PARTNERSHIPS FOR HEALTHIER COMMUNITIES

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1 CREATIVE PARTNERSHIPS FOR HEALTHIER COMMUNITIES

2 BlueCross BlueShield of Tennessee has a long standing commitment to the people and communities we serve. After 70 years of dedicated service to Tennesseans, we are uniquely positioned as an advocate for quality health care, and to lead innovative health care strategies as part of our mission to provide peace of mind through better health. 1

3 In the changing health care landscape, there is an increased awareness of health outcomes and performance based on key quality measures and scores. But some things can t be measured. What we do is about serving our members our mothers, fathers, sisters, brothers, children, neighbors, friends every day. It is about cultivating meaningful partnerships with the health care providers who help guide our members to better health, to better lives. Every day is an opportunity to serve. Dr. Andrea Willis, Chief Medical Officer BlueCross BlueShield of Tennessee We are committed to leading by offering quality care strategies that put the focus on every member, every day and provide the right care at the right time. Our strategic steps forward empower the health care team to improve when, why and how care is delivered, and target healthy outcomes with personal, affordable care. REIMBURSING BASED ON QUALITY/ OUTCOMES BUNDLED PAYMENTS SHARED RISK ARRANGEMENTS FEE-FOR-SERVICE CONTRACTS ESTABLISHING PCMH SITES PAY-FOR- PERFORMANCE CONTRACTING ESTABLISHMENT OF STRATEGIC PARTNERSHIPS ACROSS THE STATE 2 Creative Partnerships for Healthier Communities 3

4 THE COURSE WE RE LEADING EMBRACES CHANGE We are working in step with our community s health care providers on initiatives that address complex health challenges with creative solutions. By better understanding our members and their unique needs, we are able to partner in meaningful ways for improved quality outcomes. $250K GRANT TO STUDY AND PREVENT NEONATAL ABSTINENCE SYNDROME In Jellico, Tennessee, about half of all new babies are born addicted to drugs. After noticing the spike in the number of babies suffering from neonatal abstinence syndrome (NAS), we initiated and funded a partnership with community health care providers through a program called Mothers and Infants Sober Together. In addition, the BlueCross BlueShield of Tennessee Health Foundation recently presented a $1 million grant to East Tennessee Children s Hospital in Knoxville to construct a unit dedicated to the treatment of NAS babies. An additional $250,000 grant was presented to perform a study that may actually prevent babies from suffering from NAS. 4 Creative Partnerships for Healthier Communities 5

5 THE COURSE WE RE LEADING ADAPTS TO MEMBER NEEDS Our members are increasingly aware of the cost of health care and look to BlueCross for help. Our strategies reduce the cost trend while enabling consumers to be more informed about the cost of care. We re supporting that search for information through member education tools on our website, by opening a Consumer Information Center in middle Tennessee and by deploying a mobile unit that can reach consumers and members throughout the state. 6 Creative Partnerships for Healthier Communities 7

6 THE COURSE WE RE LEADING FOCUSES ON QUALITY-BASED CARE DELIVERY The path forward leaves behind a structure the health care industry has followed for decades a fee-forservice model and maps a new direction, built on value-based health care delivery and payment models that reward quality outcomes. Our focus on quality is clear when looking at the success of the Tennessee Center for Patient Safety (TCPS), a program run by the Tennessee Hospital Association (THA) and funded by the BlueCross BlueShield of Tennessee Health Foundation. Across the state, 122 hospitals participate in the TCPS, working to improve patient safety measures. Initial reports from the THA showed that central line infections in Tennessee hospitals declined by 36 percent overall and 46 percent among neonatal patients between 2008 and Staph infections were down 21 percent. As a result of these efforts, the state was recognized by the Centers for Disease Control and Prevention for showing significant reductions in hospital-acquired infections and for accuracy in reporting safety data. 36% DECREASE IN CENTRAL LINE INFECTIONS 8 Creative Partnerships for Healthier Communities 9

