YOUR TO LOWER COSTS SMARTER SOLUTIONS AND BETTER HEALTH

Transcription

1 YOUR TO LOWER COSTS SMARTER SOLUTIONS AND BETTER HEALTH

2 Transforming America s health care for everyone Serving nearly 34 million members through our affiliated health plans and some 65 million individuals through subsidiaries, our parent company is one of the nation s largest health benefits companies. 1 Each day, we are using our strength and far-reaching resources to fuel the transformation of health care in America by building stronger connections: between employers and employees, between patients and doctors, and between doctors and data ultimately connecting them to better health. Our leading position is based on a solid track record of strong financial performance and tailored innovations designed to curb the effects of rising health care costs on corporate budgets. And we demonstrate that every day through: LOWER COSTS. We offer employers exceptional total value in health care, based on network discounts. Today, nearly one in three Americans is covered by a Blue Cross and Blue Shield health plan. 2 TAILORED STRATEGIES. We understand that one size doesn t fit all and actively collaborate with our national account clients to create tailored strategies and customized solutions to meet their individual needs. HEALTHIER EMPLOYEES. Through market-leading consumer engagement strategies, a deep commitment to data transparency and an innovative, member-centered health management model, we take an integrated and personalized approach to help keep employees healthy. Today, nearly one in three Americans is covered by a Blue Cross and Blue Shield health plan. 2 As part of one of the largest health insurance organizations in the nation, we are putting the power of our strength in numbers to work on behalf of the clients and members we serve. For national accounts, our size and strength translates into low health plan costs and exceptional access to care for their employees, no matter where they live. It s an important reason that 380 of Fortune 500 companies count on Blue Cross and Blue Shield companies to cover their employees. 2 For our members, our advantage means innovations and connections designed to make health care more effective and easier to understand. Blue Cross and Blue Shield is a national leader in care delivery, with patient-centered medical homes underway in 39 states, Washington, D.C. and Puerto Rico and accountable care models in 29 states and Washington, D.C. 3 At Anthem, we re breaking new ground in care management to empower individuals to take better control of their health. And our commitment to data transparency is dramatically shifting the dynamics of the health care market. An independent licensee of the Blue Cross and Blue Shield Association, our member companies include: At Blue Cross and Blue Shield, we are 100 million members strong. 4 AND EVERY SINGLE ONE MATTERS. Blue Shield Anthem Blue Cross Empire BlueCross BlueShield Blue Cross and Blue Shield of Georgia OUR MISSION Improve the lives of the people we serve and the health of our communities OUR PROMISE We simplify the connection between health, care and value The highest-rated health insurer by reputation. March 2012 Forbes and Reputation Institute study of America s Top 150 Companies. 1 Source: 2 Source: 3 Source: 4 Source:

3 EXECUTIVE LEADERSHIP TEAM John Cannon Interim President and CEO Local Plan Presidents Unequalled access and expertise Ken Goulet Employer, Medicaid, Individual and Specialty Rob Hillman Blue Shield, Indiana Lisa Guertin Blue Shield, New Hampshire Harlan Levine, M.D. Comprehensive Health Solutions Mike Murphy Blue Shield, Nevada Lawrence Schreiber President and General Manager Blue Shield, Wisconsin Mark Wagar President and General Manager Empire BlueCross BlueShield, New York Daniel Corcoran Blue Shield, Maine Randy Brown Executive Vice President and Chief Human Resources Officer Mike Ramseier Blue Shield, Colorado David Fusco Blue Shield, Connecticut Wayne DeVeydt Executive Vice President and Chief Financial Officer Pam Kehaly President Anthem Blue Cross, California Senior Vice President, Medicaid Erin Hoeflinger Blue Shield, Ohio Gloria McCarthy Office of the CEO Steve Martenet Blue Shield, Missouri Burke King Blue Shield, Virginia Lori Beer Enterprise Business Services Morgan Kendrick Blue Cross and Blue Shield of Georgia Samuel Nussbaum, M.D. Clinical Health Policy, and Chief Medical Officer Deb Moessner Blue Shield, Kentucky

