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TWO YEARS OF OUTCOMES FROM A COMPREHENSIVE DM PROGRAM IN

COMMERCIAL AND MEDICARE HEALTH PLAN MEMBERS

TWO YEARS OF OUTCOMES FROM A COMPREHENSIVE DM PROGRAM IN

COMMERCIAL AND MEDICARE HEALTH PLAN MEMBERS

Esther J. Nash, MD, Senior Medical Director, Population Health & Wellness, Independence Blue Cross

Carolyn Young, FSA, MAAA, Senior Actuary, Medical Cost Analysis & Forecasting, Independence Blue Cross

Kimberly K. Siejak, MS, Manager, Population Health & Wellness, Independence Blue Cross

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AgendaAgenda

ConnectionsSM Programs Overview

ConnectionsSM Financial Outcomes: Program Years 1 and 2

ConnectionsSM Clinical and Member Satisfaction Outcomes: Program Years 1 and 2

Summary

Future Challenges

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Independence Blue Cross

• 1 of 4 BC plans in PA

• 3.4 million members

• PA, NJ, DE, Caribbean, Primary service area = SE PA

• Commercial HMO/PPO/POS, Medicare HMO/PPO, Traditional

• Subsidiaries: PBM, Medicare TPA, Commercial TPA, and

others

Independence Blue Cross won the Disease Management Association of America’s

Outstanding Health Plan award in December 2006.

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ConnectionsSM Programs are Broad in Scope and Fully Integrated

ConnectionsSM Programs are Broad in Scope and Fully Integrated

Programs for 22 chronic conditions

Fully integrated disease management and decision support

Fully integrated with all health plan processes Case management, pre-certification, member services,

preventive programs, mental health

Collaborative practice model with treating providers

Analytics that allow efficient use of clinical resources

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IBC ConnectionsIBC ConnectionsSMSM Program History Program History IBC ConnectionsIBC ConnectionsSMSM Program History Program History

1995 to 2003 – opt in insourced and outsourced programs for CHF, COPD, DM, asthma, CAD

2003 – Connections Health Management Program – partner is Health Dialog:• Asthma, Diabetes, CHF, CAD, COPD – “opt out”

• Decision support for back/joint pain, women’s health, men’s health, cardiac revascularization

2004 – Connections Kidney Program – partner is RMS: ESRD

2005 – Connections AccordantCareTM Program – partner is Accordant Health Services: Complex chronic diseases (e.g., Lupus, Parkinson’s,

Seizure, MS)

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ConnectionsSM Programs:Types of Outcome Evaluation

ConnectionsSM Programs:Types of Outcome Evaluation

Levels of member engagement and usage Member satisfaction Clinical indicators Provider satisfaction And of course, utilization impact and cost savings Being considered: employer satisfaction, member

retention impact

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Who Initiates Telephone ContactPTD July 2003 – February 2007Who Initiates Telephone ContactPTD July 2003 – February 2007

Members place inbound calls to Health Coaches for information, education, and help in making informed medical decisions.

Health Coaches place outbound calls to members to offer disease management, decision support, or to follow-up with a member.

OUTBOUND 59%

INBOUND41%

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Members with Chronic Disease Identified as High RiskMembers with Chronic Disease Identified as High Risk

22,398 (11%) of PA PPO and HMO members with chronic disease are considered “high-risk”

20,755 (24%) of PA Medicare members with chronic disease are considered “high-risk”

0 25 50 75 100 125 150 175 200

PA Medicare

PA PPO &HMO

Members in Thousands

High Intensity (High Risk)Standard Intensity (Low Risk)

Data program to date as of February 2007

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High Risk* Chronic Member ContactsHigh Risk* Chronic Member Contacts

13,870 (73%) of PA PPO and HMO high-risk members were reached

15,778 (91%) of PA Medicare high-risk members were reached

* High-Risk = members identified as having a high-predicted financial risk.

Data program to date as of February 2007

0 4 8 12 16 20 24

PAMedicare

PA PPO &HMO

Members in Thousands

Reached Not reached

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Savings Methodology OverviewSavings Methodology OverviewSavings Methodology OverviewSavings Methodology Overview

Pre/post comparison of included members, adjusting for the trend factors of the non-chronic population

Several classes of members are excluded in the reconciliation: e.g., HIV/AIDS, institutionalized, or with hospice, psychiatric, alcoholism, or substance abuse facilities claims

Once chronic, always chronic

6-month eligibility required to be included

Regression to the mean accounted for by a 4 month non-measured period immediately following a member’s chronic date

Consistent with DMAA 2006 outcomes guidelines

Assessed by Reden & Anders as “reasonable and appropriate”

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Actual vs. Expected CostsActual vs. Expected Costs

Base Year 1 Year 2

PM

PM

Co

st

Actual Year 1

Expected Year 1

Actual Year 2

Expected Year 2

Year 1 Savings

Year 2 Savings

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Chronic PMPM Savings Impact% Reduction from Expected

Chronic PMPM Savings Impact% Reduction from Expected

10%

17%

9%

15%

8%

15%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

HMO PPO Medicare

Year 1 Year 2

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Savings by Service TypeYear 2

Savings by Service TypeYear 2

CommercialHMO/PPO

Emergency Room 1%

Outpatient15%

Inpatient47%

Professional 37%

Medicare

Inpatient54%

Outpatient9%

Emergency Room

1%

Professional36%

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Actual vs. Expected Utilization(% below expected)

Actual vs. Expected Utilization(% below expected)

Inpatient Outpatient Professional

Year 1 Year 2

13% 22%

12%

16%

10%

11%Medicare 9% 13% 6% 20%

Year 1 Year 2

20% 25%

13%8%

HMO

PPO 18% 25%

Year 1 Year 2

12% 21%

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Prevalence by DiseaseYear 2

Prevalence by DiseaseYear 2

.4%

6.5%

.8%

6.5%

1.8%

13.6%

3.2%

9.4%

4.9%

1.6%

11.1%

37.7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

CHF COPD CAD Diabetes Asthma Total

Commercial Medicare

Assumes the following disease hierarchy: CHF, COPD, CAD, Diabetes, Asthma. Members are counted once in highest category only.