7 THE COURSE WE RE LEADING TURNS DATA INTO MEANINGFUL INFORMATION Better sharing of clinical information turns data into actionable information. This makes it easier for providers to keep members informed and help them get needed screenings and services at the most efficient cost possible. And it s helped BlueCross provide personalized, consistent and timely messaging to members on recommended care that resulted in more than 421,000 care gaps closed and more than $1.5 million in cost avoidance in just one year. Strategic reporting helps our valued customers plan the right coverage for their employees while ensuring they are achieving the best value from us. By empowering them with easy-to-understand health trends, cost drivers, and opportunities, businesses can build healthier workforces with fewer missed days through creative health and wellness programs that best fit the needs of their workforce. Meaningful data is powerful. One large employer restructured their benefit design around an issue identified through our reporting. By increasing their Emergency Room (ER) cost-share, and decreasing that of urgent care, they reduced inappropriate ER utilization by 12 percent. This resulted in savings of more than $1 million in the first 18 months. In this way, BlueCross has been a partner in helping our valued customers provide custom benefit offerings that hone in on their employees specific needs. Meaningful Data is POWERFUL 10 Creative Partnerships for Healthier Communities 11

8 THE COURSE WE RE LEADING BRINGS CARE IMPROVEMENTS T H R O U G H INNOVATION BlueCross is developing innovative payment arrangements with our provider partners to ensure our members receive the best care possible. We are aligning with health care professionals and facilities that lead their peers in efficiency while maintaining great quality and customer service. And we are providing financial rewards to members and the providers who help them who take the extra steps necessary to get their recommended preventive tests and screenings, as well as properly manage chronic medical conditions. We believe that the best health care delivers the right type of care, at the right time, and in the right setting to meet the member s health and medical needs. 12 Creative Partnerships for Healthier Communities 13

9 WE RE TAKING A FAR REACHING APPROACH TO Q UA L I T Y INNOVATION Recognizing that measurable, quality care and valuebased reimbursement models that reward results is the future of health care, we have launched a broad array of initiatives that span across our lines of business. Beyond this, BlueCross is also managing a series of existing efforts and incubating others with health care professionals across the state to positively impact our members: Patient-Centered Medical Home Pay-for-performance contracting Strategic partnerships Bundled payment strategies Network innovation Pay-for-quality incentives Centers of excellence Rewarding quality in primary care 14 Creative Partnerships for Healthier Communities 15

10 PAY-FOR- PERFORMANCE HOSPITAL CONTRACTS Pay-for-Performance contracts laid the groundwork for many of the quality incentive programs in place today. Initially, the contracts were developed to incentivize providers for producing better quality outcomes. To ensure our quality goals aligned with defined measures, BlueCross developed criteria for providers based on the Tennessee Center for Patient Safety and other national standards established by the Centers for Medicare & Medicaid Services (CMS). And now that the government is requiring more streamlined clinical integration and data sharing between hospitals and physicians, the focus really is on these national standards. As we make the shift from the fee-for-service model, Pay-for-Performance contracts are the first step in paying health care professionals for the quality of care they provide. This successful contracting model has led to its integration in Patient-Centered Medical Home reimbursement designs and today s new strategic partnerships. BlueCross has more than 60 active contracts of this nature, with new contracts still being developed. LAKE OBION WEAKLEY HENRY STEWART HOUSTON MONTGOMERY DICKSON CHEATHAM ROBERTSON DAVIDSON SUMNER WILSON MACON TROUSDALE SMITH JACKSON CLAY PUTNAM OVERTON PICKETT FENTRESS MORGAN SCOTT CAMPBELL ANDERSON UNION CLAIBORNE GRAINGER JEFFERSON HANCOCK HAMBLEN HAWKINS GREENE WASHINGTON UNICOI SULLIVAN CARTER JOHNSON DYER LAUDERDALE TIPTON GIBSON CROCKETT HAYWOOD MADISON HUMPHREYS CARROLL BENTON HENDERSON PERRY DECATUR CHESTER HICKMAN LEWIS MAURY WILLIAMSON MARSHALL RUTHERFORD BEDFORD MOORE CANNON COFFEE DEKALB WARREN GRUNDY WHITE VAN BUREN SEQUATCHIE BLEDSOE CUMBERLAND HAMILTON RHEA MEIGS ROANE MCMINN LOUDON MONROE KNOX BLOUNT SEVIER COCKE Pay-for-Performance Sites SHELBY FAYETTE HARDEMAN MCNAIRY HARDIN WAYNE LAWRENCE GILES LINCOLN FRANKLIN MARION BRADLEY POLK Patient-Centered Medical Home 16 Creative Partnerships for Healthier Communities 17

