Presentation on theme: "Improving lives through better health. Access Provide convenient and more effective access to health care Experience Actively engage and empower members."— Presentation transcript:
Access Provide convenient and more effective access to health care Experience Actively engage and empower members to achieve better health Affordability Reduce cost to create the best health care value in the industry ACCESSAFFORDABILITYEXPERIENCE
Unsustainable. In one decade, the cost of health care has more than doubled. 1 Milliman Medical Index (MMI) vs. Average Household Income One in two Americans lives with a chronic condition that is largely preventable. $9,235 $ 20,728 2012 2002
As the Affordable Care Act becomes a reality, we've got your back. You have a seasoned ally for implementation and compliance. Successfully implemented all required ACA changes for the past 3 years Proprietary ACA tools available to all brokers/consultants and employers at no cost; Financial Subsidy Calculator, Decision Support Tool, and HCR website Expert account support to help companies evaluate their options Comprehensive communication resources on demand
We’re investing to enhance our capabilities, products and programs. Lowering Costs Innovating Care Delivery Connecting Members Improving Health Integrated Solutions Anthem is miles ahead, meeting these challenges on multiple fronts.
We’re lowering costs to create the best health care value in the industry AFFORDABILITY
Undeniable impact Our size and strength 1 in 3 Americans 382 of the Fortune 500 count on Blue Cross Blue Shield
Incomparable reach Our network 90%+ of hospitals 80%+ of providers 95% of America’s Best Hospitals
Compelling value Discounts and savings #1 in 93 of 129 markets 4.3% average discount advantage $18.8 million in average savings 18.8 million in savings is a combination of the value of Network Access and Discounts AND Anthem’s claims management programs. Network Access and Discounts value represents the incremental value of our discounts over our key competitors. The gross value of our discounts (i.e. amount saved off billed charges) is much larger than the incremental value. Claims management savings reflect our estimates of the program value. *Source: Anthem Health and Wellness Solutions data study. Actuarial validation, 2011.
Compelling value Discounts and savings 5% more claims paid in network 95% versus 90% + More than twice the average savings on out-of-network claims 25-40% versus 12-20% + Higher average hospital discounts 53.9% versus 47.4%
11 Our active approach to health management results in healthier employees and lower health care costs. *WellPoint calculated rates using Quality Compass 2011 Commercial (or Medicaid or Medicare) data. Adjusted rates have been calculated using weights for the Anthem age mix and Medical/Surgical case mix. NATIONAL UTILIZATION METRICS FOR PPO PLANS* 164 160 170 169 160 38 40 43 40 Anthem Aetna Cigna UHC National Average INPATIENT DAYS PER 1000 MEDICAL + SURGICAL DISCHARGES PER 1000
Provider support Rewarding doctors for value, not volume Blue Distinction designation for facilities that meet stringent quality and cost-of-care requirements Linking hospital reimbursements to quality outcomes Promoting ACO and Patient-Centered Primary Care strategies Leveraging data to improve efficiency and effectiveness Member support Providing comprehensive assistance to help members navigate benefits and utilization Providing the education, tools and data to turn members into informed consumers Promoting wellness and early detection of high-risk conditions Providing cost comparisons and options for CTs and MRIs A new model of health We’re making it easier for providers and patients to do the right thing.
LOWERING COSTS: Anthem Health Marketplace combines the best in budget control and tailored health solutions. FOR EMPLOYERS: Short- and long-term cost control One Defined Contribution platform for all employees Reduces administrative cost and burden Keeps benefits competitive FOR EMPLOYEES: Flexibility in spending their health dollars More choices, with customized benefits solutions Easy access and consumer-friendly experience Expert support from Anthem advisors
Compelling value Our performance record FORTUNE 100 Company C 200,000+ Anthem Members Projected savings based on discount analysis, plan and clinical changes: $71 million $191 MILLION in savings FORTUNE 100 Company A 350,000+ Anthem Members Projected savings based on discount analysis: $75 million $100 MILLION in savings FORTUNE 500 Company B 100,000+ Anthem Members Projected savings based on discount analysis: $50 million $184 MILLION in savings
We’re getting back to basics with more effective access ACCESS
Powering the primary-care revolution We’re promoting a team approach to primary care that drives better health and lower costs. 24-hour care coordination Risk-stratified care management Shared decision-making Greater accountability Wellness and prevention
A good idea grows. Pay-for-Performance Programs Patient-centered Medical Homes Episode-based Payment Accountable Care Models
18% fewer hospital admissions 15% fewer ER visits, improvement in all diabetes measures 3.6% fewer hospital admissions 6.1% fewer ER visits, improvement in all diabetes measures 12-23% fewer hospital admissions 11-17% fewer ER visits Colorado PCMH New Hampshire PCMH New York PCMH * Figures per 1,000 per year. 5.81% fewer hospital admissions 10.6-18% fewer ER visits Dartmouth- Hitchcock ACO 18% fewer hospital admissions 3% fewer avoidable ER visits 29% lower readmission rate Connecticut PCMH Proof positive. Patient-centered care improves health and lowers costs across the country.
Incentives for change. We’re driving transformation to value-based care. Fee schedule increases Non-visit reimbursements Shared savings
Unprecedented Data Access – claims information, lab services, disease registry Risk Stratification – to proactively identify and close care gaps RHI eClinical Solutions – analytics software to increase clinical targeting Care Management – to work as an extension of the PCP practice Medical, Prescription, Lab Histories – to ensure personalized, outcome-based care Information Sharing. Medicine works better when doctors know the details.
Intelligence at light speed. IBM Watson can process, analyze and interpret massive amounts of data in seconds. Anthem brings that capability to health care. The latest research Select population health data Patient medical history Lab results Treatment protocols
One source for extended health-related coverage: dental, vision, life and disability Integrated solutions
Actively engage and empower members to achieve better health EXPERIENCE
Engaging our members. Through insights, we’ve created a more personalized and rewarding experience. Personalized care or prescription- drug reminders Alerting physicians to gaps in care Improved functionality of Anthem.com More targeted programs based on consumer needs
By listening, Anthem makes a good thing even better. Developing a best-in-class web & mobile experience Working with third-party transparency vendors Pioneering Reference Based Benefits packages
A healthy dose of flexibility. Consumer-driven health plans put members in control while easing the cost and administrative burden for employers. Choice of pre-fund tax options – HRA and HAS Maximum flexibility with a la carte customization Optional employer-funded incentives Robust transparency tools and communications support
Anthem takes holistic to a whole new level. Connecting everyone to better health care via: Assessment & engagement Good-health incentives Personalized coaching Online resources and transparency tools Device integration
LiveHealth Online. There’s ALWAYS a doctor in the house. Interactions via video, chat or phone Choice of credentialed provider Accessibility anytime, anywhere No appointments or waiting rooms Maximizes productivity for consumers, providers and employers
2012 NATIONAL SERVICE OPERATIONS RESULTS METRICS2012 ACTUAL2012 GOAL Average Speed of Answer2830 Abandon Rate1.6%3.0% Claims Timeliness in 30 Days*98.82%98.00% Claims Payment Accuracy98.93%98.00% Claims Financial Accuracy99.18%99.00% *Enterprise MTM results We set goals. We exceed goals.
We not only bring value to the table. We bring the whole table. Truly innovative, fully integrated programs and partnerships designed to enhance affordability, access and experience.
Access Affordability Experience Better health brought to you by Anthem