Capabilities Pres

The content provided in this presentation is for informational purposes only. For information regarding specific policy information, including regulations, limitations and exclusions, refer to your contract and/or benefit booklet. 1

City of Melbourne

Capabilities Presentation

Scott ChapmanPublic SectorJanuary 17, 2008


Points for Discussion

• A Commitment to Value

• Network and Savings

• Service

• Disease Management

• Why Blue Cross and Blue Shield of Florida?


The Leader in Employee Benefit Solutions for Florida Municipalities

Over 100 Florida Municipalities choose BCBSF Average tenure - 10.3 years

Oka

loos

a Holmes

WashingtonWalt

on

Wakulla

Flagler

Volusia

BradfordColu

mbi

a

UnionLafayette

Jeffe

rson

Taylor

Hamilton

Suwannee

Hernando

Sum

ter

Sarasota

Okeechobee

St. J

ohns

Indian River

High

land

s

Glades

NassauGadsden

Calhoun

Gilchrist

Lake

Bay

Alachua

Citrus

DeSoto

Dixie

Hendry

Jackson

Levy

Madison

Marion

Martin

Pasco

Polk

Lee

Santa

Ros

a

Franklin

Manatee

Leon

Gulf

Putnam

Charlotte

Local BCBSF office

Municipalitiesby Florida County in Blue

• Public Sector Team

• Dedicated Focus

• Local Presence

• Extensive Experience

• Customized Service Pine

llas

Broward

Oka

loos

a Holmes

WashingtonWalton

Wakulla

Seminole

Flagler

Volusia

Brad

fordC

olum

bia

UnionLafayette

Jeffe

rson

Taylor

HamiltonSuwannee

Hernando Sum

ter

Sarasota

Okeechobee

St. J

ohns

Osceola

Indian R.

Highlands

Glades

Nassau

Monroe

Gadsden

Cal

houn

Liberty

Gilc

hris

t

Lake

Bre

vard

Bay Baker

Alachua

Citrus

Clay

Collier

DeSoto

Dixie

Hardee

Hendry

Jackson

Levy

Madison

Marion

Martin

Pasco

Polk

Lee

Sant

a R

osa

Franklin

Esca

mbi

a

Hillsborough

Orange

Manatee

Leon

Duval

Gulf

Putnam

Miami-Dade

Palm Beach

Charlotte

St. Lucie


Advantage of Our Networks

BlueCare®

(HMO)

BlueChoice®

(PPO)BlueOptionsSM

NetworkBlueSM

Traditional Traditional

Brevard County – 1,055

Statewide – 18,637

Brevard County – 1,260

Statewide – 26,831

Brevard County – 950

Statewide – 19.768

Brevard County – 1,300Statewide – 31,670

Brevard County – 1,300Statewide – 31,670


Network Access

BlueCare Open Access

HMO

BlueOptions

Open Access POS

BlueChoice PPO

Traditional

Physicians (Brevard)

1,055 950 1,260 1,300

Physicians (Statewide)

18,637 19,768 26,831 31,670

Facilities

&

Key Physician Groups

• Holmes Regional• Palm Bay Comm.• Cape Canaveral• Wuesthoff• Wuesthoff-

Melbourne• MIMA• Omni• Osler

• Holmes Regional• Palm Bay Comm.• Cape Canaveral• Wuesthoff• Wuesthoff-Melbourne• MIMA• Omni• Osler

• Holmes Regional• Cape Canaveral• Palm Bay Comm.• Wuesthoff• Wuesthoff-


• Holmes Regional• Cape Canaveral• Palm Bay Comm.• Wuesthoff• Wuesthoff-



Blue Delivers Unparalleled Access to Care inFlorida and Beyond

* As of January 2006** As of March 2006 *** BlueCard statistics per BCBSA June 2005

National Network Access through BlueCard® ***

Access in ALL 50 States

More than 820,000 Physicians

More than 5,500 Hospitals

More than 31,500 Physicians*

More than 210 Hospitals**

Statewide Access

Broad, Comprehensive Local Network

Welcomed in over 200 Countries Worldwide

“Access to the Right Care at the Right Time for the Right Person at the Right Place”


