To change picture: Right-click on image. Select FORMAT BACKGROUND Select FILL Select PICTURE OR TEXTURE FILL Select INSERT FROM FILE Find the image (in a folder on your computer) Click OPEN Click CLOSE Georgia Size 36 Georgia Size 18 NOTE: TEXT AND IMAGES IN GRAY BORDER WILL NOT PRINT AND WILL NOT BE PROJECTED Advanced Illness Care Progress & Opportunities Jennifer Malin, MD, PhD Staff Vice President, Clinical Strategy Assessing Progress in End-of-Life and Serious Illness Care National Academy of Medicine May 23, 2016 COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

NOTE: TEXT AND IMAGES IN GRAY BORDER WILL NOT PRINT AND WILL NOT BE PROJECTED Sample Designs Early access to palliative care is critical to improve quality of care ANTHEM INC. CONFIDENTIAL | DO NOT COPY | DO NOT DISTRIBUTE2 60% of Anthem members with cancer have a hospital admission in month prior to death 30% have an ICU admission in month prior to death Goals of Palliative Care – are to anticipate, prevent and reduce suffering and to support the best possible quality of life for the patient and family, regardless of the stage of disease or the need for other therapies.

NOTE: TEXT AND IMAGES IN GRAY BORDER WILL NOT PRINT AND WILL NOT BE PROJECTED Sample Designs And, $4,000 to $7,000 lower cost for patients who receive palliative care ANTHEM INC. CONFIDENTIAL | DO NOT COPY | DO NOT DISTRIBUTE3 3 month improvement in survival Smith et al. Palliative Medicine 2014, 28: Hughes and Smith. Annu Rev Public Health. 2014;35: Same or better quality of life Temel et al. N Engl J Med 2010;363:733-42; Bakitas et al. J Clin Oncol 2015; 33: Gade et al. J Palliative Medicine 2008; 11:180-90; Grudzen et al. AAHPM Abstracts 2015; Higginson Lancet Respir Med 2014; 2: 979–87

NOTE: TEXT AND IMAGES IN GRAY BORDER WILL NOT PRINT AND WILL NOT BE PROJECTED Sample Designs ANTHEM INC. CONFIDENTIAL | DO NOT COPY | DO NOT DISTRIBUTE4 66% of U.S. hospitals with more than 50 beds have a palliative care team Access to palliative care outside of inpatient setting or hospice remains extremely limited Current workforce 6600 board certified palliative care physicians is only 1:20,000 persons with chronic illness Estimated shortage of 18,000 palliative care physicians 15% of spots in palliative care fellowship unfilled

Georgia Size 28 Georgia Size 24 Calibri Size 20 NOTE: TEXT AND IMAGES IN GRAY BORDER WILL NOT PRINT AND WILL NOT BE PROJECTED Quill TE and Abernethy AP. N Engl J Med Mar 28;368: Need integrated advanced illness care in addition to specialty palliative care Primary palliative care provided by physician assuming primary responsibility for caring for patients – e.g. PCP, oncologist, cardiologist – with support as needed from palliative care specialist HOSPICE Specialty Palliative Care Primary Care Specialist disease care (e.g. oncology, cardiology) + Integrated Primary Palliative Care

Georgia Size 28 Georgia Size 24 Calibri Size 20 NOTE: TEXT AND IMAGES IN GRAY BORDER WILL NOT PRINT AND WILL NOT BE PROJECTED Anthem efforts to improve access to advanced illness care  Expansion of hospice benefit  Added look-up for physicians board certified in hospice and palliative care medicine on Anthem website “Find a Doctor”  Palliative care needs assessment implemented in case management programs  Pilots with vendors that provide palliative care solutions  Developing integrated advanced illness care program to support network physicians in providing primary palliative care