James Schuster, MD, MBA VP, Behavioral Integration May 21, 2015 Using data to engage members with complex medical conditions

2.5 million members 10,200+ employer groups $5.5B annual revenue 10% average annual growth YOY 124 hospitals and other facilities and more than 11,500 physicians in network Medicaid and CHIP plans have the largest membership in western PA 4-Star HMO Medicaid plan Integrated population health and productivity products J.D. Power certified UPMC Health Plan’s Health Care Concierge Contact Center in 2014 National Business Group on Health Platinum recognition (5x since 2009) 2013 ICMI Global Call Center Award Best Customer Experience Program UPMC Insurance Services Division 2 By the numbers:

Divisions and Products 3 DivisionsProducts

Who they are: Team includes nurses, social workers and community health workers (certified peer specialists) Strong focus on psychosocial and behavioral complications Driven by data with plan for rigorous evaluation What they do: Address chronic conditions like asthma, diabetes, COPD, coronary artery disease, heart failure, etc. Engage residents through education and training about healthy lifestyles, nutrition, and exercise. Continued enhancement of five-year program that provides community- based care management for individuals with complex conditions UPMC Community Team 4

Members with medical admissions or observational stays within 12 months Allegheny (Pittsburgh), Butler, Beaver, Washington, Westmoreland counties Other predictors of clinical severity UPMC Community Team Clinical Focus 5 Exclusions: Same-day electives Physical rehabilitation Admissions for chemotherapy Admitted from skilled nursing facility Pregnancy

As a health insurance organization, have the unique ability to capture data from members who see UPMC providers and non-UPMC providers. Insurance claims (services and pharmacy) Insurance authorizations Hospital admission data Hospital and community provider clinical information UPMC Community Team Data Sources 6

Engagement rates Number of members seen while hospitalized Number of members seen within seven days after discharge Rate of PCP follow up within one week of discharge Average number of contacts per team member per day Summary of interventions using the SAMHSA 8 Dimensions of Wellness framework Sample Process Indicators 7

HEDIS measures Medicare Stars rating Total medical costs per member Total pharmacy costs per member Return on investment (ROI) Reassessment of members one year after discharged from community team Sample Outcomes Indicators 8