The Value of. Blue Care Connection. Empowering members to take charge of their health

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1 The Value of Blue Care Connection Empowering members to take charge of their health

2 Programs that Empower Companies with the most effective health and productivity programs experienced improved financial outcomes: 11 percent higher revenue per employee, reduced costs associated with medical trends by 1.2 percent, and who performed 55.3 percent better than their industry peers. Source: The Health and Productivity Advantage; 2009/2010 North American Report. Watson Wyatt Worldwide and National Business Group on Health. Health care costs are rising at a rate faster than both wages and inflation. Unhealthy behaviors make headlines every day. The good news is that you can count on Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas (referred to herein collectively as BCBS ) for an integrated, evidence-based and member-focused approach to medical care management that can help effect real change. The Blue Care Connection suite of programs and services supports healthy behaviors and outcomes for our members. Engaging members across the health care continuum from wellness and prevention through chronic conditions to complex and catastrophic care Blue Care Connection combines traditional care/utilization, case and condition management with technology, consumer resources, personal assistance, education and health advocacy. Our goal is to aid members in achieving or maintaining their optimum level of health. The meaningful engagement of members and providers has shown to be most successful in improving health status across the continuum. Managing at-risk, moderate-risk, complex and special health care needs Whether a member is experiencing an inpatient hospitalization, has complex or special health care needs or is at risk for medical complications, our advanced analytics help recognize members needing more intensive intervention. We focus on pinpointing gaps in care that may lead to the most effective clinical outcomes. Timely closing of these gaps helps support improving the member s health and helps control costs. 1 Experience. Wellness. Everywhere.

3 Condition Management We concentrate our condition management efforts where they can have a major impact. BCBS targets the top five conditions that represent roughly 40 percent * of claims costs: asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery disease (CAD) and diabetes. BCBS identifies members with certain chronic conditions who may be experiencing gaps in care that could be addressed through intervention and counseling. Our program assists members with adopting healthier behaviors, setting goals and learning to manage their medical conditions more effectively. Members who are active in a condition management program often show improvement in their health and avoid costs associated with managing their chronic conditions compared to those members who are not participating in a condition management program. On average, our program moves nearly 40 percent of non-compliant members to a well-managed member status. ** When members have multiple conditions, we take an integrated approach to manage all the conditions at the same time. Projected Annual Cost Savings per Well-Managed Member Asthma $704 Diabetes $1,013 CAD $3,229 COPD $3,237 CHF $6,403 3 conditions $10,108 4 conditions 5 or more conditions $17,019 $18,888 * Source: Health Care Service Corporation (HCSC) claims incurred from June May **Source: HCSC internal data through June Well-managed members are defined as members not experiencing gaps in care for their chronic condition(s). Source: HCSC claims data from July June 2009; 500,000+ members identified with chronic conditions. 2 bcbsil.com bcbsnm.com bcbsok.com bcbstx.com

4 Care/Utilization Management Following industry and national standard of care guidelines, our program assists covered members navigate the health care system and helps identified members receive the appropriate level of care in the most cost-effective setting. BCBS brings added value to traditional care/utilization management through short-term discharge planning, facilitating transitions between levels of care and pre-admission and/or post-discharge calls. 23 % Our Pre-Admission and Post-Discharge Call Program offers demonstrated results in reducing complications and re-admissions factors that add significantly to already high inpatient claims costs. Nurses contact identified members before and after discharge from a scheduled inpatient hospitalization or surgery to provide guidance, assistance and education, as needed. Our experience has shown that members receiving these calls reflect a 23 percent * reduction in inpatient re-admissions post hospitalization or surgery. * Source: HCSC internal data, 2009 call data of members receiving calls compared to those who were not contacted. The Pre-Admission and Post-Discharge Call Program may be an additional fee. Members engaged in the program yield an average savings of over $2,000 per case ** BCBS successfully engages 65 percent of members identified Almost 50 percent of the goals set jointly by the member and their case manager are met ** Source: HCSC internal data, Source: HCSC August 2010 Executive Benchmark Report, September August 2010 results. Case Management We have been providing personal attention, resources and support to members with complex or special health care needs for more than 30 years. Our case management program is a collaborative process that engages the member, provider, case manager and Blue Care Advisor (a registered nurse or other health care professional). Together they work to help improve the member s quality of life and attempt to slow the progression of the condition. Members are referred to case management through a variety of mechanisms, such as predictive modeling, high cost claim utilization, inbound calls, concurrent and medical peer reviews and referrals. 3 Experience. Wellness. Everywhere.

5 Healthy Behavior Changes for more productive and happier lives Our lifestyle programs offer resources and tools for influencing positive behavioral changes that can last a lifetime, such as helping members manage their weight and quit smoking. Almost 50 percent of members identified as tobacco users or as overweight and who indicated a readiness to change their behaviors are engaged in these programs. * Over 40 percent of members enrolled in the Tobacco Cessation program report that they stopped smoking. * Metabolic Syndrome Program An estimated 47 million Americans are living with Metabolic Syndrome. *** Metabolic Syndrome is a cluster of three or more health risk factors that together place people at high risk for developing debilitating illnesses such as heart disease, stroke and diabetes. These risk factors include elevated waist circumference, triglycerides, fasting glucose and blood pressure, in addition to reduced HDL or good cholesterol. BCBS offers a 10-week series of on-site or online classes led by health coaches to help address Metabolic Syndrome and encourage permanent behavior changes. Our 2009 Metabolic Syndrome program results show that after 10 weeks: There was a 24 percent decrease in the number of participants considered at-risk for Metabolic Syndrome Participants saw an average weight loss of 9.6 pounds 34 percent of participants reported that they reduced or eliminated their medication usage Weight Management Program Results 62 percent of participants lost an average of 5 percent of their body weight ** 61 percent reduced their BMI by an average of 2 points ** 55 percent increased their physical activity ** 40 percent reduced their stress levels ** * Source: HCSC August 2010 Executive Benchmark Report, September August 2010 results, members with valid contact information. ** Source: HCSC internal data, *** Source: American Heart Association, July Source: HCSC 2009 Metabolic Syndrome program results, almost 200 members identified as at-risk and program participants. Extra charges apply. 4 bcbsil.com bcbsnm.com bcbsok.com bcbstx.com

