PROTECTING THE HEALTH OF UPSTATE NY COMMUNITIES

Transcription

1 PROTECTING THE HEALTH OF UPSTATE NY COMMUNITIES HEALTH PLAN 2017 OVERVIEW A nonprofit independent licensee of the Blue Cross Blue Shield Association

2 OUR COMPANY Excellus BlueCross BlueShield is a regional, nonprofit health plan serving the communities of upstate New York since OUR MISSION To help people in our communities live healthier and more secure lives through access to high-quality, affordable health care. OUR VISION To be recognized and valued as THE community and business resource for health care security through financial strength, effective cost control, ease of use, and commitment to health improvement. OUR SERVICE AREA Excellus BlueCross BlueShield Rochester Based in Rochester Excellus BlueCross BlueShield Utica Based in Utica, with additional offices in Plattsburgh and Watertown Other Employee Locations Western New York Based in Buffalo, with an additional office in Jamestown Excellus BlueCross BlueShield Central New York Based in Syracuse Excellus BlueCross BlueShield Southern Tier Based in Elmira, with an additional office in Binghamton

3 OUR MEMBERSHIP* 1.5 MILLION MEMBERS 71% COMMERCIAL GROUP * As of 1/31/18 2% COMMERCIAL INDIVIDUAL 11% MEDICARE 16% MEDICAID & SAFETY NET PROGRAMS

4 FINANCIAL OVERVIEW $5.6 BILLION REVENUE $3.3 BILLION ASSETS $1.4 BILLION RESERVES 1.8% AVG. MARGIN (20 YEARS) $4.8 BILLION MEDICAL BENEFITS PAID

5 3.2 MONTHS OF CLAIMS & OPERATING EXPENSE IN RESERVES $1,292 RESERVES PER MEMBER Savings $407 MILLION PAID IN TAXES AND ASSESSMENTS 26% LOWER ADMIN. COSTS PER MEMBER PER MONTH* $42.99 EXCELLUS BCBS $57.84 OTHER UPSTATE HEALTH PLANS * As of 12/31/17

6 LOW COSTS CONTRIBUTE TO A HISTORICALLY LOW UNINSURED RATE * As of 1/31/18 Ranked as having among the lowest health coverage spending in the country among 306 hospital referral regions* * As reported by The New York Times, December 2015 ROCHESTER 3rd LOWEST SYRACUSE 15th LOWEST

7 LESS THAN 4%2016 UNINSURED RATE IN OUR REGION* LOWEST IN MODERN TIMES (LESS THAN HALF THE NATIONAL RATE!) 3.95% Upstate 6.06% NYS 8.58% US LOWEST 2018 RATE REQUESTS IN UPSTATE NY** INDIVIDUAL 4.4% EXCELLUS BCBS 16.6% NYS AVERAGE SMALL GROUP 8.0% EXCELLUS BCBS 11.5% NYS AVERAGE * Source: 2016 American Community Survey, 1-Year Estimates ** Source:

8 OUR WORKFORCE 3,350 HEALTH PLAN EMPLOYEES 1,696 ROCHESTER EMPLOYEES CENTRAL NY EMPLOYEES UTICA EMPLOYEES SOUTHERN TIER EMPLOYEES WESTERN NY EMPLOYEES

9 10,153 PAID VOLUNTEER WORK HOURS OUR EMPLOYEES USED TO HELP ORGANIZATIONS IN LOCAL COMMUNITIES THE EQUIVALENT OF MORE THAN1,269 EIGHT-HOUR DAYS DIVERSITY AND INCLUSION 70% FEMALE WORKFORCE 59% FEMALE MANAGEMENT 9EMPLOYEE RESOURCE GROUPS attract and welcome employees of varied backgrounds. Every member of our executive leadership team is an Employee Resource Group champion. We've been named a " Diversity Leader" by Profiles in Diversity Journal for four consecutive years.

