a blue cross and blue shield association presentation consumers take center stage 2007 health...
TRANSCRIPT
A Blue Cross and Blue Shield Association Presentation
Consumers Take Consumers Take Center StageCenter Stage
2007 Health Leaders Forum2007 Health Leaders ForumFederal Reserve Bank of Chicago and Federal Reserve Bank of Chicago and Detroit Regional ChamberDetroit Regional Chamber
Detroit, Michigan Detroit, Michigan April 24, 2007April 24, 2007
Scott P. SerotaPresident & CEO
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Meet MeredithMeet Meredith
Building a Better System
Building a Better System
ConsumersTake CenterStage
ConsumersTake CenterStage
The BluesThe BluesThe BluesThe Blues
Agenda Agenda
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Blues are the strongest Brand in healthcare across AmericaBlues are the strongest Brand in healthcare across America
#1 Brand #1 Brand #1 Brand #1 Brand
Solid FinancialsSolid Financials Solid FinancialsSolid Financials
Quality Provider Quality Provider NetworksNetworks
Quality Provider Quality Provider NetworksNetworks
Record EnrollmentRecord EnrollmentRecord EnrollmentRecord Enrollment
The BluesThe Blues
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Blues EnrollmentBlues Enrollment
87.879.3
70.565.2
80.1 82.6 85.3 88.892.3
98.694.4
0
25
50
75
100
'80 '85 '90 '94 '00 '01 '02 '03 '04 '05 '06
Cus
tom
ers
(in
mill
ions
)
Blues member enrollment is at an all-time record highBlues member enrollment is at an all-time record high
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Extending the Brand into high-profile international marketsExtending the Brand into high-profile international markets
International MarketsInternational Markets
• BlueCard Worldwide offers U.S. customers BlueCard Worldwide offers U.S. customers access to medical assistance worldwide access to medical assistance worldwide
• 7,000 physicians in 200 countries7,000 physicians in 200 countries
• 850 hospitals in 84 countries850 hospitals in 84 countries
• BlueWorldwide Expat provides specialized BlueWorldwide Expat provides specialized insurance product for expatriatesinsurance product for expatriates
• 100+ accounts100+ accounts
• 700 lives700 lives
• Blue Brands licensed to independent companies Blue Brands licensed to independent companies in 50 countries in Europe, Central America and in 50 countries in Europe, Central America and South AmericaSouth America
• 5.5 million international subscribers5.5 million international subscribers
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Agenda Agenda
MeetMeredithMeetMeredith
Building a Better System
Building a Better System
ConsumersConsumersTake CenterTake CenterStageStage
ConsumersConsumersTake CenterTake CenterStageStage
The BluesThe Blues
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A New Healthcare Model for the FutureA New Healthcare Model for the Future
A true consumer-centric healthcare system for the future A true consumer-centric healthcare system for the future should clearly focus on the wants and needs of consumersshould clearly focus on the wants and needs of consumers
Current ModelCurrent Model
ProviderProvider ConsumerConsumer
EmployerEmployer PayerPayer
GovernmentGovernment
Future ModelFuture Model
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With more than 75 million lives, BHI leads in data scope and With more than 75 million lives, BHI leads in data scope and depth and is helping shape a future healthcare delivery modeldepth and is helping shape a future healthcare delivery model
Shaping a Future Healthcare ModelShaping a Future Healthcare Model
• Shaping new care delivery modelShaping new care delivery model– Partner with providers on Partner with providers on
outcomes and care patternsoutcomes and care patterns
– Robust information for consumer Robust information for consumer decision-makingdecision-making
– Support policy development Support policy development
• State-of-the-art informaticsState-of-the-art informatics– Precise dataPrecise data
– More statistically valid measuresMore statistically valid measures
– Benchmark data across Benchmark data across geographiesgeographies
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Bank supports new Consumer-Directed Health Plans and Bank supports new Consumer-Directed Health Plans and HSAs, offering consumers integrated and easy-to-use serviceHSAs, offering consumers integrated and easy-to-use service
• Support growing number of Support growing number of Blue Plan CDHPs and HSAsBlue Plan CDHPs and HSAs
• Easy-to-use, seamless and fully Easy-to-use, seamless and fully integrated consumer serviceintegrated consumer service
• Simplify healthcare spendingSimplify healthcare spending
• Full line of financial servicesFull line of financial services
• Chartered to serve all 50 statesChartered to serve all 50 states
Serving Consumer Healthcare Financial Needs Serving Consumer Healthcare Financial Needs
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Agenda Agenda
MeetMeredithMeetMeredith
Building Building a Better a Better System System
Building Building a Better a Better System System
ConsumersTake CenterStage
ConsumersTake CenterStage
The BluesThe Blues
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Better Knowledge for Healthier LivesBetter Knowledge for Healthier Lives
Engaging consumers to enable more
informed healthcare decisions
Collaborating with Collaborating with providers to improve providers to improve quality outcomes and quality outcomes and
affordabilityaffordability
Helping consumers make more informed decisions while Helping consumers make more informed decisions while helping providers improve health outcomes and affordabilityhelping providers improve health outcomes and affordability
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Collaborating with Providers to Raise StandardsCollaborating with Providers to Raise Standards
Primary Care Medicine
Specialty Care Medicine
Raise standards, ensure more consistent quality careRaise standards, ensure more consistent quality care
Other Organizations
Surgical Care
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Higher Standards Mean Better CareHigher Standards Mean Better Care
• Bariatric surgery
• Cardiac care
• Transplants
• Cancer care
Specialty Care Centers focus on most challenging conditionsSpecialty Care Centers focus on most challenging conditions
Developed in close collaboration with leading Developed in close collaboration with leading medical providers and specialty organizationsmedical providers and specialty organizationsDeveloped in close collaboration with leading Developed in close collaboration with leading medical providers and specialty organizationsmedical providers and specialty organizations
