1. BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association. This document has been classified as CONFIDENTIAL and PROPRIETARY. Breastfeeding for NICU Infants: Aims to Improve Health, Combat Infant Mortality Infant Mortality Best Practices Forum, Nashville, August 31, 2011

2. 22 About BlueCross BlueShield of Tennessee (BCBST)  An independent, not for-profit company  Pays more than 60 million claims and nearly $9 billion in benefits  5,000 employees, headquarters in Chattanooga  Offices in Jackson, Johnson City, Knoxville, Memphis, Nashville  State's largest health benefit plan company  More than 15,000 customer companies  More than 2.3 million members http://www.bcbst.com/about/company_profile/

3. 33 About Volunteer State Health Plan, Inc. (VSHP)  VSHP is a wholly owned subsidiary of BlueCross BlueShield of Tennessee.  Has served the Medicaid population in the State of Tennessee for over a decade.  BlueCare full risk MCOs serve over 400,000 Medicaid, disabled and dual eligible members in the EAST and WEST Grand regions of the state.  TennCareSelect, a non-risk MCO, serves 43,000 members in special needs populations statewide.

4. 44 Overview of Antibiotic Initiative State of Tennessee Vital Statistics - 2009 In 2009, the Tennessee Department of Health, Office of Policy, Planning and Assessment, Division of Health reported: – 82,109 live births in Tennessee – 7,535 (9.2%) of those were low birthweight – 1,371 (1.7%) were very low birthweight Source: Tennessee Department of Health, Office of Policy, Planning and Assessment, Division of Health. (2009). Vital Statistics. Retrieved March 18, 2011 from http://health.state.tn.us/statistics/vital.htmhttp://health.state.tn.us/statistics/vital.htm

5. 55 Complications Related to Low/Very Low Birth Weight Complications of low birthweight and very low birthweight include, but are not limited to:  Necrotizing Entercolitis  Enteral Feeding Intolerance  Late Onset Sepsis Studies suggest that these complications are reduced when an infant receives breast milk.

6. 66 Necrotizing Entercolitis (NEC)  NEC affects 7% of very low birth weight (VLBW) infants.  Sisk et al reported a six fold reduction in the risk of developing NEC for VLBW infants that received ≥ 50% human milk compared to those that received < 50% human milk, over the first 14 days post birth. Sisk, P.M., Lovelady, C.A., Dillard, R.G., Gruber, K.J. & O’Shea, T.M. (2007). Early human milk feeding is associated with lower risk of necrotizing entercolitis in very low birth weight infant. Journal of Perinatalogy, 27 (7).

7. 77 Overview of Antibiotic Initiative Advantages of Receiving Human Milk American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk “Extensive research using improved epidemiologic methods and modern laboratory techniques documents diverse and compelling advantages for infants, mothers, families, and society from breastfeeding and use of human milk for infant feeding. These advantages include health, nutritional, immunologic, developmental, psychologic, social, economic, and environmental benefits.” http://aappolicy.aappublications.org/cgi/reprint/pediatrics;115/2/496.pdf

8. 88 Overview of Antibiotic Initiative Breastfeeding in Tennessee Source: U.S. Department of Health and Human Services. (2011). The Surgeon General’s Call to Action to Support Breastfeeding. Retrieved March 20, 2011 from http://www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding.pdf http://www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding.pdf

9. 99 Overview of Antibiotic Initiative BCBST Medela Breast Pump Program for Commercial Members  The program began January 1, 2011  The BCBST Medela Breast Pump Program is offered to all commercial members (excluding FEP) with an infant admitted to an NICU/Special Care Nursery  NICU Case Management is provided by ProgenyHealth on behalf of BCBST  A nurse from ProgenyHealth discusses the positive aspects of breastfeeding, and if the member chooses to breast feed, is offered a “gift” of an electric breast pump  The “gift” is not a covered benefit

10. 10 Overview of Antibiotic Initiative What the Member Receives Medela Pump in Style Advanced  Double-Electric Breast Pump  2-Phase Expression® Technology for Smart & Powerful Pumping  Simulation Mode & Expression Mode  Customized Pumping w/ Adjustable Speed & Vacuum Control  One-Touch 'Let-Down' Button for Faster Milk Flow  Stylish Backpack  Choice of either backpack or shoulder bag  Removable cooler carrier

11. 11 Overview of Antibiotic Initiative VSHP Electric Breast Pump Initiative  An electric breast pump was a covered benefit for a VSHP member when medical appropriateness criteria was met.  Beginning in July, 2011, an electric breast pump is offered to any member with an infant admitted to an NICU and managed by Alere on behalf of VSHP.  Alere discusses the benefits of a neonate receiving breast milk and if the mother chooses to breast feed, she receives an electric breast pump.  Alere coordinates with CareCentrix (contracted DME provider) for the member to receive an electric breast pump.

12. 12 Overview of Antibiotic Initiative Success Measures Measures associated with this initiative include:  Percentage of neonates admitted to an NICU and are case managed.  Percentage of mothers with an infant in an NICU who receive an electric breast pump.  Percentage of infants admitted to an NICU who receive breast milk.

13. 13 Overview of Antibiotic Initiative The Right Thing to Do for Mother and Infant  Breast feeding an infant is perhaps the closest bonding experience a mother can have with her child in addition to providing the best possible nutrition available.  When an infant is in an NICU, the mother is encouraged to participate in care, but most care is provided by a nurse trained to work with critically ill infants. It can be a frightening and alienating experience for a mother.  Mothers of infants in an NICU are not afforded the same bonding experience as mothers of healthy infants; however, they are still able to provide breast milk to their baby.  The opportunity for a mother to provide the best nutrition for her baby gives her that very important sense of participation and worth.