10 OUR HEALTH PLAN'S PROVIDER NETWORK 98% PHYSICIAN PARTICIPATION 2,642 PRIMARY CARE PHYSICIANS 9,642 SPECIALISTS AND ANCILLARY PROVIDERS 67 HOSPITALS (100% PARTICIPATION) 1,208 OTHER FACILITIES

11 QUALITY Excellus BlueCross BlueShield s private, Medicaid and Medicare products are accredited by the National Committee for Quality Assurance* (NCQA). NCQA S ANNUAL HEALTH INSURANCE PLAN RATINGS EVALUATE BOTH ACCREDITED AND NON-ACCREDITED HEALTH PLANS BY QUALITY AND PERFORMANCE METRICS. NCQA Our products have earned ratings of 4 stars and above on NCQA s 5-star quality scale. CMS Our Medicare plans have earned 4 stars and above from the Centers for Medicare & Medicaid Services (CMS). Private (Commercial) HMO/POS/PPO: Medicaid HMO: Medicare HMO: Medicare PPO: Medicare Part D: Medicare HMO: Medicare PPO: * National Committee for Quality Assurance (NCQA) is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA s HEDIS is the most widely used performance measurement tool in health care. NCQA s website ( contains information to help consumers, employers and others make more informed health care choices.

12 ACCOUNTABLE COST AND QUALITY AGREEMENTS ACQAS The ACQA model allows us to work together with providers, helping people in our communities live healthier and more financially secure lives.

13 These specific agreements focus on collaboration between our Health Plan and systems of doctors and hospitals. We work together to improve quality and keep costs down by identifying opportunities for efficiency, closing gaps in care and better controlling chronic conditions in members. In 2017: 6 IN10 MEMBERS SAW PROVIDERS IN ACQAs OR SIMILAR AGREEMENTS $3.9 MILLION PHARMACY SAVINGS SLOWER GROWTH IN MEDICAL COSTS WHEN CARE IS MANAGED BY AN ACQA PRIMARY CARE PHYSICIAN 100% OF ACQA PROVIDERS OUTPERFORMED NON-ACQA PROVIDERS IN EVERY CORE CLINICAL MEASURE DATA INFRASTRUCTURE & STRONGER COMMUNICATION BETWEEN DOCTORS AND CARE MANAGEMENT STAFF LED TO HIGHER NUMBER OF BREAST CANCER AND COLORECTAL CANCER SCREENINGS 1,700 DOCTORS SERVED HUNDREDS OF THOUSANDS OF MEMBERS

14 INVESTING IN THE HEALTH OF THE COMMUNITIES WE SERVE ROCHESTER DIABETES CARE COORDINATION Lifespan of Greater Rochester helps older adults with diabetes navigate and understand the health care system. Diabetes Care Coordinators work with program participants to better understand and manage their condition with the goal to increase compliance and reduce emergency room visits and hospitalizations. In addition, Lifespan offers diabetes selfmanagement and healthy living classes to the public. PEDIATRIC BEHAVIORAL HEALTH APPROACH REDESIGN Primary care providers receive training from child psychiatrists and behavioral health specialists on diagnoses and evidence-based management of common pediatric behavioral health conditions. The University Psychiatric Practice program improves accuracy of diagnosis and care for children with behavioral health conditions. DIABETIC EYE EXAMS VIA TELEHEALTH Providing retinal cameras to UR Medicine primary care practices allows retinal screenings to be completed at a diabetic patient s primary care appointment. Images are transmitted via telehealth to Flaum Eye Institute to be read and results are returned to the physician with recommendations. The ability to perform retinal screenings at a patient s regular visit removes the need for a separate eye appointment, making screening more convenient and more likely to be completed.

