1. Using Health Plan Data as Part of the Arsenal to Combat Bioterrorism and Enhance Epidemic Detection Dawn Wood, MD, MPH Vice President, Corporate Medical Director Blue Cross of California State Sponsored Business

2. Fred Buckwold, MD, FACP Medical Director UniCare

3. WellPoint Blue Cross and Blue Shield Companies: serving members in Colorado, Connecticut, Indiana, Kentucky, Maine, Nevada, New Hampshire, Ohio and Virginia; Blue Cross and Blue Shield plans serving members in Georgia, Missouri and Wisconsin; Blue Cross of California; and, Empire Blue Cross Blue Shield. UniCare: nationwide full-service health plan, marketed primarily where the company does not have a licensed Blue plan. State Sponsored Business: Medicaid contracts in 14 states and Puerto Rico.

4. Health Plan Membership * WellPoint34.2 million United19.5 million Aetna15.4 million Humana11.3 million CIGNA 9.3 million Kaiser 8.6 million HealthNet 6.6 million Coventry 2.5 million Total 107.4 million *Data on membership enrollment compiled by MCOL from company financial reports and web sites as of year end 2006

5. Preparedness & Response  Surveillance –National and international monitoring systems –Earliest possible warnings  Detection –Identification of critical events against background  Response –Support and leadership for immediate, short- and longer-term local and national efforts –Communication, sharing resources, mobilizing supplies and appropriately trained healthcare personnel  Containment –Limit spread and mitigate adverse impacts –Use knowledge gained to bolster preventive efforts

6. Importance of Epidemic Surveillance  SARS  Avian influenza (H5N1)  E-coli O157:H7 outbreak (recently found in spinach)  Terrorism – Anthrax cases Epidemics need to be found early

7. Current Status for Epidemic Surveillance  A national communication system for private and public partners is provided through the Centers for Disease Control’s (CDC) Health Alert Network (HAN) Posts alerts, advisories, updatesPosts alerts, advisories, updates Reporting protocolsReporting protocols First responder instructionsFirst responder instructions  National Electronic Disease Surveillance System (NEDSS) developed to promote enhanced data sharing National, state, territorial collaborationNational, state, territorial collaboration Standards development (IT architecture)Standards development (IT architecture)

8. Is there a role for health plans?

9. Health Plan Surveillance Data  Health plans regularly monitor and trend paid claims and capitated encounters  Electronic claims submission decreases claims lag  Multiple data sources available from health plans Near real-time data for:Near real-time data for:  Hospital admissions (authorizations or notifications required)  Pharmacy

10. Health Plan Surveillance Data  Diverse sources for health plan data: ER, hospitals, pharmacies, doctor’s officeER, hospitals, pharmacies, doctor’s office  Each data source can provide additional information regarding disease status of a population  Health plans have multiple data sources and can aggregate the data to increase disease detection sensitivity and specificity

11. Example of Health Plan Surveillance Data  Pharmacy claims for Cipro October 2001 increase coincided with media Anthrax coverageOctober 2001 increase coincided with media Anthrax coverage

12. Example of Health Plan Surveillance Data  Daily Pneumonia claims

13. Disaster Support and Response  Health plan data can be used to provide a basic “Virtual Electronic Medical Record”  Sources of data: Claims - outpatient and inpatient servicesClaims - outpatient and inpatient services PharmacyPharmacy Case managementCase management  Data redundancy  Disaster management Nurse advice lineNurse advice line Provider contact and referral informationProvider contact and referral information OutreachOutreach

14. Addressing Provider Capacity  Epidemics and bioterrorist events can potentially overwhelm community healthcare resources  Health plans maintain provider databases and healthcare provider communication pathways within diverse communities  Health plans can partner with Public Health To assess and share information onTo assess and share information on  Hospital bed capacity  Primary care & specialty physician capacity  Pharmacy capacity To plan mobilization of healthcare resourcesTo plan mobilization of healthcare resources

15. Post-Marketing Surveillance  Health plan data is a source for trend information on Side effects and adverse reactions leading toSide effects and adverse reactions leading to  Diagnosed conditions  Use of pharmaceutical agents  Emergency, hospital, and outpatient services  Health plan data can Support routine surveillanceSupport routine surveillance Help create methods to minimize riskHelp create methods to minimize risk  Breast cancer – estrogen link  Pain medications – cardiac damage link

16. In conclusion  Health Plans are not in the Public Health Business Most are public for-profit companiesMost are public for-profit companies  Health Plans have data that could be useful for epidemic/disease detection  Health Plans can play a supportive role during outbreaks/disasters  Health Plans have data that could be useful for public health and other medical analysis