CareFirst BlueCross BlueShield is an independent licensee of the Blue Cross and Blue Shield Association.® Registered trademark of the Blue Cross and Blue Shield Association. ®' Registered trademark of CareFirst of Maryland, Inc.

Expanding Medication Therapy Management Services beyond the

Part D population

Winston Wong, Pharm.D.Associate Vice President – Pharmacy Management

Program Part D Results

• Since 2006– 7,492 patients were touched

– 768 in 2006– 4,027 in 2010

– Estimated cost avoidance $5,342,616– Average cost avoidance per patient: $ 713.11 per patient overall

$1,010.18 per patient in 2010

• Participating Pharmacist: 369

• 2010 Pull:Push ratio – 43%:57%– TIP response rate: 9%

2

Program Recognition

National Recognition– American Pharmacist Association

• 2009 APhA-APPM Pharmacy Practice Merit Award– CMS– QIO

• Delmarva Foundation for Medical Care

Local Recognition– Maryland Pharmacist Association

• 2009 MPhA Honorary President’s Award

3

4

The CareFirst Approach to Medical Management

Healthy Population50% Population; 7% of Cost

AdvancedIllness

3% Population;29% of Cost

Multiple Chronic Conditions

7% Population; 23 of Cost

At-Risk Population10% Population; 19% of Cost

Stable Population30% Population; 22% of Cost

Medical Management Infrastructure

Primary Care Physician/Providers • No one better positioned to be the quarterback and

central point of coordination for the care of most people.

• Engaged, longstanding relationship between member and PCP goes hand in hand with a patient centric approach that is essential to achieving the best possible outcomes.

Medical Management Coordination• Care coordinators will interface between CareFirst

and the physician provide the tools and needed information to that will allow the physician to care for their patient

• Pharmacy Management will interface into this process with the Medication Management Services program

5

5

CareFirst Rx Book of Business

MMS Personal Care Pharmacists

Search Light Data Mining/Screening

CareFirst Pharmacy Management/MMS Clinical Pharmacist

Hospital Transition CoordinatorCareFirst Regional Care Coordinator

Local Care Coordinator

Primary Care Medical Home Practice (PCMH)

Delivery Source:

Searchlight

Pharmacist

Practices

Your Rx Advisor Program– Process Flow

Hospitalized Member