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Savings by type of service – Commercial HMO/PPOYear 2

Savings by type of service – Commercial HMO/PPOYear 2

78%

11%

12%

72%

18%

10%

65%

20% 15%

39% 10%51%

36% 34% 30%

CHF COPD CAD Diabetes Asthma

Inpatient Outpatient Professional

Assumes the following disease hierarchy: CHF, COPD, CAD, Diabetes, Asthma. Members are counted once in highest category only.

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Savings by type of service – Medicare HMO/PPOYear 2

Savings by type of service – Medicare HMO/PPOYear 2

79%

6%

15%

55%

9%

36%

68%

18% 15%

65%

10%

26%

53% 47%

CHF COPD CAD Diabetes Asthma

Inpatient Outpatient Professional

Assumes the following disease hierarchy: CHF, COPD, CAD, Diabetes, Asthma. Members are counted once in highest category only.

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Some Progression on Hard to Move MeasuresSome Progression on Hard to Move MeasuresSome Progression on Hard to Move MeasuresSome Progression on Hard to Move Measures

0%

37.4%

25.8%

64.6%

65.1%

62.5%66.1%

66.2%

68.4%66.3%

66.7%

67.6%

42.1%

42.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Clinical Quality Indicators Commercial PPO - Year 2

Baseline Intervention Year 1 Intervention Year 2

Controller Medication

ASTHMA

Lipid Test

CAD

Beta Blocker

CHF

Lipid Test

DIABETES

Microalbuminuria

DIABETES

Per

cen

t of

mem

bers

with

con

ditio

n

rece

ivin

g te

st o

r tr

eatm

ent

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Some Progression on Hard to Move MeasuresSome Progression on Hard to Move MeasuresSome Progression on Hard to Move MeasuresSome Progression on Hard to Move Measures

0%

30%

13.8%

77.4%81.7%

60.4%

60.5%

62.3%

79.8%

80.6%

46.8% 49.3%

63.6%

64%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Clinical Quality Indicators PA Medicare HMO and PPO - Year 2

Baseline Intervention Year 1 Intervention Year 2

Controller Medication

ASTHMA

Lipid Test

CAD

Beta Blocker

CHF

Lipid Test

DIABETES

Microalbuminuria

DIABETES

Per

cen

t of

mem

bers

with

con

ditio

n

rece

ivin

g te

st o

r tr

eatm

ent

AMI Beta Blocker

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Some Progression on Hard to Move MeasuresSome Progression on Hard to Move MeasuresSome Progression on Hard to Move MeasuresSome Progression on Hard to Move Measures

0%

25%24.7%

64.3%64.6%

62%

69.8%70.6%

70.6% 67.8%68.7%

66.1%

73.5%

76.7%77.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Clinical Quality Indicators Commercial HMO - Year 2

Baseline Intervention Year 1 Intervention Year 2

Controller Medication

ASTHMA

Lipid Test

CAD

Beta Blockers Lipid Test

DIABETES

Lipid Treatment

CAD

Per

cen

t of

mem

bers

with

con

ditio

n

rece

ivin

g te

st o

r tr

eatm

ent

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IBC Medicare, PPO, HMO Member Sat SurveyIBC Medicare, PPO, HMO Member Sat Survey

* Changes from 2004 to 2005 are not statistically significant

How satisfied were you with the assistance the Health Coach provided you? (Percent of respondents indicating “Very Satisfied” or “Satisfied” displayed)

• 87 percent of 2006 chronic and 88 percent of 2006 non-chronic users indicated that they were “very satisfied” or “satisfied” with the assistance provided to them by the Health Coach*.

87% 87%94% 88%

86% 90%

0%

20%

40%

60%

80%

100%

Chronic Non Chronic

2006 2005 2004

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• Both chronic and non-chronic users indicated that their impression of Independence Blue Cross has been positively impacted because of the Connections Program.

IBC Medicare, PPO, HMO Member Sat SurveyIBC Medicare, PPO, HMO Member Sat Survey

What number would you use to rate how you feel about Independence Blue Cross as a result of offering the Connections

Program to you?

86% 84%90%

86% 83%86%

0%

20%

40%

60%

80%

100%

Chronic Non Chronic

2006 2005 2004

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SummarySummary

ConnectionsSM produces cost savings through reduced medical cost and utilization trends.

Members with chronic conditions are highly satisfied with the ConnectionsSM programs.

IBC continues to work with our vendors to enhance and expand program offerings.

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Future ChallengesFuture Challenges Future Challenges: Near Term

Use of absenteeism and worker’s compensation data to further enhance targeting

Integration with employer- and plan-based incentives programs Enhanced program options for deeper reach into chronic and “well”

population Pharmacy initiatives Integration with workplace wellness programs

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Future ChallengesFuture Challenges

Future Challenges: Mid-term and longer What is point of declining ROI vs. total returns? Is consensus methodology where we need to be? How do we pay doctors to be a medical home so that DM is more

than a “band aid” for “medical homelessness”?

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Questions/DiscussionQuestions/Discussion

Contact Information

Esther Nash, MD, esther.nash@ibx.com

Carolyn Young, FSA, MAAA, carolyn.young@ibx.com

Kimberly K. Siejak, MS, kimberly.siejak@ibx.com