capabilities pres
TRANSCRIPT
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
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. 2
Points for Discussion
• A Commitment to Value
• Network and Savings
• Service
• Disease Management
• Why Blue Cross and Blue Shield of Florida?
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. 3
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
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. 4
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
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. 5
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-
Melbourne• MIMA• Omni• Osler
• Holmes Regional• Cape Canaveral• Palm Bay Comm.• Wuesthoff• Wuesthoff-
Melbourne• MIMA• Omni• Osler
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. 6
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”
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. 7
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
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. 8
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
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. 9
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
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. 10
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
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. 11
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
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. 12
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
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. 13
Blueprint for Health®
Disease Management Capabilities for our Customers
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. 14
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®
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. 15
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®
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. 16
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!
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. 17
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
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. 18
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
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. 19
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
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. 20
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
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. 21
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
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. 22
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
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. 23
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