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Centers for Specialty Care: Centers for Specialty Care: TransplantTransplant
There are 70 evidence-based Blue Distinction Centers There are 70 evidence-based Blue Distinction Centers for Transplants in local communities nationwidefor Transplants in local communities nationwide
Blue Distinction Centers for Transplants
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… … and 125 Blue Distinction Centers for Bariatric Surgeryand 125 Blue Distinction Centers for Bariatric Surgery
Blue Distinction Centers for Bariatric SurgeryBlue Distinction Centers for Transplants
Centers for Specialty Care:Centers for Specialty Care: Bariatric Surgery Bariatric Surgery
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Blue Distinction Centers for Cardiac CareBlue Distinction Centers for Bariatric SurgeryBlue Distinction Centers for Transplants
… … and 375 Blue Distinction Centers for Cardiac Careand 375 Blue Distinction Centers for Cardiac Care
Centers for Specialty Care:Centers for Specialty Care: Cardiac Care Cardiac Care
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Higher Standards Yield Better CareHigher Standards Yield Better Care
5%7%8%
37%
Blue DistinctionCenters for Bariatric
Surgery
Denied Facilities
7% 9%
15%
40%
Blue DistinctionCenters for Cardiac
Care
Denied Facilities
Short-Term Major Complications for Bariatric Surgery
Short-Term Major Complications for Bariatric Surgery
Inpatient Mortality(Heart Attack)
Inpatient Mortality(Heart Attack)
SMSM
Mean Maximum
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Investing in Patient Quality and SafetyInvesting in Patient Quality and Safety
• Blues contributed $5M to “5 Million Lives” campaign
• Campaign aims to protect five million lives through:
– Proven infection control practices
– Evidence-based practices for congestive heart failure
– Deployment of rapid response teams
– Reduction of adverse drug events
Example: Partnership with Institute for Healthcare Improvement Example: Partnership with Institute for Healthcare Improvement
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MeetMeetMeredithMeredithMeetMeetMeredithMeredith
Building a Better System
Building a Better System
ConsumersTake CenterStage
ConsumersTake CenterStage
The BluesThe Blues
AgendaAgenda
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Meet MeredithMeet Meredith
• ““I weigh more than I should”I weigh more than I should”
• ““I have a family history of heart disease”I have a family history of heart disease”
• ““My doctor just told me I need a My doctor just told me I need a coronary bypass”coronary bypass”
Meredith is confronting several serious health problemsMeredith is confronting several serious health problems
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Meredith’s DilemmaMeredith’s Dilemma
A few years ago, Meredith would have had limited options A few years ago, Meredith would have had limited options for help in deciding what to do about her health problemsfor help in deciding what to do about her health problems
• Get advice from friendsGet advice from friends
• Ask her doctor for recommendationsAsk her doctor for recommendations
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More Options TodayMore Options Today
With programs like Blue Distinction, Meredith has access to With programs like Blue Distinction, Meredith has access to more pertinent information to make informed decisionsmore pertinent information to make informed decisions
• Compare bypass centersCompare bypass centers
• Identify success criteria of several Identify success criteria of several hospitals for treating heart diseasehospitals for treating heart disease
• Manage costs while seeking best Manage costs while seeking best possible carepossible care
• Connect with and learn from the Connect with and learn from the experiences of other bypass patientsexperiences of other bypass patients
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More Useful Consumer Tools on the HorizonMore Useful Consumer Tools on the Horizon
• Market testing with hundreds of employees of Fortune 100 Market testing with hundreds of employees of Fortune 100 companies nationwidecompanies nationwide
• Testing a broad range of cost and quality measuresTesting a broad range of cost and quality measures
• Identifying consumer preferences for display designIdentifying consumer preferences for display design
• Measuring impact on consumer decision-makingMeasuring impact on consumer decision-making
Meredith and other consumers like her are helping shape Meredith and other consumers like her are helping shape healthcare decision-making tools to enhance transparencyhealthcare decision-making tools to enhance transparency
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Simplifying Information for MeredithSimplifying Information for Meredith
Offer consumers valuable information that is easy to useOffer consumers valuable information that is easy to use
Note: this picture is hypothetical and strictly for illustrative purposes
Benchmarks and
thresholds
Benchmarks and
thresholds
Care-specific clinical quality metrics
Care-specific clinical quality metrics
Accessible logistical
information
Accessible logistical
information
Robust patient satisfaction dataRobust patient
satisfaction data
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Collaborating with stakeholders to create consumer PHRs Collaborating with stakeholders to create consumer PHRs
Blue Cross and Blue Shield Companies Plan PHRs for 2008Blue Cross and Blue Shield Companies Plan PHRs for 2008Blue Cross and Blue Shield Companies Plan PHRs for 2008Blue Cross and Blue Shield Companies Plan PHRs for 2008
Personal Health Records for ConsumersPersonal Health Records for Consumers
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In the Future, Consumers Are Center StageIn the Future, Consumers Are Center Stage
Picture a Picture a consumer-centric, information-driven systemconsumer-centric, information-driven system
Hospitals
Health Plans
Financial services / tools
Rx
Pharmacy
Other Providers (e.g. care managers)
Physicians
Labs Health and Wellness
ConsumerConsumer
A Blue Cross and Blue Shield Association Presentation
Consumers Take Consumers Take Center StageCenter Stage
2007 Health Leaders Forum2007 Health Leaders ForumFederal Reserve Bank of Chicago and Federal Reserve Bank of Chicago and Detroit Regional ChamberDetroit Regional Chamber
Detroit, Michigan Detroit, Michigan April 24, 2007April 24, 2007
Scott P. SerotaPresident & CEO