Clinical Strategy & Measurement Initiative Group February 5, 2013

PC2: Summary Comments Everyone’s in – this isn’t an opt in or an opt out This is Anthem’s new payment model Patient Centered Primary Care (PC2) works! Evidence and clear data support this strategy Anthem’s 14 state roll out of PC2 is happening in phases and connection to other Blue Plans will begin in 2014 Anthem is doing this for its entire block of business This is about practice transformation with information and tools to help physicians manage population health

What are we expecting from Primary Care Providers in return? What we ask in return In return, we ask that providers start (or continue) the transformation to a patient-centered care model. That includes: Ensuring 24/7 availability Becoming an active participant in care management Using data/disease registry to manage chronic patients Using generic Rx substitutes when clinically appropriate Meeting appropriate performance on nationally-endorsed quality measures In short, it means practicing medicine in a way many of them envisioned when they originally chose primary care.

WellPoint CDT Process Overview The new CDT processes have been designed to provide operational excellence WellPoint CDT Process Overview Members Providers The PCP care team that is comprised of physicians, nurses and staff is responsible for the care coordination activities for attributed members PCP Care Team WellPoint The Clinical Liaison and Patient Centered Care Consultant team, which includes behavior health and social work support, works with the practices and internal WellPoint programs to ensure that each group is managing the correct member population and is the intermediary between the practices and internal WellPoint programs CLINICAL LIAISON Patient Centered Care consultant CARE MANAGERS Understanding that the new model could lead to confusion around how our internal care management programs fit within this model, the team designed the processes to ensure that both practice based population health management and internal care management were fully aligned. The team developed the role of the clinical liaison who will assist practices in managing member care and also act as the intermediary between the practice and WellPoint, ensuring that members who belong in internal care management are referred into those programs and that those members identified for practice based care are properly cared for Unlike other PCMH programs that focus on embedding care managers inside PCP offices, the WellPoint program trains the PCP practices to manage care on their own. Through the clinical liaison and the patient centered care consultant, the providers have access to the necessary knowledge to perform these tasks. In addition to people resources that support the practice, WellPoint also offers tools and technology that support the practice and give the practice the data they need to manage member care. Those tools, as they are fully developed, also offer information exchange capabilities which allows WellPoint to report back to our customers on the key metrics that they care about and that drive value The WellPoint model is designed in a differentiated way and hence it is poised to provide operational excellence and desired customer value. Our competitors are focused on relying on the primary care providers’ capabilities to deliver care management functions – they expect the primary care providers to hire care management nurses, train the practice staff, change processes to transform to patient centric medical homes, and implement technology and tools to enable it. WellPoint is making an investment to support the primary care practices in multiple ways: providing key resources to train the practice care managers and staff and serve as an intermediary with high value WellPoint care management programs (clinical liaisons and patient centered practice consultants); providing them toolkits that guide the transformation roadmap; and the technology that will enable workflows and bidirectional information exchange to connect the providers with WellPoint systems. We feel that this investment is required to get to our vision of the future since primary care practice transformation will be hard without it. WellPoint continues to support complex case management and total population health Tools, Technology and Support WellPoint provides tools, training and support to effectively and efficiently manage members’ care and operate a medical home

How will Anthem clients know it’s working? Value Based Reporting Currently designing a “Value based reporting” package Goal is to provide data to show how the program is impacting our members Want reports to be actionable so that we can identify populations that could be targeted for improvement E.g. differentiate between members not in PC2 that see a PCP vs. “medically homeless” members (not in PC2 and not seeing a PCP) Work group reviewed a preliminary PC2 report roadmap and provided feedback COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

Value Based Reporting - Samples

Value Based Reporting - Samples

23 Acute and Chronic Care Measures Appropriate Testing for Children with Pharyngitis Appropriate Treatment for Children with Upper Respiratory Infection (URI) Appropriate Antibiotic Treatment for Adults with Acute Bronchitis New Episode of Depression: Effective Acute Phase Treatment New Episode of Depression: Effective Continuation Phase Treatment Acute Myocardial Infarction (AMI): Persistence of Beta-Blocker Treatment after a Heart Attack CAD: ACE Inhibitor / Angiotensin Receptor Blocker (ARB) Therapy Complete Lipid Profile for Patients with Cardiovascular Conditions Heart Failure (HF): Beta-blocker Therapy Proportion of Days Covered (PDC): for Hypertension (ACEI or ARB) Proportion of Days Covered (PDC):for Cholesterol (Statins) 1 2 3 4 5 6 7 8 9 10 11

23 Acute and Chronic Care Measures (continued) Diabetes: Eye Exam Diabetes: Hemoglobin A1c Testing Diabetes: Lipid Profile Diabetes: Urine Protein Screening Proportion of Days Covered (PDC): Oral Diabetes Annual monitoring for patients on persistent medications: ACE/ARB Annual monitoring for patients on persistent medications: Anticonvulsants Annual monitoring for patients on persistent medications: Digoxin Annual monitoring for patients on persistent medications: Diuretics Arthritis: Disease Modifying Antirheumatic Drug Therapy in Rheumatoid Arthritis Osteoporosis Management in Women Who Had a Fracture Use of Appropriate Medications for People with Asthma 13 14 15 16 17 18 19 20 21 22 23 12

9 Preventive Care Measures Breast Cancer Screening Cervical Cancer Screening Childhood Immunization Status: MMR Childhood Immunization Status: VZV Chlamydia Screening in Women Glaucoma Screening in Older Adults Adolescent Well Visits: 12-21 years Well-Child Visits in the First 15 Months of Life Well-Child Visits: 3-11 years 1 2 3 4 5 6 7 8 9

3 Utilization Measures 1 Potentially Avoidable ER visits 2 Ambulatory Sensitive Care Hospital Admissions Rx Generic Dispensing Rate 1 2 3

What is our ask….. Support and Promote the program Encourage designation of PCP’s or use of a medical home Through plan design or communications Continue to provide feedback on reporting and evolution of the program

Next Steps Co-lead needed for this Initiative Group Helen Drexler will transition into the Anthem Lead Role in 2013 Continue to review value reporting and provide feedback Start looking at Member Engagement strategies for PC2 Continued focus on Anthem’s client reporting