1. Bringing You More Than Ever Before
Quality
Satisfaction
Efficiency
Bringing You More Than Ever Before
LVBCH • June 23, 2015

2. Partnering in Transformation
We share the same vision and mission in transforming the health care marketplace
LVBCH

3. Exceeding Triple Aim – Our Approach
Value-based programs
Realigning the delivery and payment models
Innovation

4. Product Accreditation
Since the last eValue8 submission, Capital BlueCross has achieved PPO accreditation from NCQA. Our product accreditations include:
Capital Advantage Assurance Company®
Commercial PPO; Marketplace PPO – Accredited
Capital Advantage Insurance Company®
Marketplace PPO – Accredited
Keystone Health Plan® Central
Marketplace HMO – Accredited
Keystone Health Plan Central
Medicare HMO – Excellent
Capital Advantage Insurance Company
Commercial POS – Commendable
Keystone Health Plan Central
Commercial HMO – Commendable

5. Total transparency for providers, payers, and employers
Capital BlueCross’ Clinical Care Continuum
Total transparency for providers, payers, and employers
TheonSM is a product of Geneia® LLC. On Behalf of Capital BlueCross, Geneia LLC provides health data informatics and analytical support and services. Geneia LLC is an independent company.

6. Clinical Care Patient-Centered Oncology Pilot Program (PCOPP)
Focused on developing and implementing a strategic approach, aligning financial incentives to improve delivery and outcomes of cancer care
Encourages practices to improve care and lowers costs through an episode-based model
Collaborative approach between payer and physician, allowing Capital BlueCross to measure, transform, and increase quality (HEDIS) of cancer care
Capital BlueCross has seven Accountable Care Arrangements (ACAs)
Five full ACAs that during the term of the agreement include escalating risk sharing between the organizations and include 557 physicians and 80,000 attributed lives
Two mini-ACAs that support nonintegrated community physicians in York and Adams counties that include 165 physicians and 13,000 covered lives
Looking ahead, our goal is to double our ACA membership
PCOPP
36-month program
Reduce overall expenditures (value based payment)
Engage with episode-based Quality and Cost data
Align CBC’s PCOPP with the Oncology Care Model (OCM) offered through CMS
Sharing of best practices and performance data
Decrease clinical variation through the use of evidence based guidelines (National Comprehensive Cancer Network)
Pilot Practices' will sign an agreement for the program
Remain as a community based provider throughout the term of the agreement
Practice engagement consists of three phases - Provider Engagement; Program Performance; Program Evaluation
Engagement with CBC’s vendor consultant Oncology Management Services (OMS) for practice transformation
Engage in measuring and improvement of HEDIS performance metrics

7. Investing in Innovation for Transformation
Provider and member-level actionable data and insights to identify and care for patients and populations

8. The Power Behind Our Programs
Technology that supports the transformation strategy and drives action
Unified analytics
Singular source
Simple user interface
Embedded care collaboration tool
Integrated remote patient monitoring

9. Improving Care and Outcomes
“The reason St. Luke’s University Health Network and Capital BlueCross formed this Accountable Care Arrangement (ACA) was to try to increase the quality of care for our patients, and to lower the cost of health care for the patients and the employers.
Launching the ACA means that Capital BlueCross can access data to see how patients are doing from a metric and quality perspective. Each month, we hold a case review in which we discuss patients considered to be high risk, those needing preventive services for health maintenance such as mammograms or colonoscopies, those who have been discharged from facilities, and so forth. This helps to avoid duplication of services while monitoring progress toward meeting individual health care needs.
We agree with Capital BlueCross when it says that our relationship is strong because our access to data, direct contact, and regular communication produce better outcomes for our patients. It has been a great partnership.”
- Linda Gately, Associate Vice President, St. Luke’s Physicians Group

10. Engaging Your Members Health Education and Wellness Worksite Wellness
Capital Blue
In-person Health, Wellness, and Service
The Member Experience and Member Tools
Search & Save Center
Personal Profile
Digital Health Coaching
Telehealth

11. Industry Leader in Customer Satisfaction
The American Customer Satisfaction Index (ACSI) is the only national cross-industry benchmark of customer satisfaction of its kind.
Capital BlueCross scored highest among health insurers, significantly exceeding the industry average.

12. Questions? Thank You for Your Time!
For additional information, visit: capbluecross.com/LVBCH
Capital BlueCross and its subsidiaries, Capital Advantage Insurance Company®, Capital Advantage Assurance Company®, and Keystone Health Plan® Central, are independent licensees of the BlueCross BlueShield Association.