PROPRIETARY AND CONFIDENTIAL CareFirst BlueCross BlueShield is the business name of CareFirst of Maryland, Inc., and is an independent licensee of the.

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Presentation transcript:

PROPRIETARY AND CONFIDENTIAL CareFirst BlueCross BlueShield is the business name of CareFirst of Maryland, Inc., and 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. Innovation at Work: CareFirst’s Transformation from Passive Payer to Population Health Manager

PROPRIETARY AND CONFIDENTIAL 2 The Problem: Rising Health Care Costs

PROPRIETARY AND CONFIDENTIAL 3 Part of the Solution: Discounts

PROPRIETARY AND CONFIDENTIAL 4 Challenges with Health Care Delivery

PROPRIETARY AND CONFIDENTIAL 5 Establishing the Solution

PROPRIETARY AND CONFIDENTIAL 6 How Our PCMH Program is Different

PROPRIETARY AND CONFIDENTIAL 7 Decisions of PCP: When and Where to Refer Source: CareFirst Health Care Analytics, Data as of September 2010

PROPRIETARY AND CONFIDENTIAL 8 PCMH Panels

PROPRIETARY AND CONFIDENTIAL 9 Better Care at Lower Costs

PROPRIETARY AND CONFIDENTIAL 10 Putting it all Together

PROPRIETARY AND CONFIDENTIAL 11 Hospital Coordination

PROPRIETARY AND CONFIDENTIAL 12 Complex Specialty Care

PROPRIETARY AND CONFIDENTIAL 13 Chronic Care Coordination Field force of more than 200 National and Regional Care Coordinators

PROPRIETARY AND CONFIDENTIAL 14 Enhanced Pharmacy Coordination

PROPRIETARY AND CONFIDENTIAL 15 Additional Support Programs

PROPRIETARY AND CONFIDENTIAL 16 Wellness: A Solution for All

PROPRIETARY AND CONFIDENTIAL 17 Engagement

PROPRIETARY AND CONFIDENTIAL 18 Transparency and Data-Driven Decisions

PROPRIETARY AND CONFIDENTIAL 19 Searchlight Reporting® Drill Down

PROPRIETARY AND CONFIDENTIAL 20 The Benefits of Integration Dental cleanings reduced diabetes-related medical costs up to 19% 1 68% of people with mental disorders have physical health disorders 4 24% of total health care spending is through the pharmacy benefit 2 75% of health care expenses go to treat diseases that are preventable 3 1 Managed Dental Care. Diabetic cost cutting linked to consistent oral care. February CareFirst Health Care Analytics 3 Centers for Disease Control and Prevention 4 Druss BG, Walker ER. Mental disorders and medical comorbidity. Robert Wood Johnson Foundation. Research Synthesis Report No. 21. February 2011.Benefits of Integration of Behavioral Health.

PROPRIETARY AND CONFIDENTIAL 21 Summary