Health Information Technology Health Plan Role and Perspective Charles Kennedy M.D. V.P. Health Information Technology Notes: This template should be used by: Technology & Operations Human Resources Ethics, Compliance & Internal Audit Health Solutions Legal & Public Affairs Actuarial, Integration & Information Management Finance

WellPoint’s 2010 Aspiration WellPoint is recognized for ensuring that customers receive high quality, effective care at a lower cost than competitors in the same geography. This cost advantage is built on innovative initiatives in care management, health improvement, health care quality and safety, and network management resulting in single digit trend, better outcomes and improved member health. NOTES: Please provide a brief but comprehensive summary of your 3-Year Strategic Plan. “We aspire to transform health care and become the most valued company in our industry. In our view, ensuring our members have access to proven, quality care is the most important value driver we can offer”. Larry Glascock

WellPoint Imperatives WellPoint’s 2010 Aspirations have been translated into key imperatives which include Information and Provider Partnerships 2010 Aspiration Differentiating Strategies Key Imperatives Consumer Focused Consumer Culture Most Trusted Choice Choice Based Public Perception Public Health Oriented Consumer Experience Affordable Quality Care Accessible & Affordable 360 Health Highest Quality Information Provider Friendly Provider Partnerships

Information: Comprehensive Patient View Many data sources need to be connected to form a complete patient view including clinical data sources, personal data sources (WebMD) and payer based data (PBHR) via the EDL framework

Comprehensive Electronic Health Record Patient Data Sources Comprehensive Electronic Health Record “EHR” By weaving these primary sources of patient data together, a health plan can transform itself from a payer to an Infomediary. EHR = PBHR + EMR + PHR

Disease and Integrated Care Management Infrastructure Development: Data Warehouse Clinical data sources: Such as lab, radiology, PHR, HRA, carved out services WLP health plans data (enterprise data warehouse) Physician Component Member Component Personal Health Records (WebMD) Disease and Integrated Care Management (HMC) E-Health Records (Mr ED) Clinical Research (HealthCore) Individualized Messages (RHI) E-Prescribing (RXHub) WellPoint (the infomediary) creates value through applications which access existing data warehouses. These applications present information which influence practice patterns and member behavior enabling optimal use of the health care system.

Health I.T. Application Development WellPoint is piloting key health I.T. programs, surfacing and resolving challenges. Key challenges include data timeliness, quality and granularity. Systems leverage this data for unique, differentiated value EHR Decision Support E-Prescribing, Imaging and Laboratory Procedures Payer Sentinel Systems Physician, Patient Messaging through phone/letters ResolutionHealth—System deployed, Study completed to prove value of service, larger roll out ongoing EHR Information (Electronic presentation of Diagnosis Drugs, Imaging, Lab… data) WellPoint MR. ED: Pilot deployed, analytic review of effectiveness launched, expansion of pilot underway due to early positive feedback. WellPoint E-Rx programs: Review of initial program underway, corrective action completed Easy Ease of Implementation Hard Value High Low

Clinical Messaging Development Providers Enrollment Benefits Med Claims Rx Claims Lab Results Data Standardization and Integration Clinical Literature review of evidence New knowledge via Rules Engine Identify Actionable Targets Targeted Interventions Health Plans and Care Managers Providers Members

E-Prescribing Example Before E-Rx Information changes decisions after the fact, resulting in re-work, dis- satisfaction, sub- optimal results PBM Internet Friends DTC Samples Pharma detailing After E-Rx, PBM derived information (plus other data sources over time) enables best decisions AT THE POINT OF CARE IN THE POINT OF TIME they are made PBM PBM (plus other data over time)

Anticipated Drivers of Benefit Practice pattern variation increases costs and results in sub optimal quality. Clinical data linked to clinical decision support reduces variation and increases adherence to evidence based medicine Benefit Drivers Providers Cost Practice Pattern Variation Benefit Accrual Practice Pattern Variation Diagnostic Studies Redundancy of Tests Error Reduction Overall Savings EMR Health Information Exchange Clinical Decision Support

Other Key Plan Activities Although data activities are important, other more traditional health plan functions will be required to drive health I.T.. WellPoint Opportunities Program Example Development of payment methodologies which reward the use of Health I.T. and clinical objective achievement Re-imbursement methodologies that enable gain sharing of efficiencies generated by health I.T. tools Development of new innovations that leverage clinical infrastructure WellPoint Foundation opportunities to help defray infrastructure cost challenges P4P programs with components dedicated to Health I.T. use Prospective payment methodologies which enable win-win results Phase 4 drug safety studies Center for Health Economics and Technology