Blue Care Connection Bringing Value and Managing Costs

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Blue Care ConnectionBringing Value and Managing
Costs
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How Blue Care Connection Works for Our Customers
We take a Total Care Approach that Changes
Outcomes
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How Our Members Fit into the Continuum
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How Your OrganizationFits into the Continuum
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The Value We Bring to Members
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Impact of Medical Conditions and Unhealthy
Lifestyles
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Proactive Identification of Members Needs
Identification ofMembers Needs
DataCollection
Outreach through Blue Care Connection
Health Risk Assessment Personal Health
Manager Ask a Nurse 24/7 Nurseline
Medical Claims Pharmacy Claims Lab Services Care
Management Engine
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Focusing on the Total Population

• Supports members experiencing acute, late stage
  and catastrophic events

• Enhance members self-managementof condition
• Reduce intensity and frequency of disease-related
  symptoms
• Improve member-to-physician communications

• Coordinate care for acute medical conditions such
  as hospitalization
• Pre-approval
• Pre-admission
• Concurrent review
• Medical peer review
• Transition from hospital to home care
• Welcome home calls

• Promote identification and tracking of health
  status through
• Online tools
• Telephone-based services

• Increase awareness
• Promote personal accountabilityfor prevention

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Blue Care Advisor
Integrating Health Care Coordination
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How We Connect to Help Change Behavior

• We continually track member health status and
  outcomes and help manage the cost of care

• Wellness and Prevention Touchpoints
• General mailings
• Member-specific reminders
• Web-based communication
• Health Counseling Touchpoints
• 24/7 Nurseline
• Extensive online information and education
• Cost calculators
• Hospital Comparison Tool
• Personal accountinformation
• Personal HealthManager
• Health Risk Assessment

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Outreach to Targeted Members
We identify high-cost, high-risk members through
data stratificationand create meaningful
interventions

• Touchpoints
• Phone calls
• Secure e-mails, mailings specific to a
  hospitalization or chronic illness management
• Personalizedcare plans
• Prenatal program

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Episodic Case and High-Risk Condition Management
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Complex Case Management

• Conditions targeted include
• Hepatitis C/HIV
• High-risk maternity
• Neurology (CVA and Cerebral Aneurysm)
• NICU (Neonatal Intensive Care Unit)
• Neuromuscular diseases
• Oncology (breast, colorectal, cerebral, prostate,
  ovarian)
• Pain management
• Transplants

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24/7 Nurseline
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Member Empowerment
Online health tools through Blue Access for
Members (My Health Portal)
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Personal Health Manager

• Members can
• Complete a Health Risk Assessment
• Ask health and wellness questions and receive
  secure e-mail responses from Ask A Nurse, Ask A
  Trainer, Ask A Dietitian or Ask A Life Coach
• Search an online health care encyclopedia
• Receive daily news on health topics
• Participate in online programs to improve their
  health, fitness and nutrition
• Earn Blue PointsSM (coming in 2007), a reward
  program designed to motivate members to engage in
  healthy activities

Only with Blue Care Connection
More information, more access to personal
resources
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Health Risk Assessment

• Members can
• Take holistic online assessment to determine
  treatment opportunities and identify conditions
  that put them at risk
• Receive an in-depth personal report with
  actionable next steps
• The HRA is
• Used in tracking and analyzing population health
  trends over time
• Shared electronically with Blue Care Advisors who
  review for potential health improvement
  opportunities

Health and Wellness
Interactive and user-friendly
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Employer Reporting

• Report highlights (aggregately)
• Executive summary
• Top areas of concern
• Medical conditions and medical risk
• Summary of HWB scores and risk status
• Changes year over year
• Annual reporting
• 50 members must have completed the HRA in the
  last 9 months
• Group must have 100 members to qualify for
  reports

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Blue Points Incentives
Redeem earned points for a variety of items
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Incentive Levels Adults Teens
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Blue Care Connection Member
Profile John Smith
OUTREACH
IDENTIFICATION
SUPPORT
RESULT
Blue Care Advisor calls John, creates assessment
John is effectively managing condition With
support,he was able to
51 yr. old male On medications for
hypertension/GERD
John visits his physician
John begins using the Personal Health Manager
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The Value We Bring to Providers
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Leveraging OurPhysician Relationships
Performance-Based Recognition

