Capabilities Pres


Published on

  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • Healthcare Advisor provides members with personalized health care information to help them think through their health care decisions. The Healthcare Advisor provides personalized information on the following: More that 150 conditions and procedures including medication options, condition management and procedure preparation. Questions to ask your doctor and insurance company regarding the management of a condition or preparation for a procedure. A community chat room to ask the advice of other people and provide input about any health topic. Links to other resources including useful websites, organized by healthcare topic.
  • Capabilities Pres

    1. 1. City of Melbourne Capabilities Presentation Scott Chapman Public Sector January 17, 2008
    2. 2. Points for Discussion <ul><li>A Commitment to Value </li></ul><ul><li>Network and Savings </li></ul><ul><li>Service </li></ul><ul><li>Disease Management </li></ul><ul><li>Why Blue Cross and Blue Shield of Florida? </li></ul>
    3. 3. The Leader in Employee Benefit Solutions for Florida Municipalities Over 100 Florida Municipalities choose BCBSF Average tenure - 10.3 years Okaloosa Holmes Washington Walton Wakulla Flagler Volusia Bradford Columbia Union Lafayette Jefferson Taylor Hamilton Suwannee Hernando Sumter Sarasota Okeechobee St. Johns Indian River Highlands Glades Nassau Gadsden Calhoun Gilchrist Lake Bay Alachua Citrus DeSoto Dixie Hendry Jackson Levy Madison Marion Martin Pasco Polk Lee Santa Rosa Franklin Manatee Leon Gulf Putnam Charlotte Local BCBSF office Municipalities by Florida County in Blue <ul><li>Public Sector Team </li></ul><ul><li>Dedicated Focus </li></ul><ul><li>Local Presence </li></ul><ul><li>Extensive Experience </li></ul><ul><li>Customized Service </li></ul>Pinellas Broward Okaloosa Holmes Washington Walton Wakulla Seminole Flagler Volusia Bradford Columbia Union Lafayette Jefferson Taylor Hamilton Suwannee Hernando Sumter Sarasota Okeechobee St. Johns Osceola Indian R. Highlands Glades Nassau Monroe Gadsden Calhoun Liberty Gilchrist Lake Brevard Bay Baker Alachua Citrus Clay Collier DeSoto Dixie Hardee Hendry Jackson Levy Madison Marion Martin Pasco Polk Lee Santa Rosa Franklin Escambia Hillsborough Orange Manatee Leon Duval Gulf Putnam Miami-Dade Palm Beach Charlotte St. Lucie
    4. 4. Advantage of Our Networks Blue Care ® (HMO) Blue Choice ® (PPO) Blue Options SM Network Blue SM Traditional Traditional Brevard County – 1,055 Statewide – 18,637 Brevard County – 1,260 Statewide – 26,831 Brevard County – 950 Statewide – 19.768 Brevard County – 1,300 Statewide – 31,670 Brevard County – 1,300 Statewide – 31,670
    5. 5. Network Access 31,670 26,831 19,768 18,637 Physicians (Statewide) Facilities & Key Physician Groups Physicians (Brevard) <ul><li>Holmes Regional </li></ul><ul><li>Cape Canaveral </li></ul><ul><li>Palm Bay Comm. </li></ul><ul><li>Wuesthoff </li></ul><ul><li>Wuesthoff-Melbourne </li></ul><ul><li>MIMA </li></ul><ul><li>Omni </li></ul><ul><li>Osler </li></ul><ul><li>Holmes Regional </li></ul><ul><li>Cape Canaveral </li></ul><ul><li>Palm Bay Comm. </li></ul><ul><li>Wuesthoff </li></ul><ul><li>Wuesthoff-Melbourne </li></ul><ul><li>MIMA </li></ul><ul><li>Omni </li></ul><ul><li>Osler </li></ul><ul><li>Holmes Regional </li></ul><ul><li>Palm Bay Comm. </li></ul><ul><li>Cape Canaveral </li></ul><ul><li>Wuesthoff </li></ul><ul><li>Wuesthoff-Melbourne </li></ul><ul><li>MIMA </li></ul><ul><li>Omni </li></ul><ul><li>Osler </li></ul><ul><li>Holmes Regional </li></ul><ul><li>Palm Bay Comm. </li></ul><ul><li>Cape Canaveral </li></ul><ul><li>Wuesthoff </li></ul><ul><li>Wuesthoff-Melbourne </li></ul><ul><li>MIMA </li></ul><ul><li>Omni </li></ul><ul><li>Osler </li></ul>1,300 1,260 950 1,055 Traditional BlueChoice PPO BlueOptions Open Access POS BlueCare Open Access HMO