BCBSF Provides Greater Discounts* in Brevard County and Florida

Total MedicalServices

Open Access HMO

Open Access POS PPO Traditional

BCBSF 60% 57% 55% 54%

Aetna 53.8% 53.8% N/A N/A

Cigna 51.8% 51.8% N/A N/A

United 52.3% 52.3% N/A N/A

Health First 50% N/A N/A N/A

* Based on Brevard County claims repricing off billed charges as provided in Brevard County/Schools RFP


Sophisticated Customer Service

• In person– Local Assigned Service Representative– Comprehensive, On-site Wellness Program – Local field Medical Director– Local Case Manager

• Online– MyBlueServiceSM

– Health Dialog®

– Hospital Advisor™– 24/7 self-service convenience

• By phone– Convenient service hours

9:00AM – 6:00PM, Monday through Thursday 9:00AM – 6:00PM, Friday

– English or Spanish speaking staff

From High-touch to High-tech


Easy Online Access for Members

• MyBlueServiceSM, 24/7

• Claims information

• Disease management information

• Health coaching

• Hospital and physician quality data*

• Online provider directory

• Health and wellness information

• BlueComplements discount programs and services


Dedicated Service Unit• Account Advocate assigned as single point of contact to City of Melbourne for

any service related issues

• All member calls, written correspondence and claims are directed to the Dedicated Service Unit

• Service Unit Team is experienced in Strategic Accounts

• Account Specific Action Plans will monitor team performance

• Account Specific Quarterly reports identify claims and inquiry activities

• Account Specific Quarterly reports contain recommendations for utilization enhancements.

• Lake Mary-based Account Management Specialist for monthly on-going management of account


Advisory Tools

Healthcare Advisor™• Provides information for 100+ medical

conditions and procedures• Offers questions to ask the doctor and

insurance company

Hospital Advisor™• Enables members to find, profile and compare

hospitals by procedure, patient safety, reputation and other characteristics

Physician Advisor™• Enables members to view and compare

attributes of physicians

Treatment Cost Advisor™• Enables members to view and compare costs

for various treatments, adjusted for demographic and regional differences

• Provides detail by condition and includes a list of conditions, tests and visits


Top Ranked Health Plan

Study ranks BCBSF 1st in customer satisfaction among major health plans in the South and 2nd overall nationally.

J.D. Power and Associates 2007 National Health Insurance Plan Satisfaction StudySM

Southern Region Scores

BCBSF 779

United 741

Aetna 736

CIGNA 732

Humana 729

“This stuff doesn’t happen by accident. [Blue Cross has] worked at it, and it shows at a very consistent level of scoring across all the factors.”

“They are doing… basic blocking and tackling… well, but they are going above and beyond in their interaction with their members.”

David Stefan, Executive Director of Healthcare Practice J.D. Power and Associates


Blueprint for Health®

Disease Management Capabilities for our Customers


Current Program*

• Background - Shared Decision-Making®/Unwarranted Variation• Pre-Certification, Concurrent Review, Discharge Planning• Components:

– Health Coaches - 24/7/365 Access; licensed professionals; telephonic/online access, multilingual

– Chronic Condition Management - 5 Core Conditions: Coronary Artery Disease Diabetes Congestive Heart Failure Asthma Chronic Obstructive Lung Disease

– Expanded Condition Management – 34 Chronic and “Rare Chronic” Conditions– Stratification/Predictive Modeling – Multiple Methodologies including Dartmouth

Atlas• Decision Support- Preference sensitive conditions (e.g conditions with multiple

treatment choices and high variation in care delivered)• The Dialog Center – An unbiased, evidence-based, multiple formats,

multilingual information resource

* Through Health Dialog®


Expanded Chronic Condition Management*• Depression• Oncology• End Stage Renal Disease• Acid Related Disorders• Hypertension• Irritable Bowel Syndrome• Back pain• Joint Pain• Osteoporosis• Fibromyalgia• Osteoarthritis• Migraine• Women’s Health (Benign Uterine Conditions)• Benign Prostatic Hyperplasia• Atrial Fibrillation• Chronic Kidney Disease

• Multiple Sclerosis• Systemic Lupus Erythematosis• Sickle Cell Anemia• Hemophilia• Polymyositis• Dermatomyositis• Gaucher Disease• Seizure Disorders• Amyotrophic Lateral Sclerosis (ALS)• Chronic Inflammatory Demyelinating

