1. Clinical Strategy & Measurement Initiative Group February 5, 2013

2. 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

3. 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.

4. 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

5. 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
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6. Value Based Reporting - Samples

7. Value Based Reporting - Samples

8. 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

9. 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

10. 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: 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

11. 3 Utilization Measures 1 Potentially Avoidable ER visits 2
Ambulatory Sensitive Care Hospital Admissions
Rx Generic Dispensing Rate 1 2 3

12. 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

13. 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