    6. 6. Blue Delivers Unparalleled Access to Care in Florida and Beyond * As of January 2006 ** As of March 2006 *** BlueCard statistics per BCBSA June 2005 National Network Access through BlueCard ® *** Access in ALL 50 States More than 820,000 Physicians More than 5,500 Hospitals More than 31,500 Physicians* More than 210 Hospitals** Statewide Access Broad, Comprehensive Local Network Welcomed in over 200 Countries Worldwide “ Access to the Right Care at the Right Time for the Right Person at the Right Place”
    7. 7. BCBSF Provides Greater Discounts* in Brevard County and Florida * Based on Brevard County claims repricing off billed charges as provided in Brevard County/Schools RFP N/A N/A 53.8% 53.8% Aetna 54% 55% 57% 60% BCBSF N/A N/A 51.8% 51.8% Cigna N/A N/A 52.3% 52.3% United N/A PPO N/A Open Access POS N/A 50% Health First Traditional Open Access HMO Total Medical Services
    8. 8. Sophisticated Customer Service <ul><li>In person </li></ul><ul><ul><li>Local Assigned Service Representative </li></ul></ul><ul><ul><li>Comprehensive, On-site Wellness Program </li></ul></ul><ul><ul><li>Local field Medical Director </li></ul></ul><ul><ul><li>Local Case Manager </li></ul></ul><ul><li>Online </li></ul><ul><ul><li>MyBlueService SM </li></ul></ul><ul><ul><li>Health Dialog ® </li></ul></ul><ul><ul><li>Hospital Advisor ™ </li></ul></ul><ul><ul><li>24/7 self-service convenience </li></ul></ul><ul><li>By phone </li></ul><ul><ul><li>Convenient service hours </li></ul></ul><ul><ul><ul><li>9:00AM – 6:00PM, Monday through Thursday </li></ul></ul></ul><ul><ul><ul><li>9:00AM – 6:00PM, Friday </li></ul></ul></ul><ul><ul><li>English or Spanish speaking staff </li></ul></ul>From High-touch to High-tech
    9. 9. Easy Online Access for Members <ul><li>MyBlueService SM , 24/7 </li></ul><ul><li>Claims information </li></ul><ul><li>Disease management information </li></ul><ul><li>Health coaching </li></ul><ul><li>Hospital and physician quality data* </li></ul><ul><li>Online provider directory </li></ul><ul><li>Health and wellness information </li></ul><ul><li>BlueComplements discount programs and services </li></ul>
    10. 10. Dedicated Service Unit <ul><li>Account Advocate assigned as single point of contact to City of Melbourne for any service related issues </li></ul><ul><li>All member calls, written correspondence and claims are directed to the Dedicated Service Unit </li></ul><ul><li>Service Unit Team is experienced in Strategic Accounts </li></ul><ul><li>Account Specific Action Plans will monitor team performance </li></ul><ul><li>Account Specific Quarterly reports identify claims and inquiry activities </li></ul><ul><li>Account Specific Quarterly reports contain recommendations for utilization enhancements. </li></ul><ul><li>Lake Mary-based Account Management Specialist for monthly on-going management of account </li></ul>
    11. 11. Advisory Tools <ul><li>Healthcare Advisor™ </li></ul><ul><li>Provides information for 100+ medical conditions and procedures </li></ul><ul><li>Offers questions to ask the doctor and insurance company </li></ul><ul><li>Hospital Advisor™ </li></ul><ul><li>Enables members to find, profile and compare hospitals by procedure, patient safety, reputation and other characteristics </li></ul><ul><li>Physician Advisor™ </li></ul><ul><li>Enables members to view and compare attributes of physicians </li></ul><ul><li>Treatment Cost Advisor™ </li></ul><ul><li>Enables members to view and compare costs for various treatments, adjusted for demographic and regional differences </li></ul><ul><li>Provides detail by condition and includes a list of conditions, tests and visits </li></ul>