11 M I S S I O N MOMENTS MAKING CARE REAL A longtime BlueCare Tennessee member had developed a rocky relationship with nearly everyone with whom he came in contact. People were very reluctant to work with the member. He went through multiple care coordinators. Doctors didn t want to see him. He would yell at all of our customer service reps any time he called in because he wasn t getting what he wanted, said Barry, a supervisor in BlueCare. The member suffers from multiple medical conditions and has been confined to a wheelchair for more than 30 years. He had also developed a habit of damaging the wheelchair and, because of this problem, had serious trouble getting vendors to work with him in getting new equipment. I started dealing with him because it got to the point where we wouldn t let him talk to any of our service reps because he couldn t control his anger, Barry said. Barry began joining the member at his home during visits from nurses. He would also accompany the member to doctor s appointments to show his support. That was the only way they would meet him is if I was there to be the mediator, he said. Over the next few months, the member s hard shell began to soften. He began to trust Barry. He had Barry s phone number to use whenever he needed something even on Saturdays. He was just upset about his whole situation, Barry said. It didn t really have anything to do with the wheelchair; he was angry and needed someone to care about him. And that s what I did. Because of Barry s patience and his willingness to go the extra mile, one member is back on track, and in a new wheelchair. PATIENT-CENTERED MEDICAL HOMES 180K MEMBERS SERVED THROUGH MEDICAL HOMES Many challenges that impact patient safety and quality care stem from poorly coordinated care. Patient-Centered Medical Homes are specially certified practices that focus on primary care, and strive to assure strong care coordination for their patients. Our Patient-Centered Medical Home (PCMH) model started in 2009 with two pilot sites and has grown into the largest medical home program in the state. More than 800 doctors coordinate the care for more than 180,000 members. This care coordination effort focuses on individuals with chronic conditions like diabetes, but is expanding to include preventive care while closely aligning with key quality measures like HEDIS and Stars Ratings. Best of all, these efforts are producing meaningful results for our members and the cost of their care. Members enrolled in a PCMH had lower utilization and ER usage, and the PCMH We believe in quality above all else, and by becoming a certified PCMH we learned how to do what we were doing better. We have been able to use the information to help our patients get better care and we get rewarded for the better care we provide. Dr. Harold Chertok, Cookeville Primary Care Associates sites generated a cost savings of approximately three percent. We believe these outcomes are just the beginning. We expect to experience additional results as we expand the PCMH program and invest in added resources over the next few years. We plan to reach 450,000 Tennesseans by expanding the number of practices participating in the program, adding new practices, and employing additional on-site care coordinators. 18 Creative Partnerships for Healthier Communities Creative Partnerships for Healthier Communities 19

12 QUALITY CARE REWARDS Quality Care Rewards was launched in 2014 to incentivize providers above their current reimbursement rates for helping close gaps in member care. 250K GAPS IN CARE CLOSED AS A RESULT OF THESE EFFORTS IN 2014 The program focuses on improving quality by aligning financial incentives with evidence-based measures things like comprehensive diabetes, breast cancer and colorectal cancer screenings. Select providers who treat our Commercial, BlueCare Tennessee BlueCare Plus populations are eligible. And all providers who care for our Medicare Advantage population are eligible. While the various product lines have unique aspects, there are some common elements. BlueCross provides customized reports identifying members with gaps in care. We pay providers for engaging with our members to close those gaps. The targeted gaps are all HEDIS * measures, but each division has chosen measures specific to their population. Members can earn rewards as well. Health care providers are able to directly influence the care our members receive. But they may not know that a member has skipped an appointment with a specialist or neglected to have follow-up lab work done. That s where we come in with data that bridges information gaps. We can provide those on the front lines of care with information that helps them provide better care all the while, helping our members improve their lives. * Healthcare Effectiveness Data and Information Set 20 Creative Partnerships for Healthier Communities 21

