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									       Improving Health and Reducing Costs -
        The Power of Healthcare Information

Michele Peterson and Tim Riely
Health Care Service Corporation

• What Clients Want and Why?

• Approach

• Telling the Story
   – Report Portfolio
   – Sample Customer Reports – How HSCS tells the story

• Challenges

• Q &A

                            What Clients Want to Know and Why?

•   How much money am I spending?       •   What did you do with those members?
     –   Trend                               –   CM and CCM activity
     –   High Cost Patients                  –   Clinical outcomes
     –   Condition                           –   Closing gaps in care

•   What does my employees health       •   How well are my well employees?
    look like?                               –   Health Risk Assessments – Doing more of
     –   Population Analytics                    the “good” stuff
     –   Burden of Illness
     –   Opportunity for Intervention   •   How do I keep them healthy?
                                             –   Lifestyle Management programs
•   How sick are they?                       –   Member Tools
     –   Case Management (CM)                –   Wellness Rewards
     –   Chronic Condition Management

Offer a Health/Wellness portfolio of tools and reports that:

•   Provides a consistent face to our customers and consultants

•   Demonstrates the value of Health and Wellness to our clients by:
     – Offering a detailed, regularly generated, insightful report that can be used to
       evaluate Health and Wellness programs and interventions effectively, while
       demonstrating the value proposition of those programs
     – Providing reports that contain Enterprise defined metrics that are aligned with
     – Report the relevant data that make up the Health/Wellness suite of products
     – Alignment with Blue Insight customer reporting
     – Evolves with changing marketing demands

•   Provide Tools
     –   Blue Insight
           •   Utilization and Financial data
           •   Standard reports and dashboards
           •   Interactive tools
           •   Clinical profiles
     –   Population Analytics
     –   Condition Management Program Reporting

•   Provide Standard Summary Reports
     –   Push out standard reports that tell the health and wellness story

•   Provide Detailed Ad Hoc Report Capabilities
     –   Allow employers the ability to get ad hoc reports based upon certain events
     –   Health Risk Assessment Campaign
     –   Worksite Wellness Event
     –   Stop Smoking or Weight Management Campaigns

                                 Provide Tools - Blue Insight
Blue Insight Functionality                   Reports
Analytical Capabilities                                       • Monthly and Quarterly/Annual Report
                                                                Presentation Package
  • Utilization Trend Analysis                                • Executive Summary
  • Financial Analysis                                        • Financial Summary and Utilization
  • Provider Analysis                                           Trends
  • Plan Analysis                                             • Over 100 Customizable Templates as
  • Service Category Analysis                                   Required
  • Clinical Profiling
                                             Interactive Application
Subject Areas                                (> 500 Subscriber Accounts)

  • Executive Summary                                                      • Executive Dashboards
  • Claims Overview                                                        • Drill-Down and Reach-
  • Component of Trends                                                      Through Functionality
  • Enrollment                                                             • Benchmark Data
  • Benchmarks                                                             • Data is Divided into
                                                                             Manageable Views
  • Expense Reports
                                                                           • Custom Dimensions &      6
Blue Insight is a powerful combination of glossy presentation reports and an interactive application
Where are we spending money?

                  Story Components
Eight key subject areas communicate the Health/Wellness
value proposition:

•   Population Analytics
•   Health Integration
•   Member Tools
•   Program Activity
•   Clinical Outcomes
•   Utilization Results
•   Clinical Performance Guarantee Metrics
•   Member Satisfaction

                                Story Components
1.   Population: We find the right people through early and quick identification
           •   Appropriate timing makes behavior change more likely
           •   Effective use of limited resources
2.   Health is integrated: Client reports demonstrate the integration of our programs within Care
           •   Utilization Management triggers route members to the appropriate clinician in a timely manner
           •   Gaps in care are identified across platforms
           •   Member facing tools are designed to collect self-entered data for powerful analytics
3.   Member Tools: Utilization metrics for member facing products demonstrate the access we offer to
     tools that allows members ability to mange own condition / health status that enhance the possible
     reach and efficacy of the program.
           •   Offer members the opportunity to self-direct healthcare interventions in situations where
               outreach is not necessary or practical
           •   Help HCSC cultivate relationships with members we would not otherwise have an opportunity
               to interact

                                Story Components
4.   Program Activity: These metrics demonstrate the types of activities we perform to contact and
     engage members in our chronic condition, case management, and lifestyle management
           •   Enrollment measures and the number and types of activities performed while engaging
               targeted populations

5.   Clinical Outcomes: Help drive financial outcomes through clinical interventions gaps in care
     and improvement in clinical and biometric results
           •   Continuous enrollment in a program gives us the best opportunity to influence behavior
               and outcomes
           •   There is overlap between clinical outcomes measures and performance guarantees

6.   Utilization Results: Metrics that show how the activities we have performed and the tools we
     offer to members affect the bottom line
           •   Focus on Inpatient and Emergency Room utilization/1000
           •   How does Health fit in to the total value equation HCSC offers customers

                                 Story Components
7.   Clinical Performance Guarantees: Well crafted performance guarantee metrics
           •   Alignment with key operational performance indicators ensure that we meet or exceed our
               stated guarantees
           •   Governed metrics ensure that we can report the progress towards the goal internally and
           •   Examples are participation/engagement rates, clinical gap closure rates, clinical performance
               (improvements in key condition clinical indicator for specific diseases)