15 Our Health Plan supported more than 475 community-based organizations for regional initiatives designed to improve health care access, quality and outcomes across upstate NY. Here are a few examples of the regional initiatives we supported in CENTRAL NEW YORK DIABETES SELF-MANAGEMENT EDUCATION The Lerner Center at Syracuse University facilitated the establishment of a Diabetes Self-Management Education (DSME) program at a community health center in a historically underserved neighborhood of Syracuse. In collaboration with a neighboring supermarket, the program also established a Healthy Shopper Rewards program and NuVal food index to help shoppers make healthy food choices. DIABETIC EYE SCREENING St. Joseph s Health Foundation implemented a diabetic eye screening program at two community health centers in Syracuse, NY. The program allows patients to be screened for diabetes-related eye diseases in the same location and on the same day as their primary care appointment. TOMPKINS COUNTY LEAD TESTING IMPROVEMENT The Tompkins County Health Department is working with area primary care providers to place six point-of-care blood lead level testing machines and supplies in pediatric practices, clinics and physician s offices throughout Tompkins County. By making on-site lead testing available in more primary care settings, the program aims to increase compliance with mandated screening requirements among children at the ages of 1 and 2 years.

16 UTICA/NORTH COUNTRY DIABETES EDUCATION AND FOOT CARE The Faxton St. Luke s Hospital Foundation has enhanced their CNY Diabetes Education program through the purchase of an HbA1c testing device on site, the addition of a medication adherence tool for all program participants, offering incentives for participation in the education program, and on-site diabetic foot exams and foot care services. CANTON-POTSDAM HEALTH COACHES In a partnership with the Canton-Potsdam Hospital Foundation, community volunteers and students from local colleges and universities are paired with local high-risk patients living with chronic diseases to provide one-on-one lifestyle coaching. Coaches meet with patients to discuss selfmanagement techniques, set goals, improve self-esteem, reinforce medication adherence and reduce visits to the emergency room. EXPANDING CHILDREN'S LEAD TESTING IN HERKIMER AND ONEIDA COUNTIES Herkimer HealthNet, Inc. is placing point-of-care blood lead level testing machines and supplies in seven pediatric practices, clinics and physician s offices throughout Herkimer and Oneida counties. By making on-site lead testing available in more primary care settings, the program aims to increase compliance with mandated screening requirements among children at the ages of 1 and 2 years.

17 SOUTHERN TIER NORTHSIDE OF BINGHAMTON HEALTHY FAMILIES HEALTH COACHING PROGRAM In partnership with the United Way of Broome County, we fund a program called "Healthy Families" that aims to improve the health outcomes of people who have pre-diabetes and diabetes and live in the Northside Binghamton Community. The program targets individuals to meet their individual health goals, provides safe and available locations to be physically active, offers physical activity classes free of charge and provides access to important health screenings. CAREFIRST MEMBER AND COMMUNITY HEALTH EDUCATION CONSORTIUM We fund a CareFirst health program that covers Steuben, Schuyler, and Chemung counties and focuses on educating medical staff, professional clinical teams, and individual caregivers on end-of-life care, hospice/ palliative care and falls prevention. The project also encompasses hands-on practice through use of a newly built skills lab, in partnership with over 19 facilities and agencies that work with the aging and chronically ill population. RED CROSS VETERAN'S PROGRAM We fund a program with the American Red Cross to provide behavioral health services to help people who are in military service; veterans and their families prepare for, cope with, and respond to the challenges of military service. The funding also provides comfort care kits to homeless veterans and those in care facilities or in high-need areas.

18 NATIONAL STRENGTH OF BLUE CROSS BLUE SHIELD 36 INDEPENDENT, COMMUNITY-BASED & LOCALLY OPERATED COMPANIES The Blue Cross and Blue Shield companies are the nation's oldest and largest family of health benefits companies.

19 1 in 3 NEARLY AMERICANS MORE THAN 106 MILLION MEMBERS RELY ON BLUE CROSS BLUE SHIELD COMPANIES FOR ACCESS TO SAFE, QUALITY AND AFFORDABLE HEALTH CARE. 96% OF HOSPITALS 95% OF PROVIDERS CONTRACT DIRECTLY WITH BLUE CROSS BLUE SHIELD COMPANIES.

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