6 Managing Maternity Risk 97 percent were satisfied/very satisfied with the Special Beginnings program 91 percent would participate in the program again Source: HCSC 2009 Special Beginnings program survey results, more than 600 participants responded to survey. Over $26 billion is spent annually on premature births in the United States $49,033 per pre-term infant. * Our Special Beginnings maternity program provides expectant members support and education, risk factor identification and ongoing communication/monitoring from experienced program staff. The program s goal is to help the mother throughout her pregnancy and give the baby a healthy start. Neonatal Intensive-Care Unit Savings Per Case Program participation helps enable early identification of high-risk pregnancies and allows case managers to intervene before costly admissions for complications such as threatened pre-term labor. Cost savings was nearly 50 percent higher for high-risk expectant members who participated in Special Beginnings compared to those in Case Management alone. ** * Source: March of Dimes, **Source: HCSC internal data, Special Beginnings Success Story Lila enrolled in Special Beginnings for support during her fifth pregnancy. Prior to enrolling, she experienced three unmanaged miscarriages and a complicated delivery. Lila s case manager coordinated pre-term labor support and home bed-rest care with her physician and a home care agency, while maintaining frequent contact to facilitate a positive outcome. When her blood pressure elevated, the case manager worked with the home care agency to help manage the condition and avoid a prolonged inpatient admission. Lila delivered a healthy baby girl at 37 weeks with no complications and was discharged from the program after no occurrence of postpartum depression. 5 Experience. Wellness. Everywhere.

7 Accessing Appropriate Care Around-the-Clock Assistance Health concerns don t always follow a 9-to-5 schedule. Our toll-free 24/7 Nurseline is available for members 24 hours a day, seven days a week. The Nurseline is staffed by registered nurses who can answer members general health questions and offer guidance on when to seek emergency, urgent, family or other care. An audio library on a variety of health topics (in English and Spanish) is also available. In 2009, approximately 82 percent of callers intended to go to the emergency room before calling the 24/7 Nurseline. By redirecting these cases to more appropriate care settings, members saved an average of $165 in co-pays and deductibles and long waits in the ER. * In addition to helping members save time and money, our Nurseline s redirection efforts saved over $9 million in paid dollars for ER visits last year alone. * Support for Healthy Minds and Bodies New in 2011, BCBS s integrated Behavioral Health program will be part of Blue Care Connection. The goal of the integrated Behavioral Health program is to support early identification of members who could benefit from co-management of behavioral health and medical conditions. This may result in improved outcomes, enhanced continuity of care, greater clinical efficiency, and reduced costs over time. Our new behavioral health integrated service delivery model is supported by state-of-the-art technology providing advanced data mining capabilities, communication tools, automated member and provider information and online tools. * Source: HCSC internal data, bcbsil.com bcbsnm.com bcbsok.com bcbstx.com 6

8 Helping Drive Lower Costs and Better Outcomes 65 percent of those identified through customized alerts for case management and condition management programs agree to program participation after talking to an advocate. * Leveraging Technology for a Personalized Experience We combine leading-edge technology, security and personalized attention with our best-in-class service philosophy to deliver true health advocacy. Our concierge service is centered on building relationships with each member based on his or her needs and preferences. Customer Service Advocates are evaluated on call quality and member satisfaction, rather than simply on call volume or average call times. When members call Customer Service with routine claims inquiries, customized alerts inform our advocates about client-specific benefits, upcoming events and wellness programs offered through the employer s plan. The advocate can explain benefits, answer claims questions, educate members on available care management programs, and connect members with a Blue Care Advisor for health counseling and coaching, as needed. Sixty-five percent of those identified through customized alerts for case management and condition management programs agree to program participation after talking to an advocate. * Our unique approach to customer service helps to achieve a better overall member engagement rate in Blue Care Connection programs through this streamlined collaboration between our Customer Service Advocates and medical management staff. Insight and understanding of our members health status across the continuum allows us to design our care management programs to meet members needs, address gaps in care and improve our members overall health. * Source: HCSC July 2010 YTD Member Campaign Manager Report. 7 Experience. Wellness. Everywhere.

9 Approaching Health Care Holistically Members have access to My Care Profile, an online snapshot of their medical history, based on claims and available lab results, which can be shared with their health care providers. Providers see a seamless integration of their patients care throughout all Blue Care Connection programs and a reduction of overhead costs through the Availity Care Profile *, a payer-based health record accessible through several channels. BCBS medical management clinical staff can collaborate with the member and his or her provider and access an online view of the member s health with the Rapid Assessment View. * Availity is an independent third-party vendor. BCBS is committed to serving our customers needs by our investment in health information technology. In 2008, we acquired MEDecision, a leading provider of care management platforms. Members, providers and our medical management staff can all view a member s health information through this electronic delivery platform. 8 bcbsil.com bcbsnm.com bcbsok.com bcbstx.com

10 Contact your representative for more information on how Blue Care Connection can work for your company. Blue Care Connection resources are not a substitute for the medical advice of a physician. Members are instructed to discuss any health questions or concerns with their physicians. Your individual company results may vary. Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas 1 Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association