All Blue 2014 Workshop

The Effects of ACA on Cover Tennessee CoverTN – Ended Dec. 31, Provider service line remains open ( ) 2.Timely filing deadline for claims has expired 3.Corrected bills timely filing deadline – within two (2) years of the end of the year the original claim was filed AccessTN – Membership significantly reduced CoverKids continues to grow 2

Our Members are Throughout the State 3

Significant Changes in CoverKids TennCareSelect Network 1.Effective Oct. 1, Refer to BlueCare Tennessee Provider Administration Manual 3.Need Medicaid provider number and Ownership and Disclosure (OWDC) on file 4.Member benefits remain the same 4

Significant changes in CoverKids (cont’d) 5. Quest Diagnostics became the exclusive lab provider for CoverKids and HealthyTN Babies members under the TennCareSelect network. Effective Oct. 1, 2013 For routine outpatient laboratory services In both urban and rural areas across the state with the exception of those covered services described on the Exclusion ListExclusion List 5

HealthyTNBabies (HTNB) New ID Card for each pregnancy Only routine nursery care covered under mother’s ID Baby will need his or her own policy for any other care: Effective July 15, 2014, newborns are eligible for CoverKids for one year beginning with the date the mother enrolled in HTNB. No new application required. -Encourage mother to contact Maximus with baby’s information ( ) -Must apply within 30 days of birth -Baby will receive her or his own ID card 6

CoverKids Member ID Cards 7

What is HEDIS®? Why is HEDIS important? Healthcare Effectiveness Data & Information Set The most widely used set of standardized performance measures in the managed care industry A tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service A nationally recognized indicator of quality in the health care industry Good HEDIS scores indicate Quality outcomes for our members! 8

HEDIS Priority Measures Children’s and Adolescent’s Access to Primary Care Provider (12 months to 19 years) Well Child Visits Childhood and Adolescent’s Immunizations – prior to their second and 13th birthday’s Adolescent Well Care visits (2-21 years) Weight Assessment and Counseling for Nutrition and Physical activity (3-17 years) Use of Appropriate Medication for People with Asthma (5-18 years) Follow up Care for Children Prescribed ADHD Medication (6-12 years) Chlamydia Screening (16-24 years) Comprehensive Diabetes Care (0-18 years) 9

HEDIS Quality Outcomes 10 MeasureHEDIS 2013 for MY 2012 HEDIS 2014 for MY 2013 **Benchmark Well-Child Visits in the First 15 Months of Life: 6 or More Visits Total 74.47% 79.13%  77.44% Immunizations for Adolescents  Combo 1  Meningococcal  Tdap/Td 54.99% 56.20% 83.94% 62.84%  62.84%  88.26%  85.64% 89.06% 93.19% Chlamydia Screening in Women  Age modified HEDIS years  years  Total years 31.8% 31.14% 31.23% 31.9%  31.99%  32.49%  66.38% (16-20Yrs) 66.81% Use of Appropriate Medications for People with Asthma  5-11 years  years 95.60% 87.83% 95.67%  91.36%  94.92% (5-11Yrs) 92.16% (12-18Yrs) Diabetes Care: HbA1c Testing 0-18 Years (age modified HEDIS specifications) 86.3% 92.7%  91.11% (18-75 Yrs) Follow-up Care for Children Prescribed ADHD Medication  Initiation  Continuation & Maintenance 40.71% 50.65% 44.73%  56.77%  51.86% 63.75% HealthyTNBabies: Prenatal and Postpartum Care  Prenatal Care  Postpartum Care 71.05% 60.10% 73.62%  64.07%  92.82% 73.83%

Quality Improvement Activities Provider outreach and education (face- to-face, telephonic, mailed and through website) Appointment scheduling for members Member outreach and education (face-to-face, telephonic, mailed, text messaging, through website and Facebook) Member, provider and staff educational communications (articles, brochures, monitors, posters) Community outreach events (face-to- face education, screenings) 11

What can you do to improve health care quality? Educate members at every opportunity Schedule appointments and send reminders Close gaps in care by providing age and gender recommended preventive and chronic care screenings at every appointment Refer our members to Care Management programs 12

kidcentraltn.com Tennessee’s one-stop-shop for families to raise healthy and happy kids of all ages 13

Questions? Visit our Cover Tennessee Resource Center BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association