4 Meet your Anthem team REGIONAL VICE PRESIDENTS John Martie SVP, President National Accounts Paige Rothermel RVP Sales, California Jeffrey Sepich Director of Sales, Colorado jeffrey James Augur RVP Sales, Connecticut Jai Bills VP Interplan and Planning National Accounts Kaye Newsome Staff VP Commercial Sales Administration Andrea Schell VP Underwriting National Accounts Chuie Yuen, M.D. VP Chief Clinical Sales Officer Perry Pogany VP Account Management National Accounts Helen Drexler RVP National Account Management Southeast Region Swati Mathai RVP National Account Managment Northeast Region Gregory Armer RVP National Account Management West Region Denise Tomechko RVP National Account Managment Central Region Jerry Kertesz VP Sales National Accounts Salem Shunnarah RVP Sales National Accounts Southeast Region David Aguayo RVP Sales National Accounts West Region John Hastings RVP Sales National Accounts West Region Peter Welsh RVP Sales National Accounts Central Region Brian Fetherston RVP Sales, Georgia Michael Burton RVP Sales, Maine Ethel Graber RVP Sales, Upstate New York John Cooper Director of Sales, Northern Ohio Paul Nobile RVP Sales, Wisconsin Rick Rhodes RVP Sales, Indiana Randy Ressel RVP Sales, Missouri Patrick O Keefe RVP Sales, Down State New York patrick.o keefe@empireblue.com Tim Schmalz Director of Sales, Southern Ohio tim.schmalz@anthem.com OUR OBJECTIVES Excel at day-to-day execution Create the best health care value for our customers Expand naturally from our strengths Advocate responsible health care reform Kennan Wethington RVP Sales, Kentucky kennan.wethington@anthem.com Denise McDonough RVP Sales, New Hampshire denise.mcdonough@wellpoint.com Kevin Hinkle Director of Sales, Central Ohio kevin.hinkle@anthem.com Gabrielle Sansone Director of Sales, Nevada gabrielle.sansone@anthem.com CONSULTANT RELATIONS Steve Peebles VP Automotive Account Management steve.peebles@anthem.com Molly Koester RVP Consultant Relations molly.koester@anthem.com Danielle Truong Senior Consultant, Consultant Relations danielle.truong@anthem.com

5 Connecting doctors and patients We believe the doctor-patient relationship is central to good health, which is why we were among the first in the nation to improve primary-care reimbursement and to pay providers for care coordination that hasn t typically been covered by other insurers like preparing care plans for patients with complex health problems. Ultimately, better care means lower costs savings that we ve shared with doctors as an incentive. But that s just the beginning. At Anthem, we not only advocate responsible health care reform; we practice it, every day. With Patient-Centered Primary Care, we re helping providers guide employees to smarter, more effective and more affordable solutions. Out of the $2.7 trillion the U.S. spends annually on health care, $700 billion is wasted on inefficient or ineffective care 5. We re changing that with a coordinated, patient-centered model: ACO Chronic Care takes savings a giant step further. One percent of patients accounts for 25 percent of all health care spending. Between hospital stays, emergency rooms and drugs, costs for those with multiple chronic conditions average nearly $100,000 a year per patient 6. With Anthem s ACO Chronic Care*: Medicine changes by the minute. And IBM Watson is on it. Through a relationship between our parent company and IBM, we re launching IBM Watson-based solutions to help physicians access the exact information they need, when they need it. Watson is capable of processing, analyzing and interpreting massive amounts of information in seconds. Technology combines natural language capabilities, hypothesis generation and evidence-based learning to help doctors understand treatment options. With Watson, our partnering physicians have the ultimate solution to improve the quality and effectiveness of the care they provide to members. Each employee has 24/7 access to his or her primary-care team. Primary-care teams guide employees to appropriate care facilities, avoiding unnecessary trips to emergency rooms and hospitals. Through fees and shared savings, which can add up to an 86% increase in take-home pay, physicians are encouraged to participate. Incentives are based on achievement of quality standards. A personal health team directs members to more appropriate and effective outpatient solutions. Members and employers save money by avoiding duplicated or unnecessary procedures. Employees are given actionable, personalized support on health and wellness, preventive care, and diet and weight management. Employees are motivated to become healthier, more satisfied and more productive. Anthem provides physicians with analytics, patient history, transparency and cost-comparison information to drive better behavior and lower costs. AN INNOVATION THAT WORKS: We re reducing unnecessary emergency-room visits and hospital admissions. NH PCMH PILOT PROGRAMS CO NY INPATIENT ADMISSIONS* 3.6% fewer ER VISITS* 6.1% fewer INPATIENT ADMISSIONS* 18% fewer ER VISITS* 15% fewer ER VISITS* 11-17% fewer * per 1,000 per year INPATIENT ADMISSIONS* 12-23% fewer for PCMH providers for PCMH providers 5 Thomson Reuters, 2009 White Paper: Where Can $700B in Waste Be Cut from the US Healthcare System. 6 Research Team IMS Institute for Healthcare informatics findings reported by The New York Times on Feb. 27, 2012 * ACO Chronic Care is currently being implemented in CA

