A Blue Cross and Blue Shield Association Presentation

Quality in Practice: Quality in Practice: The BCBS Blue DistinctionThe BCBS Blue Distinction®® Program Program

Iowa Health Buyers Alliance Annual ConferenceIowa Health Buyers Alliance Annual Conference

Robert Krause, DirectorRobert Krause, Director

National Labor OfficeNational Labor Office

Blue Cross and Blue Shield Association Blue Cross and Blue Shield Association

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Blue Cross and Blue Shield AssociationBlue Cross and Blue Shield Association

A national federation of 39 independent, community-A national federation of 39 independent, community-based and locally operated Blue Cross and Blue Shield based and locally operated Blue Cross and Blue Shield companies companies

Collectively we provide healthcare coverage for more Collectively we provide healthcare coverage for more than 102 million individuals – 1 in 3 Americansthan 102 million individuals – 1 in 3 Americans

For more information, visit For more information, visit www.BCBS.comwww.BCBS.com

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MissionMission

The mission of the National Labor Office (NLO) is The mission of the National Labor Office (NLO) is to position the Blues as Labor’s healthcare to position the Blues as Labor’s healthcare

partner of choice.partner of choice.

The mission of the National Labor Office (NLO) is The mission of the National Labor Office (NLO) is to position the Blues as Labor’s healthcare to position the Blues as Labor’s healthcare

partner of choice.partner of choice.

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PlansPlans Organized LaborOrganized Labor

Marketing tools Database Education Conferences New healthcare products

Affordable and accessible healthcare

MissionMission

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Our ChargeOur Charge

The National Labor Office represents the Blue The National Labor Office represents the Blue Cross and Blue Shield System with organized Cross and Blue Shield System with organized labor for the ultimate purpose of acquiring and labor for the ultimate purpose of acquiring and

retaining contracts for Blue Cross and Blue retaining contracts for Blue Cross and Blue Shield PlansShield Plans

The National Labor Office represents the Blue The National Labor Office represents the Blue Cross and Blue Shield System with organized Cross and Blue Shield System with organized labor for the ultimate purpose of acquiring and labor for the ultimate purpose of acquiring and

retaining contracts for Blue Cross and Blue retaining contracts for Blue Cross and Blue Shield PlansShield Plans

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NLO Sponsor Plans – Voluntary NLO Sponsor Plans – Voluntary

• Arkansas BCBS

• Alabama BCBS

• BS of California

• Anthem/Wellpoint, Inc.(14 states)– Empire BC – East Region– BC of California – West Region

• BCBS of Delaware

• BCBS of Florida

• BCBS of Illinois

• BCBS of Massachusetts

• BCBS of Michigan

• BCBS of Minnesota

• BCBS of Montana

• BCBS of Nebraska

• Wellmark BCBS

• Regence BCBS

• Excellus BCBS

• Western New York BCBS

• CareFirst BCBS

• Horizon BCBS

• Premera Blue Cross

• BCBS of Oklahoma

• Capital BC

• Independence BC

• Highmark BCBS

• BCBS of Rhode Island

• BCBS of South Carolina

• BCBS of Tennessee

• Mountain State BCBS

• HMSA - Hawaii

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NLO Governance StructureNLO Governance Structure

NLO Board of Directors

ExecutiveCommittee

Labor Advisory Committee(including LAC Liaison to the Board)

Early Retiree/VEBA Educationand Training Revenue

StrategicAlliance

Market Research

Distribution Channel/Partners

National LaborCollege

Blue Labor Basics

LaborCertification Program

LaborProspects

Plan MarketSurvey

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Blue Assets and ProgramsBlue Assets and Programs

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Blue Assets and Programs: Blue Assets and Programs: Maximizing the Value of Your Customer’s Healthcare DollarMaximizing the Value of Your Customer’s Healthcare Dollar

Your Customer’s Critical Healthcare Needs

• Target healthcare dollars

• Better overall health outcomes and quantifiably lower costs

• Increasing member health engagement at the worksite

The Strength that The Blues® Deliver

®

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Quality-based designation for facilities with better overall outcomes for high cost, high variability health conditions Quality-based designation for facilities with better overall outcomes for high cost, high variability health conditions

• Evidence-based selection criteria developed in collaboration with expert Evidence-based selection criteria developed in collaboration with expert clinicians and leading professional organizationsclinicians and leading professional organizations

• Broad, inclusive scope allows quality choices in four specialties for your Broad, inclusive scope allows quality choices in four specialties for your members nationwide (with more coming)members nationwide (with more coming)

• Simplified member-directed access minimizes need for employer Simplified member-directed access minimizes need for employer involvement involvement

• Results in quantifiably better overall health outcomes and lower costs Results in quantifiably better overall health outcomes and lower costs

• Provides a quality-based, cost-effective means for flexible benefit designProvides a quality-based, cost-effective means for flexible benefit design

Better Outcomes and Better Outcomes and Better Value for Specialty CareBetter Value for Specialty Care

Note: Designation as Blue Distinction Centers means that these facilities’ overall experience and aggregate data met objective criteria established in collaboration with expert clinicians’ and leading professional organizations’ recommendations. Individual outcomes may vary.

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Bariatric Surgery Cardiac Care

Complex & Rare Cancers Transplants

Evidence-based selection criteria developed in collaboration with expert clinicians and leading professional organizations

Criteria are transparent, available to the public on BCBS.comCriteria are transparent, available to the public on BCBS.com

Better Outcomes and Better Outcomes and Better Value for Specialty CareBetter Value for Specialty Care

These organizations have provided information and input, but do not formally endorse the Blue Distinction Centers program.