    12. 12. Top Ranked Health Plan <ul><li>Study ranks BCBSF 1st in customer satisfaction among major health plans in the South and 2nd overall nationally. </li></ul>J.D. Power and Associates 2007 National Health Insurance Plan Satisfaction Study SM “ This stuff doesn’t happen by accident. [Blue Cross has] worked at it, and it shows at a very consistent level of scoring across all the factors.” “ They are doing… basic blocking and tackling… well, but they are going above and beyond in their interaction with their members.” David Stefan, Executive Director of Healthcare Practice J.D. Power and Associates 736 Aetna 732 CIGNA 729 Humana 741 United 779 BCBSF Southern Region Scores
    13. 13. Blueprint for Health ® Disease Management Capabilities for our Customers
    14. 14. Current Program* <ul><li>Background - Shared Decision-Making ® /Unwarranted Variation </li></ul><ul><li>Pre-Certification, Concurrent Review, Discharge Planning </li></ul><ul><li>Components: </li></ul><ul><ul><li>Health Coaches - 24/7/365 Access; licensed professionals; telephonic/online access, multilingual </li></ul></ul><ul><ul><li>Chronic Condition Management - 5 Core Conditions: </li></ul></ul><ul><ul><ul><li>Coronary Artery Disease </li></ul></ul></ul><ul><ul><ul><li>Diabetes </li></ul></ul></ul><ul><ul><ul><li>Congestive Heart Failure </li></ul></ul></ul><ul><ul><ul><li>Asthma </li></ul></ul></ul><ul><ul><ul><li>Chronic Obstructive Lung Disease </li></ul></ul></ul><ul><ul><li>Expanded Condition Management – 34 Chronic and “Rare Chronic” Conditions </li></ul></ul><ul><ul><li>Stratification/Predictive Modeling – Multiple Methodologies including Dartmouth Atlas </li></ul></ul><ul><li>Decision Support- Preference sensitive conditions (e.g conditions with multiple treatment choices and high variation in care delivered) </li></ul><ul><li>The Dialog Center – An unbiased, evidence-based, multiple formats, multilingual information resource </li></ul>* Through Health Dialog ®
    15. 15. Expanded Chronic Condition Management* <ul><li>Depression </li></ul><ul><li>Oncology </li></ul><ul><li>End Stage Renal Disease </li></ul><ul><li>Acid Related Disorders </li></ul><ul><li>Hypertension </li></ul><ul><li>Irritable Bowel Syndrome </li></ul><ul><li>Back pain </li></ul><ul><li>Joint Pain </li></ul><ul><li>Osteoporosis </li></ul><ul><li>Fibromyalgia </li></ul><ul><li>Osteoarthritis </li></ul><ul><li>Migraine </li></ul><ul><li>Women’s Health (Benign Uterine Conditions) </li></ul><ul><li>Benign Prostatic Hyperplasia </li></ul><ul><li>Atrial Fibrillation </li></ul><ul><li>Chronic Kidney Disease </li></ul><ul><li>Multiple Sclerosis </li></ul><ul><li>Systemic Lupus Erythematosis </li></ul><ul><li>Sickle Cell Anemia </li></ul><ul><li>Hemophilia </li></ul><ul><li>Polymyositis </li></ul><ul><li>Dermatomyositis </li></ul><ul><li>Gaucher Disease </li></ul><ul><li>Seizure Disorders </li></ul><ul><li>Amyotrophic Lateral Sclerosis (ALS) </li></ul><ul><li>Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) </li></ul><ul><li>Rheumatoid Arthritis </li></ul><ul><li>Parkinson’s Disease </li></ul><ul><li>Myasthenia Gravis </li></ul><ul><li>Cystic Fibrosis </li></ul><ul><li>Scleroderma </li></ul><ul><li>Crohn’s Disease </li></ul><ul><li>* Conditions managed by Accordant ® (“Rare Chronic”) </li></ul>* Conditions managed by Health Dialog ®
    16. 16. Identifying Individuals for Care Coordination <ul><li>Monitoring, evaluation, reporting </li></ul><ul><ul><li>Large claims repository for sophisticated predictive modeling </li></ul></ul><ul><ul><li>Claims and utilization, daily census, hospital, physician utilization </li></ul></ul><ul><ul><li>Case management reporting </li></ul></ul><ul><li>Lake Mary-based clinical presence gives BCBSF a clear advantage </li></ul><ul><ul><li>Closer to our customers, Lake Mary-based Medical Director and Care Coordination Nurses </li></ul></ul><ul><ul><li>Know physicians, hospitals, other providers better </li></ul></ul><ul><ul><li>Move faster, smarter, to help people in need </li></ul></ul><ul><li>Personal referrals </li></ul><ul><ul><li>Members </li></ul></ul><ul><ul><li>Employers </li></ul></ul><ul><ul><li>Agents, Brokers, Consultants </li></ul></ul><ul><ul><li>Providers </li></ul></ul>Earlier, Faster, and More Effective!