6 Connecting employers to lower costs At Anthem, we leverage the size of our network and the strength of our provider relationships to connect employers to lower costs and exceptional value in health care. But beyond this, we actively partner with our clients to deliver health care strategies tailored to the needs of their employees and the realities of the bottom line. Anthem Health Marketplace makes it easier than ever for companies to set budgets and control costs. With health costs rising, Anthem Health Marketplace offers employers an approach that s flexible, predictable and affordable and takes the guesswork out of group health care planning. Employers set their health insurance budget; once set, there are no surprises. We help employers select benefit options for all levels of employees. Through a user-friendly, online survey, employees are guided to the ideal plan based on individual needs, family situation and budget. We move pre-tax dollars into employees Anthem Health Marketplace accounts. We manage everything, from enrollment details to HIPAA and ERISA compliance. Our Pharmacy program looks past the price tag savings. By combining medical and pharmacy, we look at 100% of health care costs not the 15% to 20% that a PBM focuses on. We ve found that some prescriptions that cost more actually result in lower total costs because they help improve member health, reducing the need for inpatient stays and ER visits. We encourage those prescriptions whenever possible. Pharmacy programs, including prior authorization and step therapy edits, are included as part of the pharmacy package; there are no buy-ups. Pharmacy, health and wellness, and medical programs work together to help close gaps in care and lower costs. We have access to extensive clinical data and claims history, which we use to coordinate care between providers and employees to improve member health. Employees get a simplified experience with one ID card, one contact and one website. Companies benefit from total coordination, one account team, one invoice and one contract. BY COMBINING MEDICAL AND PHARMACY, WE GENERALLY SAVE COMPANIES $8 TO $16 PEPM IN MEDICAL COSTS. MEDICAL PHARMACY $8 PEPM TO $16 PEPM For a company with 10,000 employees, that could mean $1.9 million a year. This internal analysis, which was independently verified, was conducted in The lower allowed medical cost savings that were associated with integration and coordination of our medical and pharmacy programs were confirmed in the general population as well as common drug-dependent disease states that drive overall costs, including diabetes, coronary artery disease, congestive heart failure, hypertension, stroke and chronic kidney disease. While an association was validated, specific causality was not. BENEFITS WITH BENEFITS: Anthem s extras help employers attract and retain excellent talent. Anthem s Dental Complete connects deep discounts with a broad network. With our highly customizable and flexible Dental Complete plan designs, we deliver a plan that is designed to meet employers coverage needs and budget. Members have access to the GRID+ network, one of the country s largest national dental networks, administered by the Grid Dental Corporation (GDC) 7. Through the national Dental GRID, the GDC has linked the dental networks of many of the nation s Blue Cross and Blue Shield plans. The GRID+ network is exclusively for members of participating Blue plans, and now offers access to more than 82,000 unique dentists at more than 140,000 access points throughout the country. So members benefits go wherever they go. Nationwide. The National Dental GRID also offers cost advantages for both employers and members. For employers, we are able to provide competitive ASO fees and fully insured bids because with the national Dental GRID, there are no leased network costs to absorb and no re-pricing charges. Plus members can take advantage of deep discounts when they see in-network providers. Members can also use the International Emergency Dental Program while traveling nearly anywhere in the world. With one call, we will help them find a credentialed, English-speaking dentist for urgent dental care. Our customer service representatives are 100% dedicated to our members dental needs. On average, our phone response time is less than 15 seconds, and we pay claims in three days or less, with financial accuracy of more than 99%. 8 With Blue View Vision, the bottom line is clear. We offer members access to one of the largest national vision networks, with more than 50,000 providers and locations across the country including private practice doctors and popular national stores like LensCrafters, Sears Optical SM, Target Optical and JCPenney Optical. Among the features employees receive: Comprehensive eye exams, which can help detect unknown health conditions early on Easy-to-use benefits with no restrictions on choice of frame and lenses Award-winning customer service available 7 days a week Clinically integrated disease management program for diabetic members 40% off retail on additional complete pairs of glasses, anytime, from any network provider 7 The GRID Dental Corporation is a separate company that provides dental network services on behalf of Blue Shield. 8 Customer Service results 2012 year-to-date results through 4/30/12.

