An Independent Licensee of the

Blue Cross Blue Shield Association

Disease Management Program

Overview

for the

Joint Health Care Committee

University of Alaska

Presented by Premera – May 19, 2009

2

Disease Management

Principles and Goals

• Improve the health of and increase the quality of life

of the University employee and dependent

population

• Enhance patient satisfaction and care experience

• Support the physician / patient relationship

• Improve employee productivity

• Reduce total health care costs

3

Disease Management History

• Premera partnered with Healthways, Inc in Dec. 2005

to provide the Healthy Connections Disease

Management Program

• Healthways is the largest Disease Management

company; has been in the business the longest

• The University of Alaska has had Disease

Management services since 2003

4

Disease Management Quick

Reference

• The Healthy Connections program

provides:

– More employee/dependent outreach

compared to previous programs

– Better integration with other Care

Facilitation and Medical Management

programs

– Enhanced engagement of members’

physicians

5

Member Identification Process

Healthways’

Clinical

Information

System Server

Data is

compiled into

a record for

each member

Clinical rules are

used to flag all

targeted diseases or

status

Premera sends

monthly data feed

to Healthways

Every month, all University of Alaska

employees are assessed for inclusion

into the program. Follow a sample member data record

Predictive Modeling is

used to assign risk

scores

Members are also

identified for intervention

through self-referral,

health plan referral,

provider referral and

case management

referral, as well as

referrals from other

sources.

6

Member Stratification Process

Healthways

Integrated Care

Management

Process –using actionable data to improve

health outcomes

=Results

A disease hierarchy is

applied to determine which

program is appropriate for

the member

Members are stratified

according to disease group

or identified as high risk for

hospitalization

Stratification 2Moderate interventions for

those at moderate risk of

exacerbations.

Stratification 1Least intensive

interventions for the

stable/low risk (managing

condition effectively)

Stratification 3Focused interventions for

those at moderate/high risk

of exacerbations

Stratification 4Intensive interventions for

the highest risk (recent

hospitalization or ER visit

Disease Management - Clinical

model focuses on standards of

care, behavior change,

individualized care plans, unique

member goals and education to

reduce costs on a large scale.

Total health care costs are

managed, treating the “whole

person” regardless of identifying

condition. The combination of

managing total health care costs

and intervening with the segment

of the population that causes the

most cost results in an impact on

the overall healthcare cost trend.

Defining Success

Improved member health, a

positive impact on cost trends,

improved member satisfaction,

improved provider satisfaction and

proven savings

7

Member Interventions

Interventions for Standard Package (A) … to reach people on

their terms

Interventions Diabetes Heart FailureCoronary Artery

Disease

Welcome Packet Initially Initially Initially

Welcome Call Initially Initially Initially

Health Reminders 3/year and flu 3/year and flu 3/year and flu

Depression Screening Annually Annually Annually

Quality of Life Annually Annually Annually

Self Care Goals As needed As needed As needed

Educational Mailings As needed As needed As needed

Newsletter Quarterly Quarterly Quarterly

Satisfaction Survey Annually Annually Annually

Care Calls

Toll Free Access Yes Yes Yes

As neededAs needed As needed

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Physician Interventions

…to provide up-to-date actionable

information for the doctor so they

can improve patient care.

I nte rv entio ns Dia b e te s H ea r t F a ilureCo ro na ry Arte ry

Disea se

W elc o m e P a c k e t Initially Initially Initially

Initially/ Initially/ Initially/

Updated Updated Updated

Initially/ Initially/ Initially/

Updated Updated Updated

M ed ic a tio n List 2/year 2/year 2/year

Aler t L ink 2/year 2/year 2/year

T o ll F ree Ac c ess Yes Yes Yes

Guid e line s

F lo w shee t

9

Clinical Program Consultants

• Registered Nurses in the field solely to support

providers regarding DM program participation

• AK providers visited since 2006

– Anchorage/Fairbanks

• Provide Lunch and Learn events

10

Disease Management Program

Packages

Disease Management Program Package OptionsStandard Expanded Enhanced Advanced

Package A Package B Package C Package DDiabetes Diabetes Diabetes Diabetes

Heart Failure Heart Failure Heart Failure Heart Failure

Coronary Artery Disease Coronary Artery Disease Coronary Artery Disease Coronary Artery Disease

Chronic Obstructive Chronic Obstructive Chronic Obstructive

Pulmonary Disease Pulmonary Disease Pulmonary Disease

Asthma Asthma Asthma

Impact Conditions* Impact Conditions*

Comprehensive Back Pain

Chronic Kidney Disease/End

Stage Renal Disease

Depression

Oncology

*Impact Conditions: Low Back Pain, Osteoporosis, Osteoarthritis, Hepatitis C, Urinary Incontinence, Pressure Ulcers, Atrial

Fibrillation, Inflammatory Bowel Disease, Irritable Bowel Syndrome, Fibromyalgia, Acid Related Disorders

Ala Carte Options available to add: Impact Conditions, Comprehensive Back Pain, Chronic Kidney Disease/End Stage

Renal Disease, Chronic Kidney Disease, Depression and Oncology to package A, B or C