Polyradiculoneuropathy (CIDP)• Rheumatoid Arthritis• Parkinson’s Disease• Myasthenia Gravis• Cystic Fibrosis• Scleroderma• Crohn’s Disease * Conditions managed by Accordant® (“Rare Chronic”)

* Conditions managed by Health Dialog®


Identifying Individuals for Care Coordination

• Monitoring, evaluation, reporting– Large claims repository for sophisticated predictive modeling– Claims and utilization, daily census, hospital, physician utilization– Case management reporting

• Lake Mary-based clinical presence gives BCBSF a clear advantage– Closer to our customers, Lake Mary-based Medical Director and Care

Coordination Nurses– Know physicians, hospitals, other providers better– Move faster, smarter, to help people in need

• Personal referrals– Members– Employers– Agents, Brokers, Consultants– Providers

Earlier, Faster, and More Effective!


Jacksonville

Gainesville

Orlando

Port St. Lucie

West Palm

Ft. Lauderdale

Miami

Panama CityTallahassee

Tampa

Sarasota

Ft. Myers

Our Care Coordination Nurses are Local!

Pensacola

• Early identification of at-risk members through Personal Outreach

• Lake Mary-based Nurses with in-depth knowledge health care system, relationships with physicians

• Lake Mary-based Nurses have online access to members claims, physician utilization data, daily hospital census

• Pre-surgical outreach helps members understand benefits, care options

• Post-discharge promotes treatment compliance, avoids costly readmissions

Personal Outreach to Members at Point-of-care


Health Coaches

• Experienced registered nurses 24x7 • Fast, accurate, confidential advice• Help with complex health issues• Unbiased, evidence-based• Decision support sensitive to patient

preferences and values• Free health videos and information

mailed to members• Online, self-service tools• Dialog Center contains health

information on more than 1,900 topics• Call volume >15,000 per quarter

(inbound, outbound and follow up)• 610,000 total targeted mailings• Integrated with other service teams

Helping Members Make Better Informed Health Decisions


Does Health Coaching Work?• 94% of high risk members were contacted in less than 60 days

• 95% of individuals followed their Health Coach’s guidance

• 40% of employees coached chose alternatives to surgery after consulting with their doctors

• Coached Employees with chronic conditions had 25-30% fewer hospital admissions

• Coached Employees require 30% fewer Emergency Room and physician visits

• 98% of individuals recommend their Health Coach to others needing similar support


Industry Leading On-site Wellness Program for City of Melbourne

• Lake Mary-based Clinical Manager• Biometric screenings (e.g., blood pressure, cholesterol,

glucose)• Health Risk Assessments for individuals with immediate

results• Data Analysis at employee and group level• Identifies urgent high risk members for immediate

medical attention• Referral of other high risk members to care programs• Health coaching onsite and online• Follow-up assessments, activities, Interventions (e.g.,

worksite lunch-n-learns)• $250,000 average cost - INCLUDED

Our Statewide 2006-07 Participation

100+ groups

20,000+ employees

350+ people received urgent

referrals


Why Blue Cross and Blue Shield of Florida?• Dedicated focus on Municipalities and Public Sector

statewide• Broadest network access – Brevard County, Statewide &

Nationwide • Greatest discounts in Brevard County and Statewide• Outstanding Dedicated Customer Service Unit with

Account Advocate• Online access to health information tools & member self-

service tools• Comprehensive Disease Management programs• On-site Wellness Program• References


References

Lake County Board of County Commissioners

Sumter County Board of County Commissioners

Sharon Wall, Director of Employee Services

(352) 343-9426

Tera Townsend, Director of Risk Mgt.

(352) 793-5607

School Board of Polk County S Wuesthoff Health Systems

Steve Henderson, Director, Risk Management

(863) 534-0785

George Fayer, Chief Financial Officer

321-636-2211 x-5030

Lake County School Board Stetson University

Becky Nelsen, Dir. Compensation & Benefits

(352) 253-6519

Betty Whiteman, Director of Human Resources

(352) 735-7186

Indian River County Schools Volusia County School Board

Gerald Koziel, Director of Risk Management

(772) 564-3060

Sandy Higgenbotham, Risk Manager(386) 734-7190 x 20300


A Few of the Companies We Serve

Leesburg Florida The Lakefront City

Note: Please do not contact these businesses without prior approval from BCBSF

Central Florida

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