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Insure New Mexico! Council Deborah Dorman-Rodriguez Vice President and General Counsel Dorane Wintermeyer Vice President, Marketing and Sales. November 4, 2004 . Blue Cross and Blue Shield of New Mexico, A Division of Health Care Service Corporation, A Mutual Legal Reserve Company,

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Insure New Mexico! CouncilDeborah Dorman-RodriguezVice President and General CounselDorane WintermeyerVice President, Marketing and Sales

November 4, 2004

Blue Cross and Blue Shield of New Mexico,

A Division of Health Care Service Corporation,

A Mutual Legal Reserve Company,

An Independent Licensee of the Blue Cross and Blue Shield Association

Introduction and overview
Introduction and Overview

  • Products

  • Utilization – Education – Wellness

  • Charitable Giving

  • Partnering with Government

Understanding new mexico s uninsured 396 000
Understanding New Mexico’s Uninsured – 396,000

11,000 of New Mexico’s uninsured are unaccounted for1

Approximately 112,000 New Mexicans may be considered short-term unisured2

Approximately 73,000 of New Mexico’s uninsured have incomes of $50,000 or more and may be able to afford coverage1

Approximately 200,000 New Mexicans may be considered long-term unisured2


1 HRSA White Paper on Unisurance in New Mexico;

Synopsis, 2004

2 Extrapolated from NM Health Care Coverage and

Access Study, 2002

U.S. Census Bureau, 2003; BCBSA analysis

New mexico s uninsured bcbsnm s perspective

Uninsured Segments

Wellness Financial Support

Product Innovation

Health Education & Services

Health Screening

New Mexico’s Uninsured: BCBSNM’s Perspective

There is no single solution for New Mexico — the diversity of the uninsured necessitates multiple public and private solutions

Health Care Costs – Understanding Cost Trends

Private Insurance Healthcare Dollar




Physician Services






Other Medical Services

Nursing Home & Home Health

Durable Medical Products

Source: CMS, BCBSA analysis March, 2003

Factors driving healthcare cost increases
FactorsDriving Healthcare Cost Increases

Fraudand Abuse




GeneralInflation (CPI)




Litigation and

Risk Mgmt


Drugs,Medical Devices& other MedicalAdvances





Mandates &


Rising Provider/

Hospital Expenses

A Market in the Midst of Change



Rapidly Rising Healthcare Costs and Increasing Consumerism Reshapingthe Industry

Employees andConsumers

Consumer DirectedHealthcare




  • Shouldering burden of rising medical costs

  • Covering 70% of premium increases

  • Looking for ways to manage short and long term costs

  • Struggling tobalance employee satisfaction and pressure on bottom line

  • Greater accountability

  • More cost transparency

  • Consumers need to understand the cost implications of their actions

  • More informed decision making

  • Empowered to make good healthcare and health plan decisions

  • Shielded from true cost of healthcare

  • Wanting more value from their benefits as out of pocket costs increase

  • Looking for more information and control over healthcare decisions

Product innovation current
Product Innovation - Current

BCBSNM has designed new products to improve access for the most vulnerable populations

  • Programs targeted towards:

    • Low-income adults

    • Children

    • Small employers

  • Provider partnerships are key to success

Product Innovation

Product innovation results
Product Innovation - Results

Preliminary results show that HSA products are helping with the uninsured problem

  • AHIP survey June 2004

  • Conducted by Hey Group

  • Preliminary results

  • 20% of individual HSA sales are for previously uninsured

Product Innovation

Consumer Driven Health Plans:Wave of the Future?

  • Approximately 80 - 85% of those insured have claims from $0 - $2,500

  • 60% of people who had Medical Savings Accounts (MSAs) had a balance at the end of the year

  • “One size fits all” group medical benefits no longer work

  • Baby boom generation in best position to participate in and benefit from Health Savings Accounts (HSAs)

  • Other options include Health Reimbursement Accounts coupled with Flexible Spending Accounts

  • With proper tools, Americans can become the center of their health care and can decide for themselves what’s best for their families.

Product innovation 2005
Product Innovation - 2005

BCBSNM is developing programs to cover the short-term uninsured and the middle-class uninsured

Short-term Products

Value Products

  • Targeted at individuals between jobs

  • Low monthly payments

  • Limited eligibility – usually six to nine months

  • Targeted at working uninsured and small employers

  • HSA’s for Individuals

  • Products without mandated benefits

Consumers Can Play Significant Role

  • The Long Term: Consumers can play a significant role over their health and future health expenses

Source: IFTF and Center for Disease Control and Prevention, Health and Healthcare 2010, January 2000

How Can We Encourage and Support BehaviorChange?

Healthcare cost campaign
Healthcare Cost Campaign

Started the campaign focusing on drivers of cost

Cost of HIPAA

Physician Cost Drivers

SupplierInduced Demand

Hospital Cost Drivers

AdministrativeCost Drivers

Healthcare cost campaign1
Healthcare Cost Campaign

Emphasizing what works to address affordability and quality in local Plan markets through BlueWorks

Partnership with Harvard Medical School




Health Education and Services - 2005

BCBSNM will sponsor the Care Van program to provide health screenings, immunizations and educate children


  • Partner with DOH, Providers, and non-profit health groups to provide a diverse range of health services in New Mexico.

  • Educate children and families throughout New Mexico about good health and choosing a healthy lifestyle.

  • Support state-wide DOH health initiatives and provide health awareness outreach to underserved communities.

Health education and services

Health Screening

Health Education and Services

BCBSNM provides education and services to other individuals in the uninsured community

BCBSNM provides:

  • Multilingual materials to Hispanic communities

  • Outreach to underprivileged groups

  • Health screenings

  • Educational materials to all groups on maintaining healthy lifestyles

Health Education& Services

Charitable giving
Charitable Giving

BCBSNM administers more than $250K in charitable giving to help the uninsured

Blues issue grants to:

  • Non-profit organizations that address community health issues

  • Groups that provide education and health resources to families and children

  • Forums on the uninsured and improving access

Health Grants