community health workers and home care