Driving to Quality Providing Transparency

1. Driving to QualityProviding Transparency Iowa Health Buyers Alliance Conference October 15, 2008 Presenters: Dr. Rick Miller Elodie Opstad Wellmark Blue Cross and Blue Shield

2. Crossing the Chasms The Quality Chasm 100,000 deaths Patients get 55% of necessary care 11% of patients get potentially harmful care The Financial Chasm Trend is logrithmic Medical costs exceed GDP in 2050 Up to 30% of care is waste Wellmark Blue Cross and Blue Shield

3. Health Care Continuum & Population Wellmark Blue Cross and Blue Shield

4. Health Care Continuum & Cost Wellmark Blue Cross and Blue Shield

5. Costs to Productivity Total costs Wellmark Blue Cross and Blue Shield

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9. Wellmark Sponsored Resources and Tools Online Provider Directory www.wellmark.com Wellmark Blue Cross and Blue Shield

10. Find a Physician – Provider Directories Finding a Physician on Wellmark.com Wellmark Blue Cross and Blue Shield

11. Find a Physician Wellmark Blue Cross and Blue Shield

12. Transparency – Provider Directory Wellmark Blue Cross and Blue Shield

13. Collaboration on Quality Wellmark Blue Cross and Blue Shield

14. Wellmark Sponsored Finding an Out-of-State Hospital on Wellmark.com Wellmark Blue Cross and Blue Shield

15. Find an Out-of-State Hospital Wellmark Blue Cross and Blue Shield

16. Find an Out-of-State Hospital Screen Shot #5 Wellmark Blue Cross and Blue Shield

17. Find an Out-of-State Hospital Symbol Key Surgical Complications and Infection Prevention Patient Safety Did not disclose this information. Willing to report publicly; did not yet meet Leapfrog’s criteria for a good early stage effort. Good early stage effort in implementing Leapfrog’s recommended quality and safety practices. Good progress in implementing Leapfrog’s recommended quality and safety practices. Fully implemented Leapfrog’s recommended quality and safety practices. Top 25% (hospital performed better than most other hospitals reporting information). Middle 50% (hospital performed near the average or as can be expected). Bottom 25% (hospital performed in the bottom group of hospitals reporting information). Wellmark Blue Cross and Blue Shield

18. Blue Cross and Blue Shield Association Blue Distinctions Centers Four programs currently in operation NEW Wellmark Blue Cross and Blue Shield

19. Blue Cross and Blue Shield Association WA ME VT ND MT NH MN OR NY MA WI SD ID RI MI PA WY CT IA NJ OH NE IN DE IL NV WV MD VA UT CO KY CA KS MO NC TN SC OK AZ AR NM AL GA MS TX LA FL AK HI PR National Presence Blues achieve national presence, with nearly 800 Blue Distinction designations spanning 43 states Blue Distinction Centers for Cardiac CareSM Blue Distinction Centers for Bariatric SurgerySM Blue Distinction Centersfor TransplantsSM Blue Distinction Centers Complex & Rare CancersSM Wellmark Blue Cross and Blue Shield

20. 57% 40% 30% 19% 15% 11% 9% 7% Mean Maximum Mean Maximum BDC Other Blue Distinctions Cardiac CareOutcomes from Clinical DataBlue Cross and Blue Shield Association data RFI data, self-reported by facilities, demonstrates better, more consistent overall outcomes Inpatient MortalityPost Heart Attack Mortality Rate One-year Post Heart Transplant 90% Variability from outliers and small volume centers Variability from outliers and small volume centers Variability from outliers and small volume centers 167% Variability from outliers and small volume centers 73% 29% Source: Hospital RFI Data Submitted to the Blue Cross and Blue Shield Association Wellmark Blue Cross and Blue Shield

21. Blue Distinctions Cardiac CareCumulative ReadmissionsBlue Cross and Blue Shield Association data BDC vs. Other Readmission rates lower at Blue Distinction Centers 32% 5% 11% n = 1741 3584 4285 2552 12864 8876 BDC Other Statistically significant difference Note: All cardiac and cardiac related readmissions during the initial admission through 90 days, 90 day eligibility required for patient cohort Source: HealthCore Analysis of WellPoint Data, July 2008 Wellmark Blue Cross and Blue Shield

22. BDC Other Statistically significant difference Blue Distinctions Cardiac CareCosts of Care – CABG and PCIBlue Cross and Blue Shield Association data BDC vs. Other Allowed amount lower at Blue Distinction Centers (with same co-morbidity rates as other facilities) 20% 7% n=4285 2552 12864 8876 Note: All allowable costs for initial admission through 90 days. 90-day eligibility required for patient cohort. Allowed amount = total claims from inpatient, outpatient and pharmacy services. Median value shown. Calculating Patient Co-Morbidity Index required six months pre-event eligibility. Source: HealthCore Analysis of WellPoint Data, July 2008. Wellmark Blue Cross and Blue Shield