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Data Observations

University of Alaska Opportunity Analysis

Claims Reporting Period: 1/1/2007 - 12/31/2007

Identification Period: 1/1/2006 - 12/31/2007

Member Age Range Included: All Ages

University Of Alaska

MembersUniversity Of Alaska Dollars PMPM

Count % Dollars %University Of

AlaskaPremera

2 Difference %

Non Disease 7,581 78.9% $14,737,348 38.3% $162.01 $132.24 22.5%

Disease 2,027 21.1% $23,699,050 61.7% $974.07 $671.46 45.1%

Total 9,608 100.0% $38,436,398 100.0% $333.37 $247.60 34.6%

2 Premera's Self-Funded Book of Business over the same member age range

Population1

1 Diseases Included

(listed in hierarchial order):

Oncology, Diabetes, Heart Failure, Coronary Artery Disease, Chronic Obstructive Pulmonary

Disease, Chronic Back Pain, ESRD, Chronic Kidney Disease, Depression, Asthma and

Impact Conditions

PMPM

$0

$200

$400

$600

$800

$1,000

$1,200

Non Disease Disease Total

University Of Alaska Premera

Confidential & Proprietary

12

Total Cost by Disease Category

University of Alaska Opportunity Analysis

Claims Reporting Period: 1/1/2007 - 12/31/2007

Identification Period: 1/1/2006 - 12/31/2007

Member Age Range Included: All Ages

Prevalence Rates PDMPM Costs

University Of

AlaskaPremera1 Difference %

University Of

AlaskaPremera1 Difference %

Oncology 105 1.10% 1.43% -0.33% $3,597.83 $1,765.58 103.8%

Diabetes 344 3.58% 4.05% -0.47% $898.56 $743.28 20.9%

Heart Failure 21 0.22% 0.48% -0.26% $5,505.55 $1,193.31 361.4%

Coronary Artery

Disease67 0.70% 1.09% -0.39% $1,570.29 $889.72 76.5%

Chronic Obstructive

Pulmonary Disease20 0.21% 0.44% -0.23% $2,252.72 $709.03 217.7%

Comprehensive Back

Pain672 6.99% 5.12% 1.87% $721.76 $567.50 27.2%

End Stage Renal

Disease1 0.02% 0.02% 0.00% $197.11 $3,312.23 -94.0%

Chronic Kidney

Disease13 0.14% 0.14% 0.00% $1,239.33 $555.32 123.2%

Depression 1 0.02% 0.59% -0.57% $626.57 $694.24 -9.7%

Asthma 277 2.89% 3.13% -0.24% $483.62 $377.98 27.9%

Impact Conditions 502 5.23% 4.90% 0.33% $755.84 $476.20 58.7%

TOTAL 2027 21.10% 21.39% -0.29% $974.07 $671.46 45.1%

1 Premera's Self-Funded Book of Business over the same member age range

Category Members

Confidential & Proprietary

13

University of Alaska Care Facilitation Quality Improvement Report

Program Enrollment for Reporting Period: From 2/1/09 to 2/28/09 Disease Management Programs

Disease Management Program Enrollment Percentage of Members Enrolled in Program

Stratification of Program Enrollees Percentage of Participants Declining Program Contacts (Opt Outs)

University of Alaska had 6.7% of the enrolled participants decline program

contacts. This compares to Premera's Disease Management Covered Lives

overall rate of 4.2%.

University of Alaska had 1,660 members enrolled in the program.

University of Alaska had 4.5% of the total membership enrolled in the Diabetes, Heart Failure and

CAD programs. This compares to the Premera Disease Management Covered Lives overall rate in

the Diabetes, Heart Failure and CAD programs of 4.1%. University of Alaska also had 12.7% of

the total membership enrolled in the COPD, Asthma and Impact Conditions programs.

325

8

103

9

123

1,092

D iabetes H eart

F ailure

C A D C OP D A sthma Impact

C o ndit io ns

1% 1%

26%

3%

65%74%

67%27%

82%

27%20%

22%

28%

13%5%

11%19%

2%

100%

6%

D iabetes H eart

F ailure

C A D C OP D A sthma Impact

C o ndit io nsUnknow n Stratif ication LevelLevel 4: Had signif icant healthcare intervention such as hospital stay or ER visit.Level 3: Moderate risk for exacerbation of condition, but still preventable.Level 2: Elevated risk for exacerbation of condition.Level 1: Managing condition effectively, at low risk for exacerbation of condition.

.

3.4%

0.1%

1.1%

0.1%

1.3%

11.3%

3.2%

4.0%

0.9%

0.1%0.8%

0.2%

D iabetes H eart

F ailure

C A D C OP D A sthma Impact

C o ndit io ns

University of AlaskaAll DM Covered Lives

6.2%

12.5%

6.8%

11.1%

8.1%

6.6%

5.4%4.8%

4.3%

3.7%

6.3%

8.1%

D iabetes H eart

F ailure

C A D C OP D A sthma Impact

C o ndit io ns

University of AlaskaAll DM Covered Lives

Current Program Enrollment

14

QUESTIONS?