13 MORE THAN TWO-THIRDS OF OUR EXISTING PROVIDER CONTRACTS INCLUDE QUALITY IMPROVEMENT MEASURES. Navigating the health care system can be challenging for patients. One key initiative funded by BlueCross was the creation of a Care Transition Team targeting high-risk patients, age 65 and older, with no primary care physician and with repeated visits to Erlanger s Emergency Room within six months. Within one week of every ER visit to Erlanger, a designated navigator on the Care Transition Team follows up with a phone call to ensure the patient is taking medications, to see if further assistance is needed, and to encourage a primary care visit. Similar programs have demonstrated significant additional savings, more efficient use of resources and vastly improved patient outcomes. By partnering with our community facilities and care providers, we will continue to drive positive change for our members and fellow Tennesseans. STRATEGIC PARTNERSHIPS Our members deserve the best possible care at an affordable price. Through the establishment of strategic provider partnerships, we ve taken necessary measures to ensure that what we pay and how we pay our partners keeps us competitive in the market. Creating strategic partnerships with highly respected and high-performing provider groups and hospital systems is a key way in which we ve been able to help keep costs in line, especially for our new Health Insurance Marketplace members. STRATEGIC PARTNERS Each of these partnerships is unique, but all share similar essential principles: Multi-year agreements on competitive pricing across networks Committed capital investment toward development of care and payment innovation efforts Willingness to incubate and pilot new initiatives 22 Creative Partnerships for Healthier Communities Creative Partnerships for Healthier Communities 23

14 INNOVATIVE NETWORK DESIGNS THAT WORK FOR OUR MEMBERS Instead of continuing the trend of paying for volume, we re moving to a model that reimburses our provider partners for quality outcomes. When our key partners continuously perform at higher levels and produce better outcomes for our members, we can customize our product designs and reimbursement models to deliver the care needed by our members. When thinking about a family member who has diabetes, we know it s crucial to have access to a network of providers that includes high-performing endocrinologists, dieticians, wound care specialists and others who can provide quality care. Imagine a benefit plan that connects members with health care providers who are skilled in providing the needed medical services, and who have a demonstrated ability to meet those needs in a cost-effective manner. Highly efficient provider networks allow our members to access care that: Meets their needs ACCESS TO HIGHLY EFFICIENT PROVIDER NETWORKS Is provided by health care professionals who agree to be reimbursed based on the quality of their care, and Places an emphasis on keeping the cost of that care affordable. 24 Creative Partnerships for Healthier Communities 25

15 TENNESSEE HEALTH CARE INNOVATION INITIATIVE BlueCross is a partner with the State of Tennessee in launching the Tennessee Health Care Innovation Initiative. In partnership, we ll work toward a health care payment system that effectively rewards patient-centered, high-quality, high-value health care outcomes for Tennesseans. The initiative is a retrospective episodebased payment strategy to reward health care professionals and facilities for providing high-quality and costefficient care. The first phase of the initiative includes three acute medical conditions: Total joint replacement (hips and knee) Acute asthma exacerbation Perinatal Providers receive quarterly reports which reflect their practice s cost and quality outcomes as they compare to their peers. Following the initial reporting-only period, the State will establish threshold levels that will ultimately be used to reward providers for delivering high-quality and efficient care. Plans for the Tennessee Health Care Innovation Initiative include adding up to 72 additional episodic medical conditions in the coming years. 26 Creative Partnerships for Healthier Communities 27

16 We are fully committed to partnering with health care providers to improve the health of our members. And we are providing our health care partners with actionable information that will help enhance the quality care our members receive. 28 Creative Partnerships for Healthier Communities

17 BlueCross BlueShield of Tennessee 1 Cameron Hill Circle Chattanooga, TN bcbst.com BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association BlueCare Tennessee, an Independent Licensee of the BlueCross BlueShield Association 14PED2185 (4/15) Enterprise Quality Value Story

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