23. Member Facing Programs Wellmark Blue Cross and Blue Shield

24. Whole Health Dimensions - Overview Pregnancy Care Complex Case Management Disease Management Personal Health Assistant Clinical Integration Wellness Services Utilization Management Pharmacy Benefits Collaboration on Quality Demonstrated Value (Performance, Outcomes, Quality) Metrics and Reporting Integrated Data Warehouse 24 Wellmark Blue Cross and Blue Shield

25. Whole Health Dimensions Overview Whole Health Dimensions - Overview Pharmacy Benefits Case Management 25 Pharmacy Benefits • Wellmark program aligned with CatalystRx & Caremark Service provided to most Wellmark members Case Management • Care coordination for the seriously ill, • Discharge outreach services initiated 07.2008 Service provided to all Wellmark covered members Wellmark Blue Cross and Blue Shield

26. Whole Health Dimensions Overview Whole Health Dimensions - Overview Personal Health Assessment 26 Personal Health Assistant Care Navigation 24/7 (non-clinical) • Directs member to resources Nurse Support 24/7 (clinical) • Urgent and medical care questions • Follow-up with primary clinician post- emergent calls Service provided to some Wellmark members Wellmark Blue Cross and Blue Shield

27. Whole Health Dimensions Overview Whole Health Dimensions - Overview Disease Management 27 Disease Management . . . Targeting members with specific conditions Core conditions • Asthma • Chronic obstructive pulmonary disease (COPD) • Coronary Artery Disease (CAD) • Congestive Heart Failure (CHF) • Diabetes Impact Conditions • Acid related stomach disorders - Irritable bowel syndrome • Atrial Fibrillation - Low back pain • Decubitus ulcers - Osteoarthritis • Fibromyalgia - Osteoporosis • Hepatitis C - Urinary incontinence • Inflammatory bowel disease Service provided to some (not all) Wellmark members Wellmark Blue Cross and Blue Shield

28. Whole Health Dimensions Overview Whole Health Dimensions - Overview Pregnancy Care Utilization Management …Two types of notification programs Precertification: Notification mandatory Prior Approval: Notification recommended Service provided to all Wellmark members Utilization Management 28 Pregnancy Care • Identification of risks through early assessment • Care coordination • Reduce preterm delivery and low birth weight infants Service provided to some Wellmark members Wellmark Blue Cross and Blue Shield

29. Whole Health Dimensions Overview Whole Health Dimensions - Overview Wellness Services 29 Wellness Services • Personal Health Assessment • Lifestyle Management Programs • Interactive behavior change programs • Web tools • QuitNet smoking cessation • Telephonic Health Coaching • Community Coordinators • Located throughout Iowa and South Dakota • Web-based community resource guide • Employer consulting Service provided to some Wellmark members Wellmark Blue Cross and Blue Shield

30. Clinical Integration Strategy Linking Primary Clinicians to Whole Health Dimension ProgramsImpacting Health and Outcomes • Primary Nurse Model • Clinician-generated referrals • Program services as an extension of the provider office 30 Wellmark Blue Cross and Blue Shield

31. Provider Facing Programs Incent and Reward Best Practices Wellmark Blue Cross and Blue Shield

32. Collaboration on QualityPrimary Care Program How Does the Program Work? Clinical team sees patient and submits data into MDdatacor Clinician Volunteers to participate in the program Patient list validated by clinician in Care Center Clinician views patient or population specific performance data Clinical team Schedule repeat visits Potential financial awards based on performance level achieved Clinical team identifies opportunities Wellmark Blue Cross and Blue Shield

33. Growing Clinician Participation Incent and Reward Best Practices: Growing Clinician Participation Wellmark Blue Cross and Blue Shield 33

34. Incent and Reward Best Practices: 2006 compared to 2007 Diabetes Process Measures* *2006 Results are an average of 12 & 17 months data, due to program not have the same reporting period for all participants. This is self-reported data by clinics, collected and compiled by MDdatacor. Wellmark Blue Cross and Blue Shield 34

35. Incent and Reward Best Practices: 2006 compared to 2007 Diabetes Outcome Measures* * These results are based on clinical information submitted to MDDatacor by clinics. * 2006 Results are an average of 12 & 17 months data, due to program not have the same reporting period for all participants. Wellmark Blue Cross and Blue Shield 35

36. 2007 Cost Outcomes Wellmark Blue Cross and Blue Shield 36

37. Percent of Diabetic Patients Receiving All Necessary Tests Wellmark Blue Cross and Blue Shield 37

39. Wellmark Blue Cross and Blue Shield Questions?