• American Society for Metabolic & Bariatric Surgery (ASMBS)

• Surgical Review Corporation (SRC)

• American College of Cardiology (ACC)

• Society of Thoracic Surgeons (STS)

• National Comprehensive Cancer Network (NCCN)

• Center for International Blood and Marrow Transplant Research (CIBMTR)

• Scientific Registry of Transplant Recipients (SRTR)

• Foundation for the Accreditation of Cellular Therapy (FACT)

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Broad, inclusive scope allows quality choices in four specialties for your members nationwide

We will expand specialty areas and increase the number of Blue Distinction designated facilities

We will expand specialty areas and increase the number of Blue Distinction designated facilities

Better Outcomes and Better Outcomes and Better Value for Specialty CareBetter Value for Specialty Care

More than 800 Designations across 45 statesMore than 800 Designations across 45 states

®

WA

OR

CA

AK

HI

TX

NMAZ

UTNV

ID

MT ND

SD

NE

WY

COKS

OKAR

LA

MSAL GA

FL

SC

NCTN

KYMO

IL

IA

MN

WIMI

INOH

WV VA

PA

NY

MEVT

NH

RIMA

CTNJDEMD

PR

Blue Distinction Centers Blue Distinction Centers for Cardiac Carefor Cardiac Care®®

Blue Distinction Centers for Bariatric Surgery®

Blue Distinction CentersBlue Distinction Centersfor Transplantsfor Transplants®®

Blue Distinction Centers Blue Distinction Centers Complex and Complex and Rare CancersRare CancersSMSM

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Simplified member-directed access minimizes need for employer involvement

DRAFT

members can easily learn more about Blue Distinction with a click of a mouse

National Doctor & Hospital Finder enables hospital comparisons based on Blue Distinction status

Better Outcomes and Better Outcomes and Better Value for Specialty CareBetter Value for Specialty Care

Memorial Hospital324 W. MainSouthpaw, MI 32012(313) 777-6329

St. Joseph’s Hospital123 Beach St.Lakeview, MI 32779(313) 777-1234

Lake County Medical Center5734 First Ave.Quinipshaw, MI 32968(313) 723-5681

North Central Hospital1 North Central Blvd.Pikesville, MI 32553(316) 878-5885

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Results in quantifiably better overall health outcomes…

Better Outcomes and Better Outcomes and Better Value for Specialty CareBetter Value for Specialty Care

Source: Based on claims data from BlueCross BlueShield Plans in eleven states

10.4%

10.9%5%

Cumulative Readmissions(0-90 Days)

Coronary Artery Bypass Graft

BDC Other

9.5%

10.5%11%

Angioplasty(CABG) (PCI)

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... and quantifiably lower costs

Better Outcomes and Better Outcomes and Better Value for Specialty CareBetter Value for Specialty Care

Average CostSavings per Procedure(1)

(per 90-day episode)

x = $65,512

Potential Savingsper Year

8.3

Average Numberof Procedures per Year(2)

(per 5,000 member group)

BDC Other

Procedure: CABG

Procedure: Angioplasty

x = $30,99621.6BDC Other

$1,435

Assumes members are not currently utilizing Blue Distinction Centers for these procedures. Source: (1) Based on claims data from BlueCross BlueShield Plans in eleven states, based on 90-day episode (2 ) American Heart Association: Heart Disease and Stroke Statistics—2008 Update

$7,893

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Provides a quality-based, cost-effective means for flexible benefit design

• National employers using and promoting Blue Distinction for member education and highlighting facilities offering better overall outcomes

• Others developing differential benefit designs to encourage or require use of Blue Distinction Centers

Better Outcomes and Better Outcomes and Better Value for Specialty CareBetter Value for Specialty Care ®

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Provides a quality-based, cost-effective means for flexible benefit design

• Example of Benefit Design driven by Blue Distinction

Better Outcomes and Better Outcomes and Better Value for Specialty CareBetter Value for Specialty Care

• 52,000 members

• 2,500 branch offices across 24 states

• Tailored benefit design to compensate for bariatric surgery only at Blue Distinction Centers, added supporting travel benefit

• Effectively steered members to higher quality care

…[BCBS] established bariatric centers of excellence. That’s helped us from the standpoint of making sure it’s a high quality service that’s provided."

– – Bruce WilsonBruce WilsonSenior Vice President, Compensation and BenefitsSenior Vice President, Compensation and Benefits

…[BCBS] established bariatric centers of excellence. That’s helped us from the standpoint of making sure it’s a high quality service that’s provided."

– – Bruce WilsonBruce WilsonSenior Vice President, Compensation and BenefitsSenior Vice President, Compensation and Benefits

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• High incidence of cardiac care need in SIC classification, particularly among older, male workers in Upper Midwest

• BCBS aggregate claims data triggers targeted education materials and resources to at-risk worksites

– Biometric screenings

– Health fairs/ workshops

– Distribution of Blue Distinction Provider Directory

• Members who require specialty care and select Blue Distinction facilities experience better overall outcomes, with fewer complications and lower overall costs

ABC Manufacturing

Better Outcomes and Better Outcomes and Better Value for Specialty CareBetter Value for Specialty Care ®

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Blue Assets and Programs: Blue Assets and Programs: Maximizing the Value of Your Customer’s Healthcare DollarMaximizing the Value of Your Customer’s Healthcare Dollar

Your Customer’s Critical Healthcare Needs

• Target healthcare dollars

• Better overall health outcomes and quantifiably lower costs

• Increasing member health engagement at the worksite

The Strength that The Blues® Deliver

®

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Questions??Questions??