7 Connecting employees to better health At Anthem, we re innovating to connect with members in new ways to drive better health. From mobile solutions and digital messaging to social media and telephonic and online medicine, we re committed to lead in the health care world of tomorrow. And we re well on our way today. WITH 360 HEALTH, BENEFITS COME FULL CIRCLE. Anthem offers a comprehensive combination of personalized programs, professional resources and other support to keep members inspired, engaged and healthy. ANTHEM.COM provides online platform for locating doctors, discounts and wellness information. MYHEALTH ASSESSMENT identifies employee health status and serves as a gateway to personalized, coordinated care. FUTURE MOMS provides information, nurse access and other tools for healthy, full-term births. 24/7 NURSELINE enables around-the-clock member access to a Nurse Coach. CONDITIONCARE helps employees actively manage chronic conditions. HOW A LITTLE WELLNESS WENT A LONG WAY FOR COMMONWEALTH OF VIRGINIA. 40% of members have used one of Anthem s Care Management programs. NurseLine offered members after-hour access in 64% of cases helping to avoid urgent-care or emergency-room situations. Complex condition management resulted in fewer ER admissions saving $830,000 net. Maternity coaching program achieved 47% participation, resulting in 92% normal birth-weight babies saving $158,000 net. Chronic condition management resulted in fewer ER admissions and increased medication compliance and care management for those with heart disease and diabetes saving $7.2 million net. Source: 2011 Local Choice Program for Commonwealth of Virginia members statewide. COMPLEXCARE provides additional support of nurse coaches and other clinicians to help patients manage chronic conditions and avoid readmissions. CASE MANAGEMENT educates employees to make more informed decisions about their treatment options and recovery. ANTHEM HEALTH REWARDS motivates and rewards members who join or take part in a health and wellness program. WORKSITE WELLNESS brings health professionals to your office to conduct biometric screenings, educational seminars, flu shot clinics and other events. ONLINE HEALTH COACHING offers personalized, professional support for tobacco cessation, weight management, nutrition, exercise and other lifestyle changes. Contact your Anthem representative for a full list of available programs.

8 Transforming member experience with powerful tools, unmatched data and better healthcare decisions Anthem.com makes it easy for members to make smarter choices. Our goal is to deliver the products, services and experiences that customers want and need so that our members feel supported, appreciated and confident. At the new anthem.com, we ve made significant advancements that are paying off daily for our members: Easy and secure access to personalized member services Friendly, easy-to-understand language, meaning no insurance jargon Seamless transition from public to member site for secure content Personalization of information at the member level An integrated health dashboard for maximum member convenience One-click access to high-value transparency and health and wellness tools Meeting the future head-on with Mobile Technology. Every day, life gets faster. At Anthem, we re developing a valuable consumer experience that leverages technology to help employees make smarter health decisions. Even better, these solutions will be nicely integrated so that providers always know what s going on. Innovations include: Widgets, games and smart-phone apps that include mobile provider finders, tablet support, mobile ID cards and health tips One-click access to high-value transparency tools for choosing doctors and comparing costs FitBit, which gives employees an accurate reading of their progress and health status An integrated platform that combines popular social media and mobile solutions including Facebook, Twitter, YouTube and Pinterest in a powerful way The use of augmented reality, creating the first-ever virtual check-up to promote our preventive care services LOWER COSTS. SMARTER SOLUTIONS. BETTER HEALTH. START NOW. As we connect employers and their employees to Anthem s amazing wealth of information, tools and personalized support, they gain the confidence to be smarter, healthier, more successful health care consumers. Welcome to the next generation of health care. LiveHealth Online reduces medical costs and increases productivity by giving employees interactive access to their choice of credentialed providers. No appointments, no waiting rooms, no time-consuming hassles. Employees have real-time visits with their doctor anywhere they have an Internet connection, via chat or two-way video. Diagnoses, prescriptions, care plans and payment can all be handled online. Records are shared with primary-care provider. Based on a 2011 study on LiveHealth Online 1 : 85% avoided more expensive care settings 90% of patients saved time 85% completely resolved issues online 90%+ were completely satisfied 1 Online Care for Employees: Case Study of Health Services Company, Mercer, LiveHealth Online is made available to clients through an arrangement with UniCare. Mobile capabilities for eligibility, benefits, pharmacy integration, claims information and health tips When people think like consumers, they make better decisions. Anthem brings that wisdom to health care. We give members the tools they need to become smarter health care consumers to track costs, compare options and ultimately, make healthier decisions. It starts with the Health Savings Account: The tax-free account can be funded by the employee, employer or a combination. Designed to complement traditional health plans, it can be used to pay for qualifying out-of-pocket medical expenses and applies toward deductible. Any unused funds roll over into next year s balance. Under the plan, preventive care is covered 100%, reinforcing healthy behavior. Employers can even decide to offer a plan, which allows employees to earn financial rewards, through their account, for healthy behavior.

9 Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-hmo benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia (excluding the City of Fairfax, the Town of Vienna and the area east of State Route 123.): Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin ( BCBSWi ), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ( Compcare ), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Anthem Blue Cross is the trade name of Blue Cross of California. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Blue Cross and Blue Shield of Georgia, Inc., is an independent licensee of the Blue Cross and Blue Shield Association. Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Independent licensees of the Blue Cross and Blue Shield Association.