• Establish benchmarks
• Track and reward improvement
• Provide reports to show
• Trends
• Areas for improvement
• Performance relative to providerswith similar
  profiles
• Tie outcomes to provider recognition

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Risk and Intervention Letters to Physicians

• An example of a mailing that may go to
  physicians
• Content is based upon members health status
• Identifies
• Potential treatment opportunities
• Potential wellness and prevention opportunities

Notification of Specific Member Risk Factors
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Pharmacy Profiling
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Patient Clinical Summary
Next Steps for 2007 Data integrated from Personal
Health Record and Patient Clinical Summary for
the first Individual Health Record as defined by
AHIP (American Health Insurance Plans)
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Patient Clinical Summary
Hurricane Rita Outreach
DATA MINING
IDENTIFICATION
PORTABLE DATA
RESULT
BCBSTX extracted three years of these members
clinical data from its internal systems
830,000 electronic Patient Clinical Summaries
were available to providers anywhere in the
country via a phone request to BCSBTX
With Hurricane Rita on its way, BCBSTX used ZIP
codes to identify members in the storms path
This was completed in just four days
Member data was securely delivered to MEDecision,
who organized the information into Patient
Clinical Summaries
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The Value We Bring to Our Customers
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Engaging Results
Members who transitioned from competitor to our
plan Members consistently with us
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Measuring Outcomes
Texas Blue Care Connection Outcomes
Represents a membership of 1,556,500 at the end
of January 2006. Burden of Illness Burden of
Illness (BOI) This score is a representation of
the average relative resource consumption weight
assigned by the 3M Clinical Risk Group algorithm,
which adjusts for the level of severity, age and
sex of the member within a specific status and/or
disease. For example, a member with early stage
or well-managed diabetes will be assigned a lower
mean severity score than a diabetic with
complications. Per Member Per Month related to
status categories 5 9 Members with one or more
chronic conditions
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Early Preventive Care Results for Texas

• Increase in Compliance for Blue Care Connection
  Members
• Percent of members identified as noncompliant
  with recommended services during the pre-BCC
  baseline period who were identified as compliant
  at post-BCC measurement

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Breast Cancer Screening
Cervical Cancer Screening
Colorectal Cancer Screening
Compliance w/Non-trauma ER Guidelines
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Blue Care Connection Group-Specific Utilization
Impact
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ER Visits
Admissions (Per 1000 Members)
Days (Per 1000 Members)
Average Lengthof Stay
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Blue Care Connection Texas Group Comparison
BOI Results With Blue Care Connection -
0.43 Without Blue Care Connection 2.58
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Early HEDIS Results for
Lower rate indicates better compliance
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Early Acute Inpatient Hospitalization Results for
Texas
Results With Blue Care Connection 3 Decrease
in Admissions 4 Decrease in Days
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Members Per Year (in thousands)
Savings Per 1,000 Members Per Year 5,705,496
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Texas Blue Care Connection Early-Managed
Conditions
Results 15 Millionin savings
2 Reductionin Blue Care ConnectionFocus
Population, Paid Dollars per Member per Month
1Burden of Illness (BOI) This score is a
representation of the average relative resource
consumption weight assigned by the 3M Clinical
Risk Group algorithm, which adjusts for the level
of severity, age and sex of the member within a
specific status and/or disease. For example, a
member with early stage or well-managed diabetes
will be assigned a lower mean severity score than
a diabetic with complications. 2Blue Care
Connection focus population includes the listed
managed conditions, as well other chronic
conditions that do not fall into traditional
condition management programs.
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Blue Care Connection Texas Group-Specific
Inpatient Rates
Q1 2003 Pre-BCC
Results Savings Per 1,000 Members Per Year
3.6 Million With Blue Care Connection
Q1 2004 Post-BCC
NCQA National Average
Members Per Year (in thousands)
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Blue Care Connection Texas Group-Specific ER
Visits
Results With Blue Care Connection 13 Reduction
Non-Trauma
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Blue Care Connection
We Excel at Personal Connections