    17. 17. Our Care Coordination Nurses are Local! Jacksonville Gainesville Orlando Port St. Lucie West Palm Ft. Lauderdale Miami Panama City Tallahassee Tampa Sarasota Ft. Myers Pensacola <ul><li>Early identification of at-risk members through Personal Outreach </li></ul><ul><li>Lake Mary-based Nurses with in-depth knowledge health care system, relationships with physicians </li></ul><ul><li>Lake Mary-based Nurses have online access to members claims, physician utilization data, daily hospital census </li></ul><ul><li>Pre-surgical outreach helps members understand benefits, care options </li></ul><ul><li>Post-discharge promotes treatment compliance, avoids costly readmissions </li></ul>Personal Outreach to Members at Point-of-care
    18. 18. Health Coaches <ul><li>Experienced registered nurses 24x7 </li></ul><ul><li>Fast, accurate, confidential advice </li></ul><ul><li>Help with complex health issues </li></ul><ul><li>Unbiased, evidence-based </li></ul><ul><li>Decision support sensitive to patient preferences and values </li></ul><ul><li>Free health videos and information mailed to members </li></ul><ul><li>Online, self-service tools </li></ul><ul><li>Dialog Center contains health information on more than 1,900 topics </li></ul><ul><li>Call volume >15,000 per quarter (inbound, outbound and follow up) </li></ul><ul><li>610,000 total targeted mailings </li></ul><ul><li>Integrated with other service teams </li></ul>Helping Members Make Better Informed Health Decisions
    19. 19. Does Health Coaching Work? <ul><li>94% of high risk members were contacted in less than 60 days </li></ul><ul><li>95% of individuals followed their Health Coach’s guidance </li></ul><ul><li>40% of employees coached chose alternatives to surgery after consulting with their doctors </li></ul><ul><li>Coached Employees with chronic conditions had 25-30% fewer hospital admissions </li></ul><ul><li>Coached Employees require 30% fewer Emergency Room and physician visits </li></ul><ul><li>98% of individuals recommend their Health Coach to others needing similar support </li></ul>
    20. 20. Industry Leading On-site Wellness Program for City of Melbourne <ul><li>Lake Mary-based Clinical Manager </li></ul><ul><li>Biometric screenings (e.g., blood pressure, cholesterol, glucose) </li></ul><ul><li>Health Risk Assessments for individuals with immediate results </li></ul><ul><li>Data Analysis at employee and group level </li></ul><ul><li>Identifies urgent high risk members for immediate medical attention </li></ul><ul><li>Referral of other high risk members to care programs </li></ul><ul><li>Health coaching onsite and online </li></ul><ul><li>Follow-up assessments, activities, Interventions (e.g., worksite lunch-n-learns) </li></ul><ul><li>$250,000 average cost - INCLUDED </li></ul>20,000+ employees 100+ groups 350+ people received urgent referrals Our Statewide 2006-07 Participation
    21. 21. Why Blue Cross and Blue Shield of Florida? <ul><li>Dedicated focus on Municipalities and Public Sector statewide </li></ul><ul><li>Broadest network access – Brevard County, Statewide & Nationwide </li></ul><ul><li>Greatest discounts in Brevard County and Statewide </li></ul><ul><li>Outstanding Dedicated Customer Service Unit with Account Advocate </li></ul><ul><li>Online access to health information tools & member self-service tools </li></ul><ul><li>Comprehensive Disease Management programs </li></ul><ul><li>On-site Wellness Program </li></ul><ul><li>References </li></ul>
    22. 22. References Volusia County School Board Indian River County Schools Wuesthoff Health Systems S School Board of Polk County Sumter County Board of County Commissioners Lake County Board of County Commissioners Tera Townsend, Director of Risk Mgt. (352) 793-5607 Sharon Wall, Director of Employee Services (352) 343-9426 Sandy Higgenbotham, Risk Manager (386) 734-7190 x 20300 Gerald Koziel, Director of Risk Management (772) 564-3060 Stetson University Lake County School Board Betty Whiteman, Director of Human Resources (352) 735-7186 Becky Nelsen, Dir. Compensation & Benefits (352) 253-6519 George Fayer, Chief Financial Officer 321-636-2211 x-5030 Steve Henderson, Director, Risk Management (863) 534-0785
    23. 23. A Few of the Companies We Serve Note: Please do not contact these businesses without prior approval from BCBSF Central Florida Leesburg Florida The Lakefront City