MyHealth Advantage Program Overview

MyHealth Advantage Program Overview

Today s webinar We will provide in depth overviews of a new 360 Health Program- MyHealth Advantage, which is being added to your benefit offering at no additional cost on July 1 st. The call will last approximately 45 minutes. All lines will be muted but through the live meeting software you will be able to ask questions and we will pause to repeat and answer them. Our main presenter today is Lance Geiger 2

Comprehensive Wellness Benefits Better Health = Financial Advantage Fully Insured Core Programs Care Management 24/7 NurseLine Future Moms ComplexCare ConditionCare MyHealth Advantage Online Tools and Resources MyHealth@Anthem MyHealth Assessment MyHealth Record Condition Centers Online Community Specialoffers@Anthem AudioHealth Library Time Well Spent Also Available ConditionCare: Support ConditionCare: Kidney MyHealth Coach Healthy Lifestyles Worksite Wellness EAP Pharmacy Benefit Management Staying Healthy Reminders Incentives 3

MyHealth Advantage: Program Overview MyHealth Advantage provides actionable and individualized messaging to members and providers about potential opportunities to: Improve health Optimize their health care spending Avoid critical health issues 4

MyHealth Advantage: Goals The MyHealth Advantage program seeks to help: Improve member health and safety Improve compliance with evidence-based guidelines Increase early detection of health issues Enable members and physicians to make more informed care management decisions Enhance results from synergistic 360 o Health programs Reduce costs for both plan sponsors and members 5

MyHealth Advantage: 360 Health Integration MyHealth Advantage seamlessly integrates with other 360º Health programs via: HRS care Management integration Claims are an integral component of identification and notification process Member Experience All 360 Health contact information is available for nurse coaches to view 6

MyHealth Advantage The MyHealth Advantage program communicates to members when gaps in care, safety issues and opportunities for saving money are identified. MyHealth Notes mailed to applicable members (approximately 1 in 5 members) Recommendations for members to help improve health and save money Listing of most recent medical, lab and pharmacy claims Links to educational information and resources Specific ways they may be able to help save money on health care Preventive reminders (if space allows) Health Coaches field inbound calls Monthly Provider letters for clinical issues 89% of recipients think the MyHealth Note is easy to understand and 72% perceive MyHealth Advantage as valuable. Q4 2009 Member Satisfaction Survey 7

MyHealth Advantage: Benefits Both members and employers benefit from MyHealth Advantage: Members Early identification of potential health issues Helps to improve health via targeted recommendations Potential pharmacy and out of pocket cost savings Helps to monitor and respond to dangerous drug issues Employers Helps to reduce costs Helps to increase savings from generic equivalent drugs Helps to improve productivity; reduced absenteeism and presenteeism Helps to reduced incidence of more serious and costly complications in the future 8

MyHealth Advantage: Advantages & Differentiators Attention getting, easy to understand MyHealth Note Lists recent claims If benefit & formulary info is available, MyHealth Advantage can alert members to actual dollar savings. 360o Health program integration Pharmacy claims reviewed daily. Staff member calls with critical issues Educational information provided by the Harvard Medical School Only program of this type to incorporate benefit information and recommend money-saving changes Program supports the total client population, not just those in disease management programs Proven increase in member compliance 9

MyHealth Advantage: How it works 10

MyHealth Advantage: The Personal Health Picture The more health information available, the more comprehensive the individual s Personal Health Picture Demographic Age 43 Female 1 Dependents Biometrics Height 5 6 (May 23 2008) Weight 165 (May 23 2008) BMI 26.63 (May 23 2008) Abdominal Girth 31in (May 23 2008) Blood Pressure 145 / 90 (May 23 2008) Medical History ER Visit (March 28, 2008) Office Visit Dr. Lynn (May 15 2008) Office Visit Dr. Wilson (May 17 2008) Office Visit Dr. Jones (Apr 12 2008) Prescriptions Cholesterol Panel (May 26 2008) Prilosec 500 mg (May 25 2008) Accupril 20 mg (Mar 28 2008) Prilosec 500mg (Mar 23, 2008) Accupril 20 mg (Feb 18 2008) Paxil 20mg (Feb 12 2008) Lipitor 20 mg (Feb 10 2008) Lipitor 20 mg (Jan 15 2008) Accupril 20 mg (Jan 12 2008) Paxil 20mg (Jan 10 2008) Lab Tests Cholesterol Panel (May 26 2008) Chest CT Scan (Feb 4 2008) Complete Blood Count (Jan 15 2008) Lab Test Results Total Cholesterol 203 (Jan 15 2008) LDL Cholesterol 152 (Jan 15 2008) HDL Cholesterol 42 (Jan 15 2008) Triglycerides 193 (Jan 15 2008) Fasting Blood Sugar 123 (Jan 15 2008) 11