8.   Member Satisfaction: The ability to report that members are satisfied with the program helps us
     make the case for soft savings or the “value on investment”
           •   Tracking member satisfaction helps us fine tune our programs internally to increase
               engagement and efficacy
           •   Having highly satisfied members helps attract and retain members, as well as build member

                      Report Portfolio

Standard Blue Care Connection and Wellness Quarterly Report
Includes Health story components as they apply to the following Health/Wellness

•   Population Analytics / Predictive Modeling
•   Utilization Management
•   Case Management
•   Chronic Condition Management
•   Lifestyle Management (tobacco cessation and weight management)
•   Health Risk Assessment
•   24/7 Nurse Line
•   Blue Points

                  Report Portfolio (continued)
Detailed Ad Hoc Activity Reports

• Health Risk Assessment: Utilization, Incentive and Summary

• Blue Points Wellness Rewards: Utilization, Incentive and
  Summary Reports

• 24/7 Nurse Line: Utilization, Summary Reports

     Report Portfolio – Sample Reports
The Blue Care Connection and Wellness Report

• Utilization and expense information is sourced
  from Blue Insight.

• Diabetes Disease Population Utilization Metrics
• Report Description: The table below illustrates Account XYX utilization metrics across all three claim types
                                                                                     BCC A ctivities                2008
                                                                    Members Targeted for Outreach                   1,308
Dia be te s Me a sure s     2008     2007    % Cha nge            Outreach
INPATIENT                                                           Enrolled                                                   774
Admits / 1,000              0.8      0.6        33.3%                 Health Education Support                                 505
                                                                    Refused Program Invitation                                  73
Days / 1,000                3.2      3.6       -11.1%
                                                                    Does Not Meet Program Eligibility                           81
Average Length of Stay      4.0      6.3       -36.5%               No Response to Program Invitation                           48
                                                                  Program Intervention A ctivity
OUTPATIENT                                                          Total Direct Mail Correspondence Sent                 2,691
                                                                    Total Member Calls Completed                          3,126
Visits / 1,000              19.7     16.3      20.9%                Total Messages Left                                      69
ER Visits / 1,000            0.6      0.6       0.0%                Disenrolled from Program                                 19
                                                                  Continuous Participants as of Last Report Day             312

• Coronary Artery Disease Population Utilization Metrics
                                                                                     BCC A ctivities              2008
                                                                  Members Targeted for Outreach                   614
   CAD                       2008     2007   % Cha nge          Outreach
   INPATIENT                                                      Enrolled                                               476
                                                                    Health Education S upport                            344
   Admits / 1,000             2.7      2.5      8.0%              Refused Program Invitation                              25
   Days / 1,000               8.2      6.4     28.1%              Does Not Meet Program Eligibility                       47
   Average Length of Stay     3.0      2.6     15.4%              No Response to Program Invitation                       14
                                                                Program Intervention A ctivity
                                                                  Total Direct Mail Correspondence S ent            1,490
   OUTPATIENT                                                     Total Member Calls Completed                      1,706
   Visits / 1,000            14.9     11.9     25.2%              Total Messages Left                                  13
   ER Visits / 1,000          0.6      0.5     20.0%              Disenrolled from Program                              4
                                                                Continuous Participants as of Last Report Day         158

• Congestive Heart Failure Disease Population Utilization Metrics
                                                                                      BCC A ctivities                2008
   CHF                       2008     2007   % Cha nge             Members Targeted for Outreach                      59
                                                                   Enrolled                                                      37
   Admits / 1,000             0.7      0.5     40.0%                 Health Education S upport                                   30
   Days / 1,000               5.9      1.6     >100%               Refused Program Invitation                                     5
   Average Length of Stay     8.9      3.4     >100%               Does Not Meet Program Eligibility                              8
                                                                   No Response to Program Invitation                              8
   OUTPATIENT                                                    Program Intervention A ctivity
   Visits / 1,000             1.6      0.8     100.0%              Total Direct Mail Correspondence S ent                       145
   ER Visits / 1,000          0.1      0.1      0.0%               Total Member Calls Completed                                 143
                                                                   Total Messages Left                                            3
                                                                   Disenrolled from Program                                       0
                                                                 Continuous Participants as of Last Report Day                   12
Report Portfolio – Sample Reports
 The HRA Summary Report

Report Portfolio – Sample Reports
  HRA Incentive Report

Report Portfolio – Sample Reports
   Blue Points Activity Report

•   Dynamic Operational Processes

•   Data Integration
     –   Multiple vendors doing the things differently
     –   Difficult to tie member-level financial and utilization data to Care Management operational processes

•   Lack of Good Story
     –   What if the right data tells a poor story?
     –   Increased trend without substantial intervention

•   Transparency
     –   Client has access to as much information as we do.
     –   Difficult anticipate questions

•   Meaningful Benchmarks

•   It’s Expensive

•   Vendor Inbreeding

        Questions and Answers

Thank You and Enjoy the rest of the Symposium!

        Michele Peterson and Tim Riely



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