Prudence Kuai

SVP and Chief Information Officer, Florida Blue

May 14, 2014

iHT² Payer-Provider Evolving

Business Models Summit:

The Power of Data

1

Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

AGENDA

• Dynamics in the Health Care and Health

Insurance Industry

• Florida Blue’s Positioning in the

Marketplace

• The Power of Data in Driving Industry

Transformation

2

Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

AGENDA

• Dynamics in the Health Care and Health

Insurance Industry

• Florida Blue’s Positioning in the Marketplace

• The Power of Data in Driving Industry

Transformation

3

Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

How Health Care is Changing…

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Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

Premium Subsidies

Age Rating

Compression

HealthInsurance

Tax

Essential Benefit

Changes

Cost-sharing Subsidies

New Market Rules

3Rs

Competition

Managing Through Change

5

Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

AGENDA

• Dynamics in the Health Care and Health

Insurance Industry

• Florida Blue’s Positioning in the

Marketplace

• The Power of Data in Driving Industry

Transformation

6

Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association. 7

• F lo r i da B lue and i t s f am i l y o f subs id i a r i es se rve

more t han 15 m i l l i on peop le ac ross t he Un i t ed S ta tes

• 30% marke t sha re i n F l o r i da

• Cus tomer re ten t i on l eve l s ave rag ing 90 %

• 25 Consecu t i ve Yea rs o f Pos i t i ve Ne t I ncome

• $10 b i l l i on o f r evenue

• Over $4 b i l l i on o f GAP equ i t y

• AM Bes t r a t i ng upg raded t o an “A+ ”

• A+ Ra t i ng f r om S tanda rd & Poo r ' s

Florida Blue – Who we are

Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

VisionA leading innovator enabling healthy communities

MissionTo help people and communities achieve better health

ValuesRespect, Integrity, Imagination, Courage, Excellence

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Our Mission, Vision & Values

Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

Riverside YMCA Florida Blue

Fitness Center

Tampa Bay Day of Caring

Community Gardens Miami Rescue Mission 9

Building Strong Communities

Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

H e a l t h I n s u r a n c e E V O L U T I O N t o H e a l t h S o l u t i o n s

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Retai l Centers

Community Health & Wellness

Sales & Retention

MemberServices

Education& Events

Care Navigation & Support

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Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

I nnova t i ons d r i ve member engagemen t / suppo r t

Care

Consulting

Navigation

Mobile Web ApplicationsBetter You From BlueSM

Worksite Wellness

Worksite Clinics

HCR e-Book

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Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association. 13

Habi t Heroes

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Our delivery system is becoming a mosaic of value models

Patient Centered Medical Homes (PCMH)

Bundled Payment Pilots

Staff Model HMOs

2

1

Physician Groups

31

2

Medicare Collaborative Care Models

ACO Models

3,5

2

1

7

4,6

8

Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

Par tnersh ips

15

Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

Agenda

• Dynamics in the Health Care and Health

Insurance Industry

• Florida Blue’s Positioning in the Marketplace

• The Power of Data in Driving Industry

Transformation

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Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

Fu tu re hea l t h p l an ro l e i n i n f o rma t i on exchange

Encounters Engagement

Clinical

IncentivesCosts

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Providers Members

Partners

Employers

Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

T h e A g e o f C o n s u m e r - C e n t r i c D i g i t a l H e a l t h

Health Consumer

Early

Disease

Detection

Personalized

Treatment

Plans

Optimized

Prevention

Complete Health Record

Real Time

Biometrics

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Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

M u l t i - C h a n n e l P h y s i c i a n C o l l a b o r a t i o n

Data

Co

llectio

n a

nd

Ana

lytics

Digitization

Genomics

Biometric Devices

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Web

Mobile

Physician Portal

ER Platform

Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

E l e m e n t s o f S u c c e s s f o rA C O P a r t n e r s h i p

Trust between parties

Shared savings that aligns

incentives with the best interest

of the member/patient

Data Transparency

All parties with a vested interest in

success

Quality being clearly defined and measurable

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Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

We b - M o b i l e - D i g i t a l

Health Care Reform

eBook

Member Website

Mobile

EMR

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Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

I n fo rma t i on L i f e Cyc le

Data Information Knowledge Value

Use/ Access ActionMeaning

We must deliver an information ecosystem and structure that enable the value creation

We must define the future information needs that will drive value

QuestionsContextSource

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Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association.

Key Messages

Technology leaders need to:

• Realize great opportunities and great responsibilities

• Establish solid data and information management

strategies and roadmap

• Engage and collaborate with business leaders

internally and externally

• Exhibit leadership to execute the strategies

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