MyHealth Advantage: The Personal Health Scan The Personal Health Scan compares the member s data with medical best practices to find gaps in care and cost savings opportunities: Evidence-Based Care Has Condition Needs Drug Has Condition Needs Test Need Test Follow-up Need Event Follow-up Need Preventive Test-Age Need Test to Optimize Drug Dose Lab Result Need Doctor Follow-up Lab Result Need Drug Rx Adherence Non-Compliance Drug Regimen Discontinued Drug Over-use of Drug Rx Effectiveness Need Test to Optimize Drug Dose Test Result - Monitor Drug Dose Started New Med - Need Doctor Follow-up Rx Cost Savings Brand Switch to Generic Brand Switch to Formulary Preferred Formulary-Preferred Switch to Generic Health Risk Has Condition Needs Drug Need Drug to Prevent Condition Need Doctor Visit Follow-up ER Need Preventive Info Condition Need Info Warning Signs 12

MyHealth Advantage: MyHealth Note Examples Examples of Gaps identified through MyHealth Advantage 13

MyHealth Advantage: Member Communication MyHealth Note: Sample Communication Front Back Member name, mailing date and notice of confidentiality Eye catching symbols with bold headlines linked to messages inside 14

MyHealth Note: Member Communication Member name Targeted suggestions regarding care gaps or cost savings opportunities Most recent medical, pharmacy, and lab claims Harvard Medical School website reference 15

MyHealth Note: Medication Graphic Insert New Medication Graphic provides an innovative, graphical representation of member medication compliance 16

MyHealth Advantage: Member Analysis We monitored members with MyHealth Advantage for twelve months to see what effect the MyHealth Note had on increasing medical compliance. 12 groups were monitored for a total of 12 months (159,959 lives total). 40,176 people, or 25.1% of the total population received at least one MyHealth Note due to an identified health opportunity. Of the 25% that received a MyHealth Note, 61.4% of people received more than one during the 12 month period. Over 12 months, 184,121 issues were addressed, excluding Daily Rx Safety Alert messages. 17

Results The Member Analysis showed increases in compliance associated with specific MyHealth Note messages: 46% showed increased compliance with clinical recommendations 1 69% refilled a high blood pressure Rx when reminded 1 60% went for annual lipid check when reminded it was overdue 1 38% scheduled a mammogram when reminded it was overdue 1 23% switched to a lower cost generic medication when told there was an alternative 1 1Based on internal review of current participants; Members acted within twelve months of receiving the initial MyHealth Note and may have been messaged more than once. 18

MyHealth Note: Member Feedback I find the MyHealth Note very informative and helpful. It truly does help me manage my health issues. Keep up the excellent job. I have found this service to be very helpful in continuing to manage my several health problems. The MyHealth Note had me write down questions to ask my physician based on the meds I already take. It is very informational and a great benefit to me. Better than any other insurance program I have had. Source: Quarterly MyHealth Advantage member surveys. 1,738 Member responses in 2009. 19

MyHealth Advantage: Medical Guidelines Evidence-based guidelines published by national medical associations and societies: The American Heart Association The American Diabetes Association Major studies and initiatives are used, including: The Global Initiative for Asthma (GINA) The United States Preventive Services Task Force (USPSTF) The National Cholesterol Education Program (NCEP) FDA information and drug package inserts from manufacturer 20

MyHealth Advantage: Provider Engagement Member-specific messages sent to physicians increase compliance with practice guidelines by 15% (5% absolute increase). Provider Care Alerts mailed monthly Member non-adherence with tests, exams and screenings, medication therapy and drug safety issues 21

Questions? The Anthem National Accounts business unit serves members of the Blue Cross licensees for California (Anthem Blue Cross Life and Health Insurance Company and Blue Cross of California using the trade name Anthem Blue Cross); the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as Empire Blue Cross Blue Shield in 17 eastern and southeastern counties, including the 5 New York City counties, and as Empire Blue Cross in 11 upstate counties), Ohio, Virginia (serving Virginia excluding the city of Fairfax, the town of Vienna and the area east of State Route 123.), and Wisconsin. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In most of 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 Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In most of Virginia (serving 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") underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare") underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees of the Blue Cross Blue Shield